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The left coronary artery (LCA) and its bifurcations, which supply blood to a large portion of the myocardium, are recognized as high-risk sites for plaque formation. This systematic review addresses the question: \u201cWhat are the main CFD approaches, modeling strategies, and hemodynamic parameters used to study LCA bifurcation over the last decade, and how have these advanced the understanding of atherosclerosis progression?\u201d A comprehensive search was conducted in PubMed, Web of Science, and Scopus databases. Following preferred reporting items for systematic reviews and meta-analyses guidelines, the search focused on original studies published within the last decade employing CFD to analyze LCA bifurcation hemodynamics. The review includes 108 CFD studies, mostly three-dimensional (3D) simulations (104 studies). Forty-seven used idealized 3D LCA models and 48 used patient-specific models focusing on bifurcation. Recent studies increasingly focus on hemodynamic parameters linked to atherosclerosis and the impact of stenosis and post-stenting restenosis on local blood flow. Simulations incorporating physiological features, such as fluid\u2013structure interaction, cardiac motion, and blood rheology, are also included. Additionally, artificial intelligence is being integrated to efficiently predict hemodynamic parameters, reducing simulation time and cost. There is a clear trend toward using high-resolution imaging and advanced modeling for patient-specific CFD simulations. Despite methodological differences, disturbed flow patterns, low wall shear stress, and high oscillatory shear index are studied in the LCA bifurcation, supporting their role in atherogenesis. Standardizing protocols and integrating clinical data are essential for translating CFD findings into practice.<\/jats:p>","DOI":"10.1063\/5.0310403","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T14:40:36Z","timestamp":1769524836000},"update-policy":"https:\/\/doi.org\/10.1063\/aip-crossmark-policy-page","source":"Crossref","is-referenced-by-count":0,"title":["A decade of computational fluid dynamics to study local hemodynamics in left main coronary bifurcation: A systematic review"],"prefix":"10.1063","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-0373-4060","authenticated-orcid":false,"given":"Andreia","family":"Quinteiro","sequence":"first","affiliation":[{"name":"Polytechnic University of Coimbra, Rua da Miseric\u00f3rdia, Lagar dos Corti\u00e7os, S. Martinho do Bispo 1 , 3045-093 Coimbra,","place":["Portugal"]},{"name":"CERNAS, Research Center for Natural Resources, Environment and Society, Polytechnic University of Coimbra 2 , Bencanta, 3045-601 Coimbra,","place":["Portugal"]},{"name":"CEFT, Transport Phenomena Research Center, Faculty of Engineering, University of Porto 3 , 4200-465 Porto,","place":["Portugal"]},{"name":"ALiCE, Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto 4 , 4200-465 Porto,","place":["Portugal"]}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4888-8868","authenticated-orcid":false,"given":"Erica","family":"Doutel","sequence":"additional","affiliation":[{"name":"CEFT, Transport Phenomena Research Center, Faculty of Engineering, University of Porto 3 , 4200-465 Porto,","place":["Portugal"]},{"name":"ALiCE, Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto 4 , 4200-465 Porto,","place":["Portugal"]}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8113-7142","authenticated-orcid":false,"given":"Jo\u00e3o","family":"Moreira de Campos","sequence":"additional","affiliation":[{"name":"CEFT, Transport Phenomena Research Center, Faculty of Engineering, University of Porto 3 , 4200-465 Porto,","place":["Portugal"]},{"name":"ALiCE, Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto 4 , 4200-465 Porto,","place":["Portugal"]}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5710-7488","authenticated-orcid":false,"given":"Maria Nazar\u00e9","family":"Coelho Pinheiro","sequence":"additional","affiliation":[{"name":"Polytechnic University of Coimbra, Rua da Miseric\u00f3rdia, Lagar dos Corti\u00e7os, S. Martinho do Bispo 1 , 3045-093 Coimbra,","place":["Portugal"]},{"name":"CERNAS, Research Center for Natural Resources, Environment and Society, Polytechnic University of Coimbra 2 , Bencanta, 3045-601 Coimbra,","place":["Portugal"]},{"name":"CEFT, Transport Phenomena Research Center, Faculty of Engineering, University of Porto 3 , 4200-465 Porto,","place":["Portugal"]},{"name":"ALiCE, Associate Laboratory in Chemical Engineering, Faculty of Engineering, University of Porto 4 , 4200-465 Porto,","place":["Portugal"]}]}],"member":"317","published-online":{"date-parts":[[2026,1,27]]},"reference":[{"key":"2026012709403405400_c1","unstructured":"World Health Organization, see https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/cardiovascular-diseases for \u201cCardiovascular Diseases\u201d (2025) (accessed September 01, 2025)."},{"key":"2026012709403405400_c2","doi-asserted-by":"publisher","first-page":"1630","DOI":"10.1016\/j.cell.2022.04.004","article-title":"Atherosclerosis: Recent developments","volume":"185","year":"2022","journal-title":"Cell"},{"key":"2026012709403405400_c3","doi-asserted-by":"publisher","first-page":"e3207","DOI":"10.1002\/cnm.3207","article-title":"Geometrical effects in the hemodynamics of stenotic and non-stenotic left coronary arteries-numerical and in vitro approaches","volume":"35","year":"2019","journal-title":"Numer. 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