Abstract
Background
Endothelial shear stress (ESS) may play a key role in the pathobiology of stent restenosis (SR). Nevertheless, limited data are available about ESS and its relation to SR.
Patients and methods
We enrolled 14 patients who underwent successful percutaneous coronary intervention (PCI) in this study. Three-dimensional (3D) reconstruction of 14 coronary arteries before and after stent implantation was performed. Using computational fluid dynamics, mean ESS was calculated proximally, in tertiles within and distal to the stent, both before and after stent implantation.
Results
Stent implantation resulted in a significant ESS decrease in the entire atherosclerotic lesion (1.83 vs. 1.26 Pa, p = 0.02). Regarding the five territories in which the entire lesion was divided, ESS decrease was marginally significant in the area of the second in-stent tertile, and in the area 5 mm distal to the stent, whereas ESS decrease was not significant in the area 5 mm proximal to the stent, and in the area of the first and third in-stent tertile. At 12 months, two patients had SR, but restenosis was not related to ESS decrease.
Conclusion
ESS decreases after stent implantation but not uniformly, with the major reduction being in the middle tertile of the stent, and distal to the stent. In-stent ESS decrease may create local hemodynamic conditions leading to in-stent and in-segment restenosis.
Zusammenfassung
Hintergrund
Die Scherbelastung des Endothels („endothelial shear stress“, ESS) kann eine wichtige Rolle in der Pathobiologie der Stent-Restenosen (SR) spielen. Dennoch sind die vorliegenden Daten über die ESS und ihren Zusammenhang mit SR begrenzt.
Patienten und Methoden
Die Autoren rekrutierten 14 Patienten nach einer erfolgreichen perkutanen koronaren Intervention (PCI). Vor und nach der Stentimplantation wurde eine 3‑D-Rekonstruktion von 14 Koronararterien durchgeführt. Mit numerischer Strömungsdynamik wurde die mittlere ESS vor und nach der Stentimplantation wie folgt berechnet: proximal, in Terzilen innerhalb und distal des Stents.
Ergebnisse
Die Stentimplantation führte zu einer signifikanten ESS-Abnahme in der gesamten atherosklerotischen Läsion (1,83 vs. 1,26 Pa, p = 0,02). Hinsichtlich der 5 Bereiche, in welche die Gesamtläsion geteilt wurde, war die ESS-Abnahme marginal signifikant im Bereich des 2. Terzils innerhalb des Stents und im Bereich 5 mm distal des Stents; im Gegensatz dazu war die ESS-Abnahme nicht signifikant im Bereich 5 mm proximal des Stents und in den Bereichen des 1. und 3. Terzils innerhalb des Stents. Zwölf Monate später kam eine SR bei 2 Patienten vor; die Restenose war jedoch nicht mit einer ESS-Abnahme assoziiert.
Schlussfolgerung
Die ESS nimmt nach der Stentimplantation ab, nicht jedoch einheitlich, mit der höchsten Abnahme im mittleren Terzil und distal des Stents. Die ESS-Abnahme innerhalb des Stents kann lokale hämodynamische Bedingungen erzeugen, die zu Restenosen innerhalb des Stents und innerhalb von Segmenten führen können.
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Acknowledgements
The authors would like to thank Alexandros Androutsos for the support given on the study’s completion.
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F. Economou , S. Katranas, G. Giannoglou, K. Gemitzis, I. Styliadis, G. Efthimiadis, H. Karvounis, and A. Ziakas state that they have no competing interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
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Economou, F., Katranas, S., Giannoglou, G. et al. Impact of stent implantation on endothelial shear stress. Herz 42, 505–508 (2017). https://doi.org/10.1007/s00059-016-4487-4
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DOI: https://doi.org/10.1007/s00059-016-4487-4
Keywords
- Coronary artery disease
- Percutaneous coronary intervention
- Drug-eluting stents
- Stent restenosis
- Endothelial shear stress