Challenges of the 21ST Century: Part 2 - Dynamic angiography in the investigation of cavitation in coronary arteries: Standard description of coronary lesions and blood flow

Abstract

There is no confirmed mechanism in the formation and growth of atherosclerotic plaques, or coronary artery disease (CAD). In all patients, the entire arterial tree is exposed to the atherogenic effects of systemic risk factors and yet only few arteries develop plaques. The hypothesis was that damage on the intima was caused by the cavitation phenomenon frequently seen in domestic/industrial pipes. Herein, a summary of hydraulic principles and cavitation phenomenon is presented. Then, a novel method is introduced for review and analysis of the coronary angiogram based on these principles and the underlying anatomic structure of the coronary vasculature. Coronary angiograms of patients with one or two de novo mild-to-moderate lesions in any of the coronary arteries were examined for correlation between types of flow and lesions. This novel technique allowed comparison of local factors effecting one coronary segment with local factors on other coronary segments in a same patient. The most frequent location (75%) of lesions was at the COLLISION LINE, where antegrade and retrograde flows collided during the transition from diastole to systole. Lesions at the collision line appeared earlier and grew faster compared with the lesions in other coronary arteries of a same patient in 76% of cases. There was a strong relation between the presence of lesions with the abnormalities of blood flow at the collision line or a side branch of mild-to-moderate size. The mechanism for formation of coronary lesions is most likely from explosion of air bubbles, injuring the intima and starting the atherosclerotic process. The new technique of angiography, review of the dynamic flows and their anatomical correlations opens new chapters in the clinical anatomy and interventional management of CAD.