Certain lesion characteristics on angiography, such as length and ostial location, can predict adverse outcomes. The indication for CAS should be carefully evaluated in these cases.

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Objective-Angiogenesis plays a key role in the growth and function of normal and pathological tissues. We investigated the effect of pulsatile flow on endothelial cell (EC) in vitro angiogenic activity. Methods and Results-Bovine aortic ECs were exposed to "static" or "flow" (1.2 to 67.0 mL/min, shear stress 1.4 to 19.2 dyne/cm 2 ) conditions for 2 to 24 hours. After exposure, angiogenesis was measured as tubule formation on Matrigel, and EC migration was assessed by filter migration assay. Pulsatile flow increased angiogenesis and EC migration in a temporal and force-dependent manner, with a maximal effect at 16 hours (13.2 dyne/cm 2 ). Pertussis toxin completely inhibited the effect of pulsatile flow on angiogenesis and migration. Transfection of ECs with inhibitory mutants of the ␣ subunit of G i 1 or G i 3, but not G i 2, inhibited the flow-induced angiogenic response by 61Ϯ2% and 32Ϯ6%, respectively, whereas transfection with constitutively activated mutants of the ␣ subunit of G i 1 or G i 3, but not G i 2, increased the flow-induced response by 202Ϯ23% and 70Ϯ4%, respectively. In contrast, inhibition of G␤␥ by the carboxy terminal fragment of ␤-adrenergic receptor kinase overexpression increased the flow-induced response by 82Ϯ8%. Conclusions-These results suggest that pulsatile flow stimulates angiogenesis and that this effect is mediated by activation of G i␣ 1 or G i␣ 3, but not G␤␥, subunits.

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