Impact of Coronary Tortuosity on Coronary Blood Supply: a Patient-specific Study

Background: Tortuous coronary arteries are commonly observed in clinical screenings and it may cause a reduction of the coronary pressure. However, whether this reduction leads to significant decreasing in the coronary blood supply is still unknown. The purpose of this study was to investigate the effect of the coronary tortuosity (CT) on the coronary blood supply.

Method: A computational fluid dynamics (CFD) study was conducted to evaluate the impact of tortuosity on the coronary blood supply. Two patient-specific left anterior descending coronary artery (LAD) models and the corresponding non-tortuous models were reconstructed to perform three-dimensional CFD analysis. The lumped parameter model was coupled to the outlet of the simulated branches to represent the absent downstream vasculatures. The rest and exercise conditions were modeled by specifying proper boundary conditions.

Result: Under resting condition, the mean flow rate could be maintained by decreasing less than 8% of the downstream vascular bed's resistance for tortuous models. While during exercise (maximal dilatation condition), the maximal coronary blood supply would reduce up to 14.9% due to tortuosity. Assuming that the flow rate can be maintained by the auto-regulation effect under the maximal dilatation condition, the distal resistances for CT models still have to reduce more than 23% to maintain blood perfusion.

Conclusions: Coronary tortuosity has minor influence on coronary blood supply at rest; while during exercise, patients with CT may lack the ability to adjust distal resistance sufficiently to compensate for the extra resistances generated by tortuosity and this may further lead to an ineffective regulation of the blood supply.