Determination of Flow Conditions in Coronary Bifurcation Lesions in the Context of the Medina Classification

Abstract

Coronary artery bifurcation lesions are complex and several classifications are presented to describe them. Recently, the Medina classification has been proposed. This classification uses binary values for characterization of stenosis. Flow conditions according to Medina classification have not been described. In this paper, bifurcation lesions corresponding to anatomical Medina lesion classification are compared on the basis of flow and Wall Shear Stress (WSS). Computational models of healthy and stenosed coronary artery bifurcations ((1, 1, 1), (0, 1, 1) and (1, 0, 1)) with moderate and severe stenoses of 50% and 75% diameter were analyzed. The results showed that, flow conditions vary in bifurcation lesion types according to the clinically-oriented Medina classification. The flow in SB of bifurcation was dependent of the Medina lesion type and was more affected in lesion type (1, 0, 1). The magnitudes of WSS on the inner and outer walls of SB of bifurcation lesion (1, 0, 1) in post-stenotic region and along the arterial wall were smaller than bifurcations lesions (0, 1, 1) and (1, 1, 1) respectively. Our results suggest that SB of bifurcation lesion (1, 0, 1) is more prone to atherosclerosis progression compared to types (0, 1, 1) and (1, 1, 1).