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Computed Tomography-based Patient-specific Biomechanical and Fluid Dynamic Study of Anomalous Coronary Arteries with
Gianluca Rigatelli1, Marco Zuin1,2
1Cardiovascular Diagnosis and Endoluminal Interventions Unit, Rovigo General Hospital, Rovigo, Italy.
Insights
Anomalous coronary arteries with intramural course (ACAOS-IM) cause vessel compression and pressure drop. Stenting normalizes flow, corrects deformation, and reverses pressure loss in these coronary anomalies.
Area of Science:
- Cardiovascular Medicine
- Biomedical Engineering
- Medical Imaging
Background:
- Anomalous coronary arteries originating from the opposite sinus of Valsalva (ACAOS) are clinically significant coronary artery anomalies.
- The pathophysiology and stenting impact of the intramural (IM) course segment in ACAOS-IM remain unclear.
Purpose of the Study:
- To elucidate the pathophysiology of ACAOS-IM using patient-specific models.
- To evaluate the biomechanical impact of stenting the intramural segment in ACAOS-IM.
Main Methods:
- Utilized computed tomography (CT) for patient-specific coronary vessel reconstruction.
- Applied computational fluid dynamics (CFD) and biomechanical analysis to simulate exercise conditions before and after virtual stenting.
- Analyzed blood pressure gradients, flow, vorticity, wall shear stress (WSS), and IM segment deformation.
Main Results:
- Higher basal WSS values were observed in the IM course of both L- and R-ACAOS compared to other segments.
- Stenting significantly decreased WSS and vorticity magnitude.
- Biomechanical analysis revealed IM segment compression and twisting, causing a significant distal pressure drop (32-35%) that was corrected by stenting.
Conclusions:
- The IM segment in ACAOS-IM experiences phasic compression, deformation, and twisting, leading to reduced distal pressure.
- Stenting the IM segment normalizes the coronary flow profile, corrects segment deformation, and restores distal pressure in both L- and R-ACAOS subtypes.
Background:
The anomalous coronary arteries originating from the opposite sinus of Valsalva (ACAOS) constitutes one of the most clinically relevant coronary artery anomalies in adults. Exact pathophysiology and the impact of intramural (IM) course segment stenting in ACAOS with IM course (ACAOS-IM) has not been clarified. We aimed to elucidate the pathophysiology and impact of stenting applying biomechanical and computational fluid dynamics to computed tomography (CT) in patient-specific coronary vessel reconstruction.
Methods:
We separated coronary artery (left or L-, right or R-) ACAOS-IM into segments (proximal, mid and distal), based on coronary angiography and coronary CT angiography features, in a series of patients at Rovigo General Hospital, Italy, between 1 January 2003 and 1 January 2018. Blood pressure gradient across the coronary circulation, calculated blood flow, vorticity magnitude, wall shear stress (WSS) and IM segment deformation were analysed by simulating exercise, before and after virtual stent implantation.
Results:
In 21 symptomatic patients (13 males, mean age 46.1 ± 8.1 years, L-ACAOS-IM in 9 and R-ACAOS-IM in 12 patients), computational fluid dynamic analysis in both L- and R-ACAOS demonstrated higher basal WSS values in the IM course (9.5 ± 0.2 and 8.6 ± 0.2 Pa for R- and L-ACAOS, respectively), than in the rest of the vessels. These values decreased after stenting. Vorticity magnitude significantly decreased after stenting as well, compared with baseline. Biomechanical deformation analysis revealed not only compression, but also a twisting of the IM segment with a mean distal pressure drop of 32% and 35% in R- and L-ACAOS, respectively, which was corrected by stent implantation.
Conclusions:
In both L- and R-ACAOS subtypes, the IM segment appeared to be phasically compressed and deformed with a degree of twisting that causes resting and exercise cross-sectional deformation and a drop in distal pressure. Stenting of the IM segment results in normalisation of the flow profile, correction of the IM segment deformation and reverses the drop in pressure, for both variants of ACAOS.
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