Effects of Low Endothelial Shear Stress After Stent Implantation on Subsequent Neointimal Hyperplasia and Clinical Outcomes in Humans
Background In‐stent hyperplasia (ISH) may develop in regions of low endothelial shear stress (ESS), but the relationship between the magnitude of low ESS, the extent of ISH, and subsequent clinical events has not been investigated. Methods and Results We assessed the association of poststent ESS wit...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2016-09-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://doi.org/10.1161/JAHA.115.002949 |
| _version_ | 1818280061250306048 |
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| author | Koki Shishido Antonios P. Antoniadis Saeko Takahashi Masaya Tsuda Shingo Mizuno Ioannis Andreou Michail I. Papafaklis Ahmet U. Coskun Caroline O'Brien Charles L. Feldman Shigeru Saito Elazer R. Edelman Peter H. Stone |
| author_facet | Koki Shishido Antonios P. Antoniadis Saeko Takahashi Masaya Tsuda Shingo Mizuno Ioannis Andreou Michail I. Papafaklis Ahmet U. Coskun Caroline O'Brien Charles L. Feldman Shigeru Saito Elazer R. Edelman Peter H. Stone |
| author_sort | Koki Shishido |
| collection | DOAJ |
| description | Background In‐stent hyperplasia (ISH) may develop in regions of low endothelial shear stress (ESS), but the relationship between the magnitude of low ESS, the extent of ISH, and subsequent clinical events has not been investigated. Methods and Results We assessed the association of poststent ESS with neointimal ISH and clinical outcomes in patients treated with percutaneous coronary interventions (PCI). Three‐dimensional coronary reconstruction was performed in 374 post‐PCI patients at baseline and 6 to 10 months follow‐up as part of the PREDICTION Study. Each vessel was divided into 1.5‐mm‐long segments, and we calculated the local ESS within each stented segment at baseline. At follow‐up, we assessed ISH and the occurrence of a clinically indicated repeat PCI for in‐stent restenosis. In 246 total stents (54 overlapping), 100 (40.7%) were bare‐metal stents (BMS), 104 (42.3%) sirolimus‐eluting stents, and 42 (17.1%) paclitaxel‐eluting stents. In BMS, low ESS post‐PCI at baseline was independently associated with ISH (β=1.47 mm2 per 1‐Pa decrease; 95% CI, 0.38–2.56; P<0.01). ISH was minimal in drug‐eluting stents. During follow‐up, repeat PCI in BMS was performed in 21 stents (8.5%). There was no significant association between post‐PCI ESS and in‐stent restenosis requiring PCI. Conclusions Low ESS after BMS implantation is associated with subsequent ISH. ISH is strongly inhibited by drug‐eluting stents. Post‐PCI ESS is not associated with in‐stent restenosis requiring repeat PCI. ESS is an important determinant of ISH in BMS, but ISH of large magnitude to require PCI for in‐stent restenosis is likely attributed to factors other than ESS within the stent. |
| first_indexed | 2024-12-12T23:43:14Z |
| format | Article |
| id | doaj.art-e1cfd37358124d448ccea2ba54deccb5 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-12T23:43:14Z |
| publishDate | 2016-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-e1cfd37358124d448ccea2ba54deccb52022-12-22T00:07:03ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802016-09-0159n/an/a10.1161/JAHA.115.002949Effects of Low Endothelial Shear Stress After Stent Implantation on Subsequent Neointimal Hyperplasia and Clinical Outcomes in HumansKoki Shishido0Antonios P. Antoniadis1Saeko Takahashi2Masaya Tsuda3Shingo Mizuno4Ioannis Andreou5Michail I. Papafaklis6Ahmet U. Coskun7Caroline O'Brien8Charles L. Feldman9Shigeru Saito10Elazer R. Edelman11Peter H. Stone12Cardiovascular Division Brigham and Women's Hospital Harvard Medical School Boston MACardiovascular Division Brigham and Women's Hospital Harvard Medical School Boston MADepartment of Cardiology Shonan Kamakura General Hospital Kamakura JapanHakodate Municipal Hospital Hakodate JapanDepartment of Cardiology Shonan Kamakura General Hospital Kamakura JapanCardiovascular Division Brigham and Women's Hospital Harvard Medical School Boston MACardiovascular Division Brigham and Women's Hospital Harvard Medical School Boston MAMechanical and Industrial Engineering Northeastern University Boston MAInstitute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MACardiovascular Division Brigham and Women's Hospital Harvard Medical School Boston MADepartment of Cardiology Shonan Kamakura General Hospital Kamakura JapanCardiovascular Division Brigham and Women's Hospital Harvard Medical School Boston MACardiovascular Division Brigham and Women's Hospital Harvard Medical School Boston MABackground In‐stent hyperplasia (ISH) may develop in regions of low endothelial shear stress (ESS), but the relationship between the magnitude of low ESS, the extent of ISH, and subsequent clinical events has not been investigated. Methods and Results We assessed the association of poststent ESS with neointimal ISH and clinical outcomes in patients treated with percutaneous coronary interventions (PCI). Three‐dimensional coronary reconstruction was performed in 374 post‐PCI patients at baseline and 6 to 10 months follow‐up as part of the PREDICTION Study. Each vessel was divided into 1.5‐mm‐long segments, and we calculated the local ESS within each stented segment at baseline. At follow‐up, we assessed ISH and the occurrence of a clinically indicated repeat PCI for in‐stent restenosis. In 246 total stents (54 overlapping), 100 (40.7%) were bare‐metal stents (BMS), 104 (42.3%) sirolimus‐eluting stents, and 42 (17.1%) paclitaxel‐eluting stents. In BMS, low ESS post‐PCI at baseline was independently associated with ISH (β=1.47 mm2 per 1‐Pa decrease; 95% CI, 0.38–2.56; P<0.01). ISH was minimal in drug‐eluting stents. During follow‐up, repeat PCI in BMS was performed in 21 stents (8.5%). There was no significant association between post‐PCI ESS and in‐stent restenosis requiring PCI. Conclusions Low ESS after BMS implantation is associated with subsequent ISH. ISH is strongly inhibited by drug‐eluting stents. Post‐PCI ESS is not associated with in‐stent restenosis requiring repeat PCI. ESS is an important determinant of ISH in BMS, but ISH of large magnitude to require PCI for in‐stent restenosis is likely attributed to factors other than ESS within the stent.https://doi.org/10.1161/JAHA.115.002949imagingin‐stent restenosisneointimal hyperplasiapercutaneous coronary interventionshear stress |
| spellingShingle | Koki Shishido Antonios P. Antoniadis Saeko Takahashi Masaya Tsuda Shingo Mizuno Ioannis Andreou Michail I. Papafaklis Ahmet U. Coskun Caroline O'Brien Charles L. Feldman Shigeru Saito Elazer R. Edelman Peter H. Stone Effects of Low Endothelial Shear Stress After Stent Implantation on Subsequent Neointimal Hyperplasia and Clinical Outcomes in Humans Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease imaging in‐stent restenosis neointimal hyperplasia percutaneous coronary intervention shear stress |
| title | Effects of Low Endothelial Shear Stress After Stent Implantation on Subsequent Neointimal Hyperplasia and Clinical Outcomes in Humans |
| title_full | Effects of Low Endothelial Shear Stress After Stent Implantation on Subsequent Neointimal Hyperplasia and Clinical Outcomes in Humans |
| title_fullStr | Effects of Low Endothelial Shear Stress After Stent Implantation on Subsequent Neointimal Hyperplasia and Clinical Outcomes in Humans |
| title_full_unstemmed | Effects of Low Endothelial Shear Stress After Stent Implantation on Subsequent Neointimal Hyperplasia and Clinical Outcomes in Humans |
| title_short | Effects of Low Endothelial Shear Stress After Stent Implantation on Subsequent Neointimal Hyperplasia and Clinical Outcomes in Humans |
| title_sort | effects of low endothelial shear stress after stent implantation on subsequent neointimal hyperplasia and clinical outcomes in humans |
| topic | imaging in‐stent restenosis neointimal hyperplasia percutaneous coronary intervention shear stress |
| url | https://doi.org/10.1161/JAHA.115.002949 |
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