Atherosclerosis and coronary artery bifurcation lesions: Anatomy and flow characteristics

Although the coronary arterial tree is uniformly exposed to the systemic risk factors, we have learned since the beginning of the 20th century that atherosclerotic “plaques” preferentially develop at vessel branch points . As a result, coronary bifurcations in recent reports account for 15–20% of all percutaneous coronary interventions (PCI) . Coronary artery bifurcations are predilection sites for atherosclerosis development as a result of specific flow characteristics and local endothelial shear stress (ESS) presentation . Anatomic features of coronary bifurcations, such as diameter of the main vessel (MV) and the side branches (SB), atherosclerotic plaque burden in the proximal and distal part of the MV and the SB, and bifurcation angle, all impact on local flow patterns . The relationship among the coronary anatomy, local flow and vascular biology promotes the progression and complexity of atherosclerosis in coronary bifurcations. The complex local hemodynamic microenvironment after bifurcation stenting also influences in-stent restenosis, thrombosis and clinical outcomes . In this review, we summarized the current data with respect to coronary artery bifurcation anatomy and flow characteristics, the impact of local hemodynamic conditions in initiation and progression of atherosclerosis and application of this basic knowledge in contemporary PCI. Fractal geometry of coronary artery bifurcations