Relationship Between Neointimal Thickness and Shear Stress After Wallstent Implantation in Human Coronary Arteries

Wentzel, Jolanda J.; Krams, Rob; Schuurbiers, Johan C.H.; Oomen, Jan A.; Kloet, Jeroen; Giessen, Willem J. van der; Serruys, Patrick W.; Slager, Cornelis J.

doi:10.1161/01.cir.103.13.1740

Cited by 300 publications

(236 citation statements)

References 36 publications

(36 reference statements)

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“…5,6 The poststent FFR detects a residual pressure gradient across the stented and adjacent segments that can play an important role in restenosis. 8,14 Although the validation of FFR for the purpose of the assessment of optimal bare metal stent deployment was reported, 5,8 to our knowledge, few reports on its use in the context of DESs have been published. In the present study, several intuitive findings were observed according to the FFR range after stent implantation.…”

Section: Discussionmentioning

confidence: 99%

Relation of Fractional Flow Reserve After Drug-Eluting Stent Implantation to One-Year Outcomes

Nam

Hur

Cho

et al. 2011

The American Journal of Cardiology

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Section: Discussionmentioning

confidence: 99%

Relation of Fractional Flow Reserve After Drug-Eluting Stent Implantation to One-Year Outcomes

Nam

Hur

Cho

et al. 2011

The American Journal of Cardiology

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“…Following coronary stent deployment, sites of aggressive neointimal hyperplasia also correspond to sites subjected to non-physiological flow conditions, and this has been attributed to increased endothelial dysfunction and permeability. 6,17,18,20,21,52,71,79,88 The hemodynamic impact of the investigated stents was evaluated in terms of the relative residence time distribution predicted upon the lumen surface during the third cardiac cycle. The RRT accounts for temporal variations in both the magnitude and the orientation of the instantaneous wall shear stress vector and is calculated as follows:…”

Section: Analysis Of Balloon-expandable Coronary Stentsmentioning

confidence: 99%

“…6,17,18,20,21,52,71,79,88 In light of these observations, a significant body of research has been carried out in this area. Due to the difficulty involved in the evaluation of these phenomena in an in vivo setting however, a large portion of this research has been carried out using computational methods of analysis.…”

Section: Introductionmentioning

confidence: 99%

Sequential Structural and Fluid Dynamics Analysis of Balloon-Expandable Coronary Stents: A Multivariable Statistical Analysis

Martín¹,

Boyle²

2015

Cardiovasc Eng Tech

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Abstract-Several clinical studies have identified a strong correlation between neointimal hyperplasia following coronary stent deployment and both stent-induced arterial injury and altered vessel hemodynamics. As such, the sequential structural and fluid dynamics analysis of balloon-expandable stent deployment should provide a comprehensive indication of stent performance. Despite this observation, very few numerical studies of balloon-expandable coronary stents have considered both the mechanical and hemodynamic impact of stent deployment. Furthermore, in the few studies that have considered both phenomena, only a small number of stents have been considered. In this study, a sequential structural and fluid dynamics analysis methodology was employed to compare both the mechanical and hemodynamic impact of six balloon-expandable coronary stents. To investigate the relationship between stent design and performance, several common stent design properties were then identified and the dependence between these properties and both the mechanical and hemodynamic variables of interest was evaluated using statistical measures of correlation. Following the completion of the numerical analyses, stent strut thickness was identified as the only common design property that demonstrated a strong dependence with either the mean equivalent stress predicted in the artery wall or the mean relative residence time predicted on the luminal surface of the artery. These results corroborate the findings of the large-scale ISAR-STEREO clinical studies and highlight the crucial role of strut thickness in coronary stent design. The sequential structural and fluid dynamics analysis methodology and the multivariable statistical treatment of the results described in this study should prove useful in the design of future balloon-expandable coronary stents.

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“…2 In addition to conventional risk factors for stent restenosis, the restored level of blood flow seems to be a crucial factor in the development of neointimal hyperplasia (NH). 3 It has been postulated that wall shear stress (WSS) is an important causative factor. Indeed, other studies 4 have demonstrated that low WSS is associated with and even predicts NH in either bypass graft or stents.…”

mentioning

confidence: 99%

Augmentation of Wall Shear Stress Inhibits Neointimal Hyperplasia After Stent Implantation

Carlier¹,

Damme²,

Blommerde³

et al. 2003

Circulation

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Background-Low wall shear stress (WSS) increases neointimal hyperplasia (NH) in vein grafts and stents. We studied the causal relationship between WSS and NH formation in stents by locally increasing WSS with a flow divider (Anti-Restenotic Diffuser, Endoart SA) placed in the center of the stent. Methods and Results-In 9 rabbits fed a high-cholesterol diet for 2 months to induce endothelial dysfunction, 18 stents were implanted in the right and left external iliac arteries (1 stent per vessel). Lumen diameters were measured by quantitative angiography before and after implantation and at 4-week follow-up, at which time, macrophage accumulation and interruption of the internal elastic lamina was determined. Cross sections of stent segments within the ARED (SϩARED), outside the ARED (S[minus]ARED), and in corresponding segments of the contralateral control stent (SCTRL) were analyzed. Changes in WSS induced by the ARED placement were derived by computational fluid dynamics. Computational fluid dynamics analysis demonstrated that WSS increased from 0.38 to 0.82 N/m 2 in the SϩARED immediately after ARED placement. This augmentation of shear stress was accompanied by (1) ARED, and SCTRL), and (3) a reduced inflammation score and a reduced injury score. Increments in shear stress did not change the relationship between injury score and NH or between inflammation score and NH. Conclusions-The newly developed ARED flow divider significantly increases WSS, and this local increment in WSS isaccompanied by a local reduction in NH and a local reduction in inflammation and injury. The present study is therefore the first to provide direct evidence for an important modulating role of shear stress in in-stent neointimal hyperplasia. Key Words: shear stress Ⅲ restenosis Ⅲ stents Ⅲ cells Ⅲ inflammation A lthough stents are responsible for a clear reduction in the restenosis rate, 1 stents exacerbate the normal proliferative reaction because of a variety of factors related to stent design. 2 In addition to conventional risk factors for stent restenosis, the restored level of blood flow seems to be a crucial factor in the development of neointimal hyperplasia (NH). 3 It has been postulated that wall shear stress (WSS) is an important causative factor. Indeed, other studies 4 have demonstrated that low WSS is associated with and even predicts NH in either bypass graft or stents. However, these earlier studies could not exclude the possibility that other factors in addition to WSS explained the observations. This hypothesis is not unrealistic, because it is known that the strain and lipid distribution are different in inner and outer curves of blood vessels. 5,6 In view of the above-mentioned arguments, we devised an experiment to evaluate the role of shear stress on NH with a more direct approach. To that end, we induced a local augmentation in WSS with a new device, the AntiRestenotic Diffuser (ARED) flow divider (Figure 1; European patent number EP0989830), which is positioned in 1 of the 2 stents placed at similar locations in...

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Relationship Between Neointimal Thickness and Shear Stress After Wallstent Implantation in Human Coronary Arteries

Cited by 300 publications

References 36 publications

Relation of Fractional Flow Reserve After Drug-Eluting Stent Implantation to One-Year Outcomes

Relation of Fractional Flow Reserve After Drug-Eluting Stent Implantation to One-Year Outcomes

Sequential Structural and Fluid Dynamics Analysis of Balloon-Expandable Coronary Stents: A Multivariable Statistical Analysis

Augmentation of Wall Shear Stress Inhibits Neointimal Hyperplasia After Stent Implantation

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