Optimal Revascularization Strategy on Medina 0,1,0 Left Main Bifurcation Lesions in Type 2 Diabetes

Abstract

Aim. Diabetes mellitus (DM) is a major risk factor for cardiovascular disease. The implications of a diagnosis of DM are as severe as the diagnosis of coronary artery disease. For many patients with complex coronary artery disease, optimal revascularization strategy selection and optimal medical therapy are equally important. In this study, we compared the hemodynamic results of different stenting techniques for Medina 0,1,0 left main bifurcation lesions. Methods. We use idealized left main bifurcation models and computational fluid dynamics analysis to evaluate hemodynamic parameters which are known to affect the risk of restenosis and thrombosis at stented bifurcation. The surface integrals of time-averaged wall shear stress (TAWSS) and oscillatory shear index (OSI) at bifurcation site were quantified. Results. Crossover stenting without final kissing balloon angioplasty provided the most favorable hemodynamic results (integrated values of TAWSS = 2.96 × 10^-4 N, OSI = 4.75 × 10^-6 m²) with bifurcation area subjected to OSI values >0.25, >0.35, and >0.45 calculated as 0.39 mm², 0.06 mm², and 0 mm², respectively. Conclusion. Crossover stenting only offers hemodynamic advantages over other stenting techniques for Medina 0,1,0 left main bifurcation lesions and large bifurcation angle is associated with unfavorable flow profiles.

Figure 1

Idealized models of considered stenting techniques under different bifurcation angle conditions. (a), (b), and (c) illustrate stenting techniques under 70° bifurcation angle condition; (d), (e), and (f) under 90° bifurcation angle condition; (g), (h), and (i) under 110° bifurcation angle condition.

Figure 2

(a) Imposed inflow boundary conditions. (b) Outflow boundary conditions. (c) Idealized left main bifurcation model of crossover stenting followed by final kissing balloon angioplasty under right bifurcation angle condition. A residual diameter stenosis of 30% is considered at the proximal LCX. (d) The numeric solution of flow velocity distribution.

Figure 3

Time-averaged wall shear stress (TAWSS) distribution at the bifurcation for the considered three stenting techniques under different bifurcation angle conditions. (a), (b), and (c) illustrate stenting techniques under 70° bifurcation angle condition; (d), (e), and (f) under 90° bifurcation angle condition; (g), (h), and (i) under 110° bifurcation angle condition.

Figure 4

Oscillatory shear index (OSI) distribution at the bifurcation for the considered three stenting techniques under different bifurcation angle conditions. (a), (b), and (c) illustrate stenting techniques under 70° bifurcation angle condition; (d), (e), and (f) under 90° bifurcation angle condition; (g), (h), and (i) under 110° bifurcation angle condition.