Complex coronary lesions such as bifurcation lesions occur in about 20% of the total number of surgical procedures performed to treat coronary diseases. Further, complications such as in-stent restenosis occurs in 30% of the bifurcation lesion cases following intervention. A similar story prevails for ostial lesions which respond poorly to conventional interventional procedures and present higher procedural and medium-term complications. Optimal interventional treatment for ostial lesions remains elusive, posing significant challenges in vessel cannulation and resulting in >50% geographic miss rate and three-times higher target-lesion revascularization. Due to the morphological complexity of these lesions, an established interventional strategy does not exist and data on the hemodynamic characteristics at complex lesions remains unavailable. There is an urgent need to correct this knowledge gap to prevent patients with complex bifurcation and ostial lesions from having long-term, major adverse cardiac events such as in-stent restenosis. The overall objective of this study is to understand why atherosclerosis affects certain coronary regions resulting in in-stent restenosis preferentially in bifurcation and ostial lesions and why clinical manifestations occur more for certain morphological types. This analysis will allow us to characterize anatomic features of complex lesions in conjunction with local hemodynamic risk profiles to establish a clinically-relevant metric to diagnose coronary artery disease. Our central hypothesis is that both morphological parameters and hemodynamic factors are required characteristics in defining a phenotypic profile of complex lesions, each influencing key clinical diagnostic metrics. The rationale for our hypothesis is that spatial heterogeneity of coronary atherosclerosis is connected to the local hemodynamic risk factors in arteries, which can be used to determine functional severity of complex lesions on a per-patient basis. Using this spatial and physiological characterization, we will determine combination of features that result in impaired diagnostics and development of atherosclerosis. The successful completion of this study would allow us to develop a much-needed anatomy-physiology guided metric to supplement conventional pressure-based diagnostic metrics to diagnose patient with ostial and bifurcation coronary lesions.
|Program type||Predoctoral Fellowship|
|Effective start/end date||01/01/2020 → 12/31/2021|