Hemodynamics in left coronary artery with ramus intermedius: A patient-specific computational study

Abstract

Clinical studies based on coronary computed tomography angiography (CCTA) images suggest that the presence of ramus intermedius (RI) in the left coronary artery (LCA) may aggravate the atherosclerotic depositions in the furcation region. In this study, computational fluid dynamics simulations are performed in patient-specific coronary models consisting of bifurcating LCA and two models having trifurcating LCA. Three-dimensional patient-specific coronary models are constructed from CCTA images obtained from North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, India. Results indicate that the flow redistribution happens in the left coronary branch due to the presence of RI and the flow to left anterior descending artery (LAD) is reduced significantly. Recirculation and flow separation regions are observed in the proximal parts of the LAD and left circumflex artery for trifurcation geometries. The qualitative and quantitative analysis of wall shear stress-based descriptors suggests that the presence of the intermediate branch may affect the atherosusceptibility of the proximal region of LAD. The study indicates that the presence of RI may act as a contributing factor for plaque development and progression in the furcation region and proximal parts of LAD.