Disease patterns at arterial branches and their relation to flow

The distribution of lesions around arterial branch points is complex and changes with age. Four distinct patterns - here termed the arrowhead pattern, the lateral pattern, the upstream streak and the volcano - have been reported around the origins of intercostal arteries in the human aorta at different ages. The first two patterns also occur in young and old rabbits, the third in minipigs, and the fourth in apolipoprotein E/LDL receptor knockout mice. It is unclear how all four patterns can depend solely on flow; a particular problem is that the prevalence of lipid deposition remains highly nonuniform for several branch diameters upstream of the ostium. Variations in the prevalence of fatty streaks may originate near the branch and then spread by the migration of activated endothelial cells towards the heart. The pattern of raised lesions may reflect a different aetiology.