Bài giảng Violent collision of Antegrade with retrograde coronary flow causing the first endothelial injury, starting a plaque and breaking the cap of vulnerable plaques

Lecture answers to 3 questions: how to create an animal model for atherosclerosis; it starts with a mechanical injury; the inside of a pipe is damage by air bubble rupture (cavitation).

Violent Collision of Antegrade with Retrograde Coronary Flow Causing the First Endothelial Injury, Starting a Plaque and Breaking the Cap

Background 1

How to create an animal model for

atheroslerosis

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Background 2

It starts with a mechanical injury

Background 3: The inside of a pipe is damage

by air bubble rupture (cavitation)

http://www.scielo.org.za/pdf/jsai ce/v56n3/08.pdf

• In hydraulic studies, the

damage in the pipelines is due

to the bursting of air bubbles

• During diastole, bubbles

would form when the local

dynamic coronary pressure

decreases below the vapor

pressure (VP) of gases in the

blood

• WHICH GAS?

Figue 2 : Bubble Formation and Implosion Formation

of a bubble and its burst creating micro-jets

• When the bubbles explode,

the endothelial layer is

damaged and lets the LDL

particles pass through and

form the cholesterol

plaques

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Methods

• Select the coronary angiograms with one or two mild lesions

• Review angiogram at 15 frames per second

– The left main (LM)

– The proximal left anterior descending (LAD) and left circumflex (LCX)

– The right coronary artery (RCA)

Figure 3.

To review the coronary angiogram frame by frame

at 15 frames per second,

first right click and then select Key Image option, then use the up and down arrows to move the

picture, one at a time

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• In the angiogram of the rightcoronary artery, the lesion wasseen at the mid-segment(arrow)

• No lesion was seen in proximal

or distal segment (WHY?)

• Laminar flow is a well organized flow with peripheral layer, regular border and a pointed tip

• It represents uniform distribution of pressure

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• Turbulent flow isdefined as coarsemixing of blood

contrast in black

• To compare the type of flow of same patient betweenthe Right Coronary Artery (RCA) (with turbulent flow)and the Left Circumflex Artery (LCX) withoutturbulent flow

• (same risk factors: HTN, hyperlipidemia, etc)

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• The flow at the left circumflex artery was laminar without turbulence flow in systole and

in diastole

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• In the angiogram of the rightcoronary artery, multipleplaques were seen at the mid-segment (arrow)

• No lesion was seen in proximal

or distal segment

• The flow study of the rightcoronary artery with multipleareas of turbulence (coarsemixing of contrast in black and

midsegment This is the samearea with multiple plaques inthe previous slide

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Methods

Methods (2nd, 3rd 3th, 6th frame)

Methods (11th, 12th, 14th, 16th frame)

• 80% of flow in the mid segment were turbulent and theyhappened in the area with multiple lesions

• Only 10% lesion happened in the area without turbulence

1 TURBULENT FLOW at the mid segment of the

right, circumflex and left anterior descending artery arteries coincide with the presence of atherosclerotic lesions

2 This is the indirect evidence of the formation of

coronary plaques caused by mechanical injury to

the endothelium and the birth of coronary plaques

Thank You for Your Attention