Impact of vessel curvature on neointimal healing after stent implantation as assessed by optical coherence tomography

Abstract

Purpose:Previous studies have indicated that stent implantation could alter the vessel geometry, which may impact the neointimal healing process. Curvature is an important parameter for evaluating vessel geometry. The purpose of our study was to investigate the relationship between vessel curvature and neointimal healing after stent implantation.Methods:Fifty-nine patients with acute coronary syndrome (ACS) who underwent stent implantation were enrolled in the study. According to the post-percutaneous coronary intervention vessel curvature measured by quantitative coronary angiography, patients were divided into high (n = 30) and low (n = 29) curvature groups. Neointimal thickness and area together with the neointimal type were assessed by optical coherence tomography at a 6-month follow-up.Results:Baseline clinical characteristics were comparable between the 2 groups. The vessel curvature at pre- and 6-month follow-up was significantly higher in the high curvature group than the low curvature group. At 6-month follow-up, neointimal thickness (0.22 [0.08–0.32] mm vs. 0.10 [0.07–0.16] mm, P = .043) and neointimal area (1.86 [0.66–2.66] vs. 0.82 [0.60–1.41] mm2, P = .030) were significantly higher in the high curvature group than the low curvature group. In the high curvature group, the incidence of the heterogeneous neointimal type was higher than that in the low curvature group (50.00% vs. 17.20%, respectively, P = .004), whereas the frequency of the homogeneous neointimal type was lower (43.30% vs. 82.80%, respectively, P = .004) in the high curvature group than the low curvature group.Conclusion:Higher vessel curvature after stent implantation may potentially have an impact on the neointimal healing with a higher incidence of heterogeneous neointimal.

Correlation between pre‐procedural plaque morphology and patterns of in‐stent neointimal hyperplasia at 1‐year follow‐up in patients treated with new‐generation drug‐eluting stents: An optical coherence tomography based analysis

“…A previous study has reported that irregular protrusion post DES implantation was associated with subsequent heterogeneous neointima at 8‐month follow‐up . Higher vessel curvature after stent implantation may also have an potential impact on the neointimal healing with a higher incidence of heterogeneous neointima . Recent evidences suggested that age, blood lipid level, PCI for ACS, history of cerebrovascular disease and time interval to OCT follow‐up were independent determinants for heterogeneous in‐stent proliferation .…”

Parent Artery Straightening after Flow-Diverter Stenting Improves the Odds of Aneurysm Occlusion

“…[7][8][9] Our study also suggests that this straightening phenomenon goes on after deployment, because follow-up angles were significantly superior to immediate postdeployment angles. 4 In addition to its effects on the incident angle of blood flow into the aneurysm sac, this straightening effect could improve aneurysm occlusion through other mechanisms: It might influence the wall apposition of the flow-diverter stents, 10 and it could also improve the "scaffolding" effect for reconstruction of the aneurysmal neck 11 and promote arterial remodeling in a more favorable geometric configuration. It is, nonetheless, hypothesized that despite the flow-diverting effect, flow-diverter stents inducing important parent artery straightening may, in part, correct the geometric configuration that was involved in aneurysm development in the first place.…”