The effect of coronary bifurcation and haemodynamics in prediction of atherosclerotic plaque development: a serial computed tomographic coronary angiographic study

The aim of this study was to examine the effect of the daughter branches on the haemodynamics and the potential prediction of atherosclerotic plaque development as well as the best flow division model for accurate blood flow modelling.We analysed computed tomography coronary angiography retrospective data portraying 17 coronary artery bifurcations in 15 patients recruited into the PROSPECT MSCT study. Baseline and three-year follow-up imaging data were used to reconstruct coronary artery anatomy. In the baseline models blood flow simulations were performed using three flow division approaches: stress-free, Murray's law and Doriot's fit. Blood flow simulation was also performed omitting the daughter branch. The association between ESS estimated in models that incorporated the daughter branches and lumen reduction was higher than the cases where the side branch was omitted. Murray's law provides the most accurate results when comparing the different flow division models. More specifically, low ESS is a predictor of significant lumen reduction (p=0.007), plaque burden increase (p=0.0006) and necrotic core change (p=0.025).The ESS distribution in coronary models including the daughter branches and based on the calculations implementing Murray's law allows more accurate prediction of atherosclerotic evolution than ESS estimated in models including only the main vessel.