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

Jenei, Csaba; Balogh, Emília; Szabó, Gábor; Dézsi, Csaba András; Kőszegi, Zsolt

doi:10.5603/cj.a2016.0047

Cited by 30 publications

(12 citation statements)

References 39 publications

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“…In line with previous literature data, we demonstrated that the curvature of the target coronary artery segment significantly decreased after stenting due to the straightening effect of the stent. In contrast to some previous studies [8, 10, 27], our results did not support the idea that the straightening effect of the stent always generates an increase of the angles at the edges of the stent. In particular, we observed an increase after stenting in cases of pre-stent edge bending angles < 7°.…”

Section: Discussioncontrasting

confidence: 99%

“…The mechanism behind this phenomenon was proposed to be the change of the wall shear stress, as a contributor of intimal hyperplasia [5–7]. However, the question “whether the detected intimal hyperplasia is a part of the healing process after stent implantation or a predictor of later clinical restenosis” has not yet been answered [8].…”

Section: Introductionmentioning

confidence: 99%

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

Üveges

Jenei

Kiss³

et al. 2019

Int J Cardiovasc Imaging

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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.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Üveges

Jenei

Kiss³

et al. 2019

Int J Cardiovasc Imaging

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“…Presently, provisional T-stenting (PTS) is the best approach [2,3]. However, the optimal strategy for coronary bifurcations treatment remains a subject of debate, mainly when the side branch (SB) is large, not easily accessible or narrowed by a long lesion [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

The approach to coronary bifurcation treatment and its outcomes in Poland: The single center experience

et al. 2017

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“…At a macro-level, animal studies have shown that tissue regrowth in stented arteries is prominent at sites of low and/or oscillatory WSS [ 9 – 11 ]. Although limited by the small number of analyzed cases, some patient studies have found a similar relationship between neointimal regrowth and altered WSS pattern [ 12 ]. These evidences explain the recent research interest on the accurate quantification of patient-specific stented artery hemodynamics as a means to predict stent failure induced by thrombosis or in-stent restenosis in the clinical setting.…”

Section: Introductionmentioning

confidence: 99%

Patient-Specific Modeling of Stented Coronary Arteries Reconstructed from Optical Coherence Tomography: Towards a Widespread Clinical Use of Fluid Dynamics Analyses

Chiastra

Migliori

Burzotta

et al. 2017

J. of Cardiovasc. Trans. Res.

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The recent widespread application of optical coherence tomography (OCT) in interventional cardiology has improved patient-specific modeling of stented coronary arteries for the investigation of local hemodynamics. In this review, the workflow for the creation of fluid dynamics models of stented coronary arteries from OCT images is presented. The algorithms for lumen contours and stent strut detection from OCT as well as the reconstruction methods of stented geometries are discussed. Furthermore, the state of the art of studies that investigate the hemodynamics of OCT-based stented coronary artery geometries is reported. Although those studies analyzed few patient-specific cases, the application of the current reconstruction methods of stented geometries to large populations is possible. However, the improvement of these methods and the reduction of the time needed for the entire modeling process are crucial for a widespread clinical use of the OCT-based models and future in silico clinical trials.

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

Abstract: The average wall shear stress (WSS) (Cardiol J 2016; 23, 4: 365-373)

Cited by 30 publications

References 39 publications

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

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

The approach to coronary bifurcation treatment and its outcomes in Poland: The single center experience

Patient-Specific Modeling of Stented Coronary Arteries Reconstructed from Optical Coherence Tomography: Towards a Widespread Clinical Use of Fluid Dynamics Analyses

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