Usefulness of shear stress pattern in predicting neointima distribution in sirolimus-eluting stents in coronary arteries

Gijsen, Frank; Oortman, Remko M.; Wentzel, Jolanda J.; Schuurbiers, Johan C.H.; Tanabe, Kengo; Değertekin, Muzaffer; Ligthart, Jürgen; Thury, Attila; Feyter, Pim J. de; Serruys, Patrick W.; Slager, Cornelis J.

doi:10.1016/j.amjcard.2003.08.017

Cited by 80 publications

(61 citation statements)

References 13 publications

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“…With the exception of the articles published by Suzuki et al [21] and Papafaklis et al [22], where the WSS was not associated with NIH after implantation of SES, further data on straight vessels confirmed that the WSS determines neointimal formation in DESs [23][24][25].…”

Section: Des Studiesmentioning

confidence: 80%

Wall shear stress in the development of in-stent restenosis revisited. A critical review of clinical data on shear stress after intracoronary stent implantation

et al. 2016

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Section: Des Studiesmentioning

confidence: 80%

Wall shear stress in the development of in-stent restenosis revisited. A critical review of clinical data on shear stress after intracoronary stent implantation

et al. 2016

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“…Previous work showed that shear stress modulates the neointimal healing after stenting, and the thickness of the neointimal hyperplasia layer covering the struts is inversely related to the local level of shear stress. [25][26][27][28] The similarity in dose-response relations suggests that the more detached the strut, the larger its distance from the existing endothelial layer and the higher the shear stress on the strut wall, and subsequently the more hampered the neointimal reaction intended to cover the detached struts.…”

Section: Discussionmentioning

confidence: 99%

“…Shear stress has been shown to modulate the neointimal healing after stenting in BMS 25 and DES. 26,27 It has also been advocated to explain the differences in coverage between the luminal and abluminal sides of the struts in bioresorbable scaffolds. 44 The increase in shear rate as a function of the detachment distance might well explain the incomplete coverage of ISA regions and why the risk of incomplete coverage is also a function of the detachment distance (Figures 4 and 5).…”

Section: Shear Stress As a Mechanism To Explain The Delayed Healing Omentioning

confidence: 99%

“…24 ISA struts exhibit delayed neointimal coverage as compared with well-apposed struts. [21][22][23] Shear rate, defined as the local gradient in velocity between adjacent flow streamlines, affects biological arterial response [25][26][27][28] and is a known modulator of platelet activation and thrombosis. [29][30][31][32] Normal human shear rate (shear rate in large-to-medium-sized arteries) usually varies from 100 to 1000/s.…”

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confidence: 99%

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Incomplete Stent Apposition Causes High Shear Flow Disturbances and Delay in Neointimal Coverage as a Function of Strut to Wall Detachment Distance

Foin

Gutiérrez‐Chico

Nakatani

et al. 2014

Circ: Cardiovascular Interventions

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189

118

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13are common morphological findings in fatal cases of LST after DES.9-14 DES can interfere with this physiological healing process through different mechanisms: first, the antiproliferative drug released by the device prevents the cellular mitosis required to restore the endothelial continuity; second, the polymer carrying the drug exerts a proinflammatory effect itself 15 ; finally, in Background-Lack of re-endothelialization and neointimal coverage on stent struts has been put forward as the main underlying mechanism leading to late stent thrombosis. Incomplete stent apposition (ISA) has been observed frequently in patients with very late stent thrombosis after drug eluting stent implantation, suggesting a role of ISA in the pathogenesis of this adverse event. The aim of this study was to evaluate the impact of different degrees of ISA severity on abnormal shear rate and healing response with coverage, because of its potential implications for stent optimization in clinical practice. Methods and Results-We characterized flow profile and shear distribution in different cases of ISA with increasing strutwall detachment distance (ranging from 100 to 500 μm). Protruding strut and strut malapposed with moderate detachment (ISA detachment distance <100 μm) have minimal disturbance to blood flow as compared with floating strut that has more significant ISA distance. In vivo impact on strut coverage was assessed retrospectively using optical coherence tomography evaluation on 72 stents (48 patients) sequentially at baseline and after 6-month follow-up. Analysis of coverage revealed an important impact of baseline strut-wall ISA distance on the risk of incomplete strut coverage at follow-up. Malapposed segments with an ISA detachment <100 μm at baseline showed complete strut coverage at follow-up, whereas segments with a maximal ISA detachment distance of 100 to 300 μm and >300 μm had 6.1% and 15.7% of their struts still uncovered at follow-up, respectively (P<0.001). Conclusions-Flow disturbances and risk of delayed strut coverage both increase with ISA detachment distance. Insights from this study are important for understanding malapposition as a quantitative, rather than binary phenomenon (present or absent) and to define the threshold of ISA detachment that might benefit from optimization during stent implantation. (Circ Cardiovasc Interv. 2014;7:180-189.)

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“…hyperplasia or restenosis after stent implantation 5,6 . Microfocal X-ray computed tomography (CT) imaging provides a rapid means of capturing detailed geometric information within stented vascular segments.…”

mentioning

confidence: 99%

Microfocal X-ray computed tomography post-processing operations for optimizing reconstruction volumes of stented arteries during 3D computational fluid dynamics modeling

LaDisa

Olson

Ropella

et al. 2005

Computer Methods and Programs in Biomedicine

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Summary:Restenosis caused by neointimal hyperplasia (NH) remains an important clinical problem after stent implantation. Restenosis varies with stent geometry, and idealized computational fluid dynamics (CFD) models have indicated that geometric properties of the implanted stent may differentially influence NH. However, 3D studies capturing the in vivo flow domain within stented vessels have not been conducted at a resolution sufficient to detect subtle alterations in vascular geometry caused by the stent and the subsequent temporal development of NH. We present the details and limitations of a series of post-processing operations used in conjunction with microfocal X-ray CT imaging and reconstruction to generate geometrically accurate flow domains within the localized region of a stent several weeks after implantation. Microfocal X-ray CT reconstruction volumes were subjected to an automated program to perform arterial thresholding, spatial orientation, and surface smoothing of stented and unstented rabbit iliac arteries several weeks after antegrade implantation. A transfer function was obtained for the current post-processing methodology containing reconstructed 16 mm stents implanted into rabbit iliac arteries for up to 21 days after implantation and resolved at circumferential and axial resolutions of 32 and 50 μm, respectively. The results indicate that the techniques presented are sufficient to resolve distributions of WSS with 80% accuracy in segments containing 16 surface perturbations over a 16 mm stented region. These methods will be used to test the hypothesis that reductions in normalized wall shear stress (WSS) and increases in the spatial disparity of WSS immediately after stent implantation may spatially correlate with the temporal development of NH within the stented region.

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Usefulness of shear stress pattern in predicting neointima distribution in sirolimus-eluting stents in coronary arteries

Cited by 80 publications

References 13 publications

Wall shear stress in the development of in-stent restenosis revisited. A critical review of clinical data on shear stress after intracoronary stent implantation

Wall shear stress in the development of in-stent restenosis revisited. A critical review of clinical data on shear stress after intracoronary stent implantation

Incomplete Stent Apposition Causes High Shear Flow Disturbances and Delay in Neointimal Coverage as a Function of Strut to Wall Detachment Distance

Microfocal X-ray computed tomography post-processing operations for optimizing reconstruction volumes of stented arteries during 3D computational fluid dynamics modeling

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