Temporal Correlation between Wall Shear Stress and In-Stent Stenosis after Wingspan Stent in Swine Model

Fujimoto, Motoaki; Takao, Hiroyuki; Suzuki, Takashi; Shobayashi, Yasuhiro; Mayor, Fernando; Tateshima, Satoshi; Yamamoto, Makoto; Murayama, Yuichi; Viñuela, Fernando

doi:10.3174/ajnr.a3773

Cited by 5 publications

(5 citation statements)

References 33 publications

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“…Such a vascular profile can be individualized and is a promising method for stratifying stroke risk and facilitating prophylactic treatment for intracranial atherosclerotic disease. Furthermore, an in vitro animal study showed a close correlation between low WSS and intracranial in-stent stenosis growth [29] . As a local hemodynamic factor, a normal or relatively high level of WSS maintenance may be helpful in reducing the risk of in-stent stenosis.…”

Section: Discussionmentioning

confidence: 92%

Non-invasive assessment of intracranial wall shear stress using high-resolution magnetic resonance imaging in combination with computational fluid dynamics technique

Chen

Liu

et al. 2022

Fundamental Research

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Section: Discussionmentioning

confidence: 92%

Non-invasive assessment of intracranial wall shear stress using high-resolution magnetic resonance imaging in combination with computational fluid dynamics technique

Chen

Liu

et al. 2022

Fundamental Research

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“…Our study found that poor collateral circulation, evaluated by cerebral angiography, was an independent risk factor for ISR after CAS. We speculate that the related mechanisms may be the following: first, the vascular wall shear stress dramatically declines in patients with poor collateral circulation after stenting, which increases the expression of pro-inflammatory genes and leads to intimal hyperplasia ( 24 ); second, patients with poor collateral circulation have a greater change in blood flow at the stenosis after stenting, which could further stimulate the vascular endothelial cell proliferation ( 46 ). Therefore, we consider that evaluating collateral circulation may help to predict the risk of ISR after CAS.…”

Section: Discussionmentioning

confidence: 99%

Cerebral collateral circulation as an independent predictor for in-stent restenosis after carotid artery stenting

Liu¹,

Su²,

Zhang³

et al. 2023

Quant Imaging Med Surg

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Background In-stent restenosis is a crucial problem after carotid artery stenting, but the exact predictors of in-stent restenosis remain unclear. We aimed to evaluate the effect of cerebral collateral circulation on in-stent restenosis after carotid artery stenting and to establish a clinical prediction model for in-stent restenosis. Methods This retrospective case-control study enrolled 296 patients with severe carotid artery stenosis of C1 segment (≥70%) who underwent stent therapy from June 2015 to December 2018. Based on follow-up data, the patients were divided into the in-stent restenosis and no in-stent restenosis groups. The collateral circulation of the brain was graded according to the criteria of the American Society for Interventional and Therapy Neuroradiology/Society for Interventional Radiology (ASITN/SIR). Clinical data were collected, such as age, sex, traditional vascular risk factors, blood cell count, high-sensitivity C-reactive protein, uric acid, stenosis degree before stenting and residual stenosis rate, and medication after stenting. Binary logistic regression analysis was performed to identify potential predictors of in-stent restenosis, and a clinical prediction model for in-stent restenosis after carotid artery stenting was established. Results Binary logistic regression analysis showed that poor collateral circulation was an independent predictor of in-stent restenosis (P=0.003). We also found that a 1% increase in residual stenosis rate was associated with a 9% increase in the risk of in-stent restenosis (P=0.02). Ischemic stroke history (P=0.03), family history of ischemic stroke (P<0.001), in-stent restenosis history (P<0.001), and nonstandard medication after stenting (P=0.04) were predictors of in-stent restenosis. The risk of in-stent restenosis was lowest when the residual stenosis rate was 12.5% after carotid artery stenting. Furthermore, we used some significant parameters to construct a binary logistic regression prediction model for in-stent restenosis after carotid artery stenting in the form of a nomogram. Conclusions Collateral circulation is an independent predictor of in-stent restenosis after successful carotid artery stenting, and the residual stenosis rate tends to be below 12.5% to reduce restenosis risk. The standard medication should be strictly carried out for patients after stenting to prevent in-stent restenosis.

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“…The mechanisms, we consider, may be due to the following reasons: rst, after stenting the vascular wall shear stress dramatic decline in poor collateral circulation patients, which increases the expression of proin ammatory genes and leads to intimal hyperplasia 22 . Second, the patients with poor collateral circulation after stenting have a greater change in blood ow in-stent sites, which leads to the activation of vascular endothelial cells, the releases of in ammatory cytokines, and remodelling of the blood vessels 31 . Third, the patients with poor collateral circulation have higher vasoconstrictor peptide, which may increase vasoconstrictor force and promote restenosis 14 .…”

Section: Discussionmentioning

confidence: 99%

Collateral circulation is a predictor for in-stent restenosis after cerebral anterior circulation large artery stenting

Liu

et al. 2021

Preprint

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Background- In-stent restenosis (ISR) is a critical issue of endovascular therapy. The predictors for ISR are not fully explored. We aimed to investigate the predictors for ISR, especially the effect of collateral circulation on ISR after cerebral large artery stenting. Methods- From June, 2015 to June, 2018, a total of 312 patients, who performed stenting, with severe cerebral anterior circulation stenosis (≥ 70%), were enrolled. According to the flow velocity indicated by carotid artery ultrasound or Transcranial Doppler, the patients were divided into the ISR and no-ISR groups. Clinical data were collected, including age, sex, cerebrovascular risk factors, preoperative serum lipid, inflammatory markers, and platelet count, stent site, residual stenosis rate, drug therapy after stenting. The collateral circulation was graded according to digital subtraction angiography (DSA). Univariable and multivariable logistic regression analyses were performed to assess the potential risk factors related to restenosis in such patients. Results- Higher residual stenosis rate (median 11% vs 10%, p = 0.040), fewer patients received standard drug therapy ( 73.3% vs 89.4%, p = 0.001), more patients with poor collateral circulation (70.0% vs 41.0%, p = 0.007) were found in ISR group. Residual stenosis rate increased by 10% was associated with a 19.1% increase in restenosis risk. Good collateral circulation (OR 0.16, [95%CI, 0.04–0.49]; p = 0.002) and receiving standard drug therapy (OR 0.14, [95%CI, 0.05–0.58]; p = 0.002) were significantly related to the lower risk of ISR. Conclusion- Collateral circulation is an independent factor related with ISR after successful cerebral anterior circulation large artery stenting, and long-term standard drug therapy after stenting should be strictly carried out in such patients.

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Temporal Correlation between Wall Shear Stress and In-Stent Stenosis after Wingspan Stent in Swine Model

Cited by 5 publications

References 33 publications

Non-invasive assessment of intracranial wall shear stress using high-resolution magnetic resonance imaging in combination with computational fluid dynamics technique

Non-invasive assessment of intracranial wall shear stress using high-resolution magnetic resonance imaging in combination with computational fluid dynamics technique

Cerebral collateral circulation as an independent predictor for in-stent restenosis after carotid artery stenting

Collateral circulation is a predictor for in-stent restenosis after cerebral anterior circulation large artery stenting

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