Three-dimensional evaluation of the spatial morphology of stented coronary artery segments in relation to restenosis

Abstract

To investigate the correlations between the three-dimensional (3D) parameters of target coronary artery segments and restenosis after stent implantation. Sixty-four patients after single, cobalt chromium platform stent (27 BM stents and 37 DES) implantation were investigated retrospectively 12 ± 6 months after the index procedure. 3D coronary artery reconstruction was performed before and after the stent implantation using appropriate projections by a dedicated reconstruction software. The curve of the target segment was characterized by the ratio of the vessel length measured at midline (arc: A) and the distance between the edge points of the stent (chord: C): A/C ratio (ACr). Age, diabetes and hyperlipidaemia were taken into account for the statistical evaluation. 22 patients were diagnosed with ISR, while 42 patients without any restenosis served as controls. The two groups did not differ regarding major cardiovascular risk factors, proportion of the treated vessels or the type of stents. Higher initial ACr values were associated with greater straightening of the vessel curvature in all groups (p < 0.001). Significant negative correlations were found in cases of proximal or distal edge bending angles (p < 0.001). Pre-stent edge bending angles < 7° often showed an increase after the stent implantation, while in case of higher initial values, the bending angles generally decreased. Using multivariate logistic regression modelling we found that the pre-stent ACr was an independent predictor of in-stent restenosis (odds ratio for 1% increase of the ACr: 1.08; p = 0.012). Changes of angles at the stent edges following stent implantation correlate with the initial local bending angles. The ACr predispose to chronic shear stress in the vessel wall, which may contribute to the pathological intimal proliferation.

The Effects of Percutaneous Coronary Intervention on the Flow in Acute Coronary Syndrome Patients—Geometry in Focus

“…Percutaneous coronary intervention (PCI) and stent implantation are considered the most appropriate approach in ACS [ 8 ]. When it comes to 3D changes in the coronary arteries during PCI, pre-stenting arch-cord ratio is an independent risk factor for in-stent restenosis, along with existing causative findings between changes at stent edges, shear stress, and consequential intimal proliferation [ 9 ]. In our previous paper on 3D reconstruction from 2D invasive angiography images, percent area stenosis and plaque volume correlated well with invasive fractional flow measurements [ 10 ].…”

Towards effects from stent implantation into coronary bifurcation stenosis: experiment and simulation

“…Анализ результатов лечения пациентов с единичными поражениями в нативных коронарных артериях показал, что использование биорезорбируемого сосудистого каркаса вызывает меньшее изменение угла коронарной артерии [23]. Схожий результат продемонстрирован в работе [24], где установлено, что изменение естественного извилистого хода коронарных сосудов в результате имплантации стента может повлиять на клинический долгосрочный прогноз, поскольку уменьшение угла изгиба коронарных артерий потенциально является основным фактором, влияющим на рестеноз после имплантации стента. Учитывая высокую вариабельность ангиоархитектоники коронарных сосудов, представляет интерес то, насколько существенные изменения в ней происходят при установке стента.…”

Predictors of restenosis following percutaneous coronary stent implantation: The role of trimetazidine therapy

“…inflammatory responses and the migration of smooth muscle cells from the tunica media and tunica adventitia to the tunica intima (neointimal hyperplasia) (4,23,24). The introduction of DES has drastically reduced ISR development by inhibiting one of its main causes, the proliferation of the neointima.…”