Assessing the hemodynamic influence between multiple lesions in a realistic right coronary artery segment: A...

Area of Science:

• Cardiovascular Medicine
• Biomedical Engineering
• Interventional Cardiology

Background:

• Coronary artery disease (CAD) is a leading global cause of death.
• Accurate assessment of coronary lesions is crucial for effective treatment.
• Fractional flow reserve (FFR) is a key functional index for stenosis severity.

Purpose of the Study:

• To investigate the hemodynamic interplay of multiple coronary stenoses.
• To evaluate the adequacy of lumen area assessment versus FFR in complex lesions.
• To improve percutaneous coronary intervention (PCI) strategy guidance.

Main Methods:

• Created patient-specific 3D coronary artery models from IVUS and angiographic data.
• Simulated FFR in healthy and diseased models with single and multiple stenoses.
• Compared FFR values with lumen area reduction percentages.

Main Results:

• A healthy model showed FFR of 0.96 (measured) and 0.98 (simulated).
• Two sequential 90% lumen area stenoses resulted in an FFR of 0.65.
• Single proximal and distal stenoses yielded FFRs of 0.90 and 0.73, respectively.

Conclusions:

• Angiographic lumen assessment alone is insufficient for evaluating coronary lesions with multiple stenoses.
• Hemodynamic severity can differ significantly despite similar lumen area reduction.
• Accurate FFR assessment is vital for guiding PCI in complex coronary lesions.