Growth and Development Trend of Lateral Plaques and Subsequent Plaques in Bifurcated Vessels: A Dynamic Simulation

Objective To investigate vascular remodeling and low-density lipoprotein (LDL) deposition, the growth and development trends of lateral branch plaques in bifurcated vessels, and the potential locations of subsequent plaque growth due to the presence of plaques. Methods An idealized model of bifurcated vessels was established and the distribution of wall shear stress before and after the growth of edge-branch plaques was obtained using computational fluid dynamics. Seven sections were intercepted in the areas of low shear stress: planes 1-3 were the low shear stress areas on the lateral branch before plaque formation, planes 4-5 were the proximal and distal edges of the plaque, and planes 6 - 7 were the lower shear stress areas of the plaque. Vascular remodeling and LDL deposition in the cross section were simulated. The growth and development trends of plaques are also discussed. Results Among planes 1-3, plane 2 produced obvious negative remodeling and the highest concentration of LDL deposition (102. 266 mmol/ L), thereby indicating that this was the initial location of the atherosclerotic plaque. Compared to plane 4, plane 5 produced more pronounced vascular remodeling, lumen narrowing, and the highest deposition concentration (110. 17 mmol/ L) after plaque formation, which indicated that the patch had a tendency for eccentric growth downstream. Compared to plane 6, plane 7 (blood flow separation reattachment site) produced more negative remodeling and the highest deposition concentration (93. 851 mmol/ L), thereby indicating the possibility of new plaque formation near the reattachment point of blood flow separation. Conclusions Obvious vascular remodeling at low shear stress in the lateral branches leads to lumen stenosis and high LDL deposition, thus, forming atherosclerotic plaques. The lateral wall of the bifurcated blood vessels is the initial location of atherosclerotic plaque growth. After growth, the plaque tends to develop downstream, and subsequent plaques may form at the flow separation and reattachment points.