Impact of marginal artery bifurcation on coronary blood flow and myocardial perfusion: a cadaveric and histological analysis

Moultrie, GA

Introduction

Coronary artery anatomy exhibits significant variability, with certain structural variations potentially influencing myocardial perfusion and predisposing individuals to ischemic heart disease. One such variation, the bifurcation of the left marginal artery, may alter coronary blood flow dynamics, leading to localized ischemia or increased susceptibility to atherosclerosis. Recent studies have identified bifurcation lesions as predictors of thrombotic events, suggesting that arterial bifurcations create a hemodynamic environment that may facilitate plaque deposition and clot formation. Given the role marginal artery has in supplying the lateral wall of the left ventricle, any disruption to the perfusion could have clinical implications for ischemic risk. Understanding how these anatomical differences impact coronary circulation is critical for optimizing surgical planning, risk stratification, and interventional cardiology approaches, particularly in patients requiring coronary artery bypass grafting or stent placement.

Objectives

This study aims to investigate whether a bifurcated left marginal artery alters myocardial perfusion and contributes to ischemic risk. We seek to determine if this anatomical variation influences coronary blood flow dynamics and predisposes the artery to vascular changes, such as atherosclerosis or structural remodeling. Our findings will provide insight into potential clinical implications, particularly regarding risk stratification and surgical considerations in patients with this coronary variant.

Methods

We will examine histological samples of the left ventricular wall and marginal artery for signs of atherosclerosis or vascular remodeling, while measuring the diameter, length, and branching angle of the marginal artery. These findings will be compared to published data on normal coronary anatomy. By integrating structural and histological analysis, we seek to determine whether this anatomical variation influences coronary blood flow and ischemic risk.

Results

If our cadaveric analysis identifies evidence of atherosclerosis at the bifurcation site, it would support the notion that bifurcated arteries may be more prone to ischemic complications. Furthermore, any significant anatomical differences in diameter, length, or branching angle are observed compared to normal coronary anatomy could suggest a structural predisposition to altered perfusion dynamics.

Discussion

This study emphasizes the importance of recognizing coronary artery bifurcation variations in ischemic risk assessment and interventional planning. Future research using angiographic imaging and computational flow dynamics could further clarify whether bifurcated marginal arteries exhibit the same turbulence-prone characteristics as other bifurcation sites known to predispose patients to thrombotic events.