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 w...
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| Format: | Article |
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Ovid Technologies (Wolters Kluwer Health)
2017
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| Online Access: | http://hdl.handle.net/1721.1/112765 https://orcid.org/0000-0002-2890-2319 https://orcid.org/0000-0002-7832-7156 |
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| author | Shishido, Koki Antoniadis, Antonios P. Takahashi, Saeko Tsuda, Masaya Mizuno, Shingo Andreou, Ioannis Papafaklis, Michail I. Coskun, Ahmet U. Feldman, Charles L. Saito, Shigeru Stone, Peter H. O'Brien, Caroline C. Edelman, Elazer R |
| author2 | Institute for Medical Engineering and Science |
| author_facet | Institute for Medical Engineering and Science Shishido, Koki Antoniadis, Antonios P. Takahashi, Saeko Tsuda, Masaya Mizuno, Shingo Andreou, Ioannis Papafaklis, Michail I. Coskun, Ahmet U. Feldman, Charles L. Saito, Shigeru Stone, Peter H. O'Brien, Caroline C. Edelman, Elazer R |
| author_sort | Shishido, Koki |
| collection | MIT |
| 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 mm 2 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 | 2024-09-23T12:42:12Z |
| format | Article |
| id | mit-1721.1/112765 |
| institution | Massachusetts Institute of Technology |
| last_indexed | 2024-09-23T12:42:12Z |
| publishDate | 2017 |
| publisher | Ovid Technologies (Wolters Kluwer Health) |
| record_format | dspace |
| spelling | mit-1721.1/1127652022-09-28T09:32:33Z Effects of Low Endothelial Shear Stress After Stent Implantation on Subsequent Neointimal Hyperplasia and Clinical Outcomes in Humans Shishido, Koki Antoniadis, Antonios P. Takahashi, Saeko Tsuda, Masaya Mizuno, Shingo Andreou, Ioannis Papafaklis, Michail I. Coskun, Ahmet U. Feldman, Charles L. Saito, Shigeru Stone, Peter H. O'Brien, Caroline C. Edelman, Elazer R Institute for Medical Engineering and Science Harvard University--MIT Division of Health Sciences and Technology O'Brien, Caroline C. Edelman, Elazer R 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 mm 2 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. Hellenic Cardiological Society Schaubert Family George D. Behrakis Cardiovascular Research Fellowship 2017-12-14T20:19:10Z 2017-12-14T20:19:10Z 2016-09 2016-01 2017-12-14T18:56:14Z Article http://purl.org/eprint/type/JournalArticle 2047-9980 2047-9980 http://hdl.handle.net/1721.1/112765 Shishido, Koki, et al. “Effects of Low Endothelial Shear Stress After Stent Implantation on Subsequent Neointimal Hyperplasia and Clinical Outcomes in Humans.” Journal of the American Heart Association, vol. 5, no. 9, Sept. 2016, p. e002949. https://orcid.org/0000-0002-2890-2319 https://orcid.org/0000-0002-7832-7156 http://dx.doi.org/10.1161/JAHA.115.002949 Journal of the American Heart Association Creative Commons Attribution-NonCommercial 4.0 International http://creativecommons.org/licenses/by-nc/4.0/ application/pdf Ovid Technologies (Wolters Kluwer Health) American Heart Association |
| spellingShingle | Shishido, Koki Antoniadis, Antonios P. Takahashi, Saeko Tsuda, Masaya Mizuno, Shingo Andreou, Ioannis Papafaklis, Michail I. Coskun, Ahmet U. Feldman, Charles L. Saito, Shigeru Stone, Peter H. O'Brien, Caroline C. Edelman, Elazer R Effects of Low Endothelial Shear Stress After Stent Implantation on Subsequent Neointimal Hyperplasia and Clinical Outcomes in Humans |
| 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 |
| url | http://hdl.handle.net/1721.1/112765 https://orcid.org/0000-0002-2890-2319 https://orcid.org/0000-0002-7832-7156 |
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