Morphometry and hemodynamics of coronary artery aneurysms caused by atherosclerosis


      • A two-step analysis method is proposed to improve the risk assessment of CAAs due to atherosclerosis.
      • Patients with the CAA covering a bifurcation have the higher occurrence of myocardial ischemia.
      • Patients with the CAA of L/W ≥ 2 covering a bifurcation show the worst hemodynamic environment.


      Background and aims

      Atherosclerosis is the first etiology of coronary artery aneurysm (CAA). It is, however, challenging to inhibit the development of CAA. The aim of the study is to carry out morphometric and hemodynamic analyses in epicardial coronary arteries of patients with CAAs caused by atherosclerosis.


      Various morphometric parameters were obtained from the reconstructed epicardial coronary arterial trees of 61 patients and multiple hemodynamic parameters were determined from the computed flow fields. A two-step analysis method was proposed to enhance the risk assessment of CAAs, i.e., coronary artery bifurcation is the major risk factor for CAA followed by high aneurysm shape index (L/W, where L and W refer to the aneurysm length and maximum diameter, respectively).


      Patients with CAA covering a bifurcation have the higher occurrence (71% and 55% for L/W ≥ 2 and L/W < 2, respectively) of myocardial ischemia relevant to abnormal hemodynamic parameters in comparison with those with CAA in one vessel (43% and 40% for L/W ≥ 2 and L/W < 2, respectively). Patients with CAA of L/W ≥ 2 covering a bifurcation show the worst hemodynamic environment.


      Morphometric and hemodynamic studies support the two-step analysis method, which provides a clinical rationale for the noninvasive assessment of CAAs.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kleinstreuer C.
        • Hyun S.
        • Buchanan J.R.
        • et al.
        Hemodynamic parameters and early intimal thickening in branching blood vessels.
        Crit. Rev. Biomed. Eng. 2001; 29: 1-64
        • Malek A.M.
        • Alper S.L.
        • Izumo S.
        Hemodynamic shear stress and its role in atherosclerosis.
        J. Am. Med. Assoc. 1999; 282: 2035-2042
        • Huo Y.
        • Luo T.
        • Guccione J.M.
        • et al.
        Mild anastomotic stenosis in patient-specific CABG model may enhance graft patency: a new hypothesis.
        PLoS One. 2013; 8e73769
        • Nordgaard H.
        • Swillens A.
        • Nordhaug D.
        • et al.
        Impact of competitive flow on wall shear stress in coronary surgery: computational fluid dynamics of a LIMA-LAD model.
        Cardiovasc. Res. 2010; 88: 512-519
        • Fan T.
        • Lu Y.
        • Gao Y.
        • et al.
        Hemodynamics of left internal mammary artery bypass graft: effect of anastomotic geometry, coronary artery stenosis, and postoperative time.
        J. Biomech. 2016; 49: 645-652
        • Swaye P.S.
        • Fisher L.D.
        • Litwin P.
        • et al.
        Aneurysmal coronary artery disease.
        Circulation. 1983; 67: 134-138
        • Hartnell G.G.
        • Parnell B.M.
        • Pridie R.B.
        Coronary artery ectasia. Its prevalence and clinical significance in 4993 patients.
        Br. Heart J. 1985; 54: 392-395
        • Roberts W.C.
        Natural history, clinical consequences, and morphologic features of coronary arterial aneurysms in adults.
        Am. J. Cardiol. 2011; 108: 814-821
        • Pahlavan P.S.
        • Niroomand F.
        Coronary artery aneurysm: a review.
        Clin. Cardiol. 2006; 29: 439-443
        • Aboeata A.S.
        • Sontineni S.P.
        • Alla V.M.
        • et al.
        Coronary artery ectasia: current concepts and interventions.
        Front Biosci (Elite Ed). 2012; 4: 300-310
        • Akyurek O.
        • Berkalp B.
        • Sayin T.
        • et al.
        Altered coronary flow properties in diffuse coronary artery ectasia,.
        Am. Heart J. 2003; 145: 66-72
        • Devabhaktuni S.
        • Mercedes A.
        • Diep J.
        • et al.
        Coronary artery ectasia-A review of current literature.
        Curr. Cardiol. Rev. 2016; 12: 318-323
        • Dhar S.
        • Tremmel M.
        • Mocco J.
        • et al.
        Morphology parameters for intracranial aneurysm rupture risk assessment.
        Neurosurgery. 2008; 63: 185-197
        • Nikolic I.
        • Tasic G.
        • Bogosavljevic V.
        • et al.
        Predictable morphometric parameters for rupture of intracranial aneurysms - a series of 142 operated aneurysms.
        Turkish Neurosurgery. 2012; 22: 420-426
        • Raghavan M.L.
        • Ma B.S.
        • Harbaugh R.E.
        Quantified aneurysm shape and rupture risk.
        J. Neurosurg. 2005; 102: 355-362
        • Ujiie H.
        • Tachibana H.
        • Hiramatsu O.
        • et al.
        Effects of size and shape (aspect ratio) on the hemodynamics of saccular aneurysms: a possible index for surgical treatment of intracranial aneurysms.
        Neurosurgery. 1999; 45: 119-129
        • Yu H.
        • Li H.
        • Liu J.
        • et al.
        An approach to quantitative assessment of hemodynamic differences between unruptured and ruptured ophthalmic artery aneurysms.
        Comput. Methods Biomech. Biomed. Eng. 2016; 19: 1456-1461
        • Parlea L.
        • Fahrig R.
        • Holdsworth D.W.
        • et al.
        An analysis of the geometry of saccular intracranial aneurysms.
        Am. J. Neuroradiol. 1999; 20: 1079-1089
        • Ho A.L.
        • Lin N.
        • Frerichs K.U.
        • et al.
        Intrinsic, transitional, and extrinsic morphological factors associated with rupture of intracranial aneurysms.
        Neurosurgery. 2015; 77 (; discussion 441-432): 433-441
        • Chien A.
        • Tateshima S.
        • Sayre J.
        • et al.
        Patient-specific hemodynamic analysis of small internal carotid artery-ophthalmic artery aneurysms.
        Surg. Neurol. 2009; 72: 444-450
        • Pereira V.M.
        • Brina O.
        • Bijlenga P.
        • et al.
        Wall shear stress distribution of small aneurysms prone to rupture a case-control study.
        Stroke. 2014; 45: 261-264
        • Huang X.
        • Liu D.
        • Yin X.
        • et al.
        Morphometry and hemodynamics of posterior communicating artery aneurysms: ruptured versus unruptured.
        J. Biomech. 2018; 76: 35-44
        • Sengupta D.
        • Kahn A.M.
        • Burns J.C.
        • et al.
        Image-based modeling of hemodynamics in coronary artery aneurysms caused by Kawasaki disease.
        Biomechanics Model. Mechanobiol. 2012; 11: 915-932
        • Sengupta D.
        • Kahn A.M.
        • Kung E.
        • et al.
        Thrombotic risk stratification using computational modeling in patients with coronary artery aneurysms following Kawasaki disease.
        Biomechanics Model. Mechanobiol. 2014; 13: 1261-1276
        • Fan T.
        • Feng Y.
        • Feng F.
        • et al.
        A comparison of postoperative morphometric and hemodynamic changes between saphenous vein and left internal mammary artery grafts.
        Phys. Rep. 2017; 5
        • Chen X.
        • Gao Y.
        • Lu B.
        • et al.
        Hemodynamics in coronary arterial tree of serial stenoses.
        PLoS One. 2016; 11e0163715
        • Weigold W.G.
        • Abbara S.
        • Achenbach S.
        • et al.
        Standardized medical terminology for cardiac computed tomography: a report of the Society of Cardiovascular Computed Tomography.
        J. Cardiovasc. Comput. Tomogr. 2011; 5: 136-144
        • Huo Y.
        • Wischgoll T.
        • Choy J.S.
        • et al.
        CT-based diagnosis of diffuse coronary artery disease on the basis of scaling power laws.
        Radiology. 2013; 268: 694-701
        • Rautaharju P.M.
        • Surawicz B.
        • Gettes L.S.
        • et al.
        AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part IV: the ST segment, T and U waves, and the QT interval: a scientific statement from the American heart association electrocardiography and arrhythmias committee, council on clinical cardiology; the American College of cardiology foundation; and the heart rhythm society: endorsed by the international society for computerized electrocardiology.
        Circulation. 2009; 119: e241-250
        • Wagner G.S.
        • Macfarlane P.
        • Wellens H.
        • et al.
        AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part VI: acute ischemia/infarction: a scientific statement from the American heart association electrocardiography and arrhythmias committee, council on clinical cardiology; the American College of cardiology foundation; and the heart rhythm society: endorsed by the international society for computerized electrocardiology.
        Circulation. 2009; 119: e262-270
        • Yin X.
        • Huang X.
        • Li Q.
        • et al.
        Hepatic hemangiomas alter morphometry and impair hemodynamics of the abdominal aorta and primary branches from computer simulations.
        Front. Physiol. 2018; 9: 334
        • Huang X.
        • Yin X.
        • Xu Y.
        • et al.
        Morphometric and hemodynamic analysis of atherosclerotic progression in human carotid artery bifurcations.
        Am. J. Physiol. Heart Circ. Physiol. 2016; 310: H639-H647
        • Yin X.
        • Huang X.
        • Feng Y.
        • et al.
        Interplay of proximal flow confluence and distal flow divergence in patient-specific vertebrobasilar system.
        PLoS One. 2016; 11e0159836
        • Nichols W.W.
        • McDonald D.A.
        McDonald's Blood Flow in Arteries: Theoretic, Experimental, and Clinical Principles.
        Hodder Arnold, London2011 (xiv,755 pp.)
        • Diaz-Zamudio M.
        • Bacilio-Perez U.
        • Herrera-Zarza M.C.
        • et al.
        Coronary Artery Aneurysms and Ectasia: Role of Coronary CT Angiography, Radiographics.
        vol. 29. a review publication of the Radiological Society of North America, Inc, 2009: 1939-1954
        • Altinbas A.
        • Nazli C.
        • Kinay O.
        • et al.
        Predictors of exercise induced myocardial ischemia in patients with isolated coronary artery ectasia.
        Int. J. Cardiovasc. Imaging. 2004; 20: 3-17
        • Ohkubo T.
        • Fukazawa R.
        • Ikegami E.
        • et al.
        Reduced shear stress and disturbed flow may lead to coronary aneurysm and thrombus formations.
        Pediatr. Int. 2007; 49: 1-7
        • Huo Y.
        • Choy J.S.
        • Svendsen M.
        • et al.
        Effects of vessel compliance on flow pattern in porcine epicardial right coronary arterial tree.
        J. Biomech. 2009; 42: 594-602
        • Huo Y.
        • Wischgoll T.
        • Kassab G.S.
        Flow patterns in three-dimensional porcine epicardial coronary arterial tree.
        Am. J. Physiol. Heart Circ. Physiol. 2007; 293: H2959-H2970
        • Huo Y.
        • Finet G.
        • Lefevre T.
        • et al.
        Which diameter and angle rule provides optimal flow patterns in a coronary bifurcation?.
        J. Biomech. 2012; 45: 1273-1279
        • Ogawa S.
        • Gerlach H.
        • Esposito C.
        • et al.
        Hypoxia modulates the barrier and coagulant function of cultured bovine endothelium. Increased monolayer permeability and induction of procoagulant properties.
        J. Clin. Investig. 1990; 85: 1090-1098
        • Matsushita H.
        • Morishita R.
        • Nata T.
        • et al.
        Hypoxia-induced endothelial apoptosis through nuclear factor-kappaB (NF-kappaB)-mediated bcl-2 suppression: in vivo evidence of the importance of NF-kappaB in endothelial cell regulation.
        Circ. Res. 2000; 86: 974-981
        • Deng X.
        • Marois Y.
        • How T.
        • et al.
        Luminal surface concentration of lipoprotein (LDL) and its effect on the wall uptake of cholesterol by canine carotid arteries.
        J. Vasc. Surg. 1995; 21: 135-145
        • Liu X.
        • Pu F.
        • Fan Y.
        • et al.
        A numerical study on the flow of blood and the transport of LDL in the human aorta: the physiological significance of the helical flow in the aortic arch.
        Am. J. Physiol. Heart Circ. Physiol. 2009; 297: H163-H170
        • Hulten L.M.
        • Levin M.
        The role of hypoxia in atherosclerosis.
        Curr. Opin. Lipidol. 2009; 20: 409-414
        • Liu X.
        • Fan Y.B.
        • Deng X.Y.
        Effect of spiral flow on the transport of oxygen in the aorta: a numerical study.
        Ann. Biomed. Eng. 2010; 38: 917-926
        • Lu Y.
        • Wu H.
        • Li J.
        • et al.
        Passive and active triaxial wall mechanics in a two-layer model of porcine coronary artery.
        Sci. Rep. 2017; 7: 13911
        • Huo Y.
        • Zhao X.
        • Cheng Y.
        • et al.
        Two-layer model of coronary artery vasoactivity.
        J. Appl. Physiol. 1985; 114: 1451-1459
        • Huo Y.
        • Cheng Y.
        • Zhao X.
        • et al.
        Biaxial vasoactivity of porcine coronary artery.
        Am. J. Physiol. Heart Circ. Physiol. 2012; 302: H2058-H2063

      Further reading

        • Choy J.S.
        • Kassab G.S.
        Scaling of myocardial mass to flow and morphometry of coronary arteries.
        J. Appl. Physiol. 1985; 104: 1281-1286
        • Huo Y.
        • Kassab G.S.
        Intraspecific scaling laws of vascular trees.
        J. R. Soc. Interface. 2012; 9: 190-200
        • Dole W.P.
        • Richards K.L.
        • Hartley C.J.
        • et al.
        Diastolic coronary artery pressure-flow velocity relationships in conscious man.
        Cardiovasc. Res. 1984; 18: 548-554