Structural and hemodynamic analysis for predicting side branch occlusion in coronary bifurcation interventions

Cardiovascular diseases, particularly atherosclerosis, remain the leading cause of mortality worldwide. Atherosclerosis is caused by a buildup of plaque in arteries such as the coronary arteries. The main branch (MB) of coronary bifurcations is a common location where atherosclerotic plaque accumulates, often necessitating stenting procedures. However, MB stenting carries a significant risk of side branch occlusion (SBO), known as a complication with irreversible clinical consequences. This study investigates the effective factors on SBO during MB stenting using a structural and hemodynamic modeling framework. To conduct this modeling, patient-based geometries experienced SBO were reconstructed to simulate balloon inflation in the MB, followed by computational fluid dynamics analysis of pre-stenting hemodynamic parameters using experimentally validated flow conditions. Key geometric and pathological factors, including bifurcation angle (BA), MB stenosis severity (MS), free side branch diameter (SD), and plaque morphology (MP), were systematically varied to assess their impact on the risk of SBO. The simulations revealed that narrow BA and higher MS contribute to deformation of the bifurcation and promote disturbed flow, characterized by enlarged recirculation zone, elevated oscillatory shear index, and enlarged regions of negative period of wall shear stress. In contrast, eccentric plaques (MP) and larger SD can preserve side branch patency by mitigating structural deformation. The results revealed that investigating geometric and pathological factors, as well as hemodynamic parameters, could predict the risk of SBO. The proposed approach can support better-informed decision-making, guide the planning of interventional strategies, and potentially improve long-term procedural outcomes.