Document Detail

Effect of endothelial shear stress on the progression of coronary artery disease, vascular remodeling, and in-stent restenosis in humans: in vivo 6-month follow-up study.
MedLine Citation:
PMID:  12860915     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Native atherosclerosis and in-stent restenosis are focal and evolve independently. The endothelium controls local arterial responses by transduction of shear stress. Characterization of endothelial shear stress (ESS) may allow for prediction of progression of atherosclerosis and in-stent restenosis. METHODS AND RESULTS: By using intracoronary ultrasound, biplane coronary angiography, and measurement of coronary blood flow, we represented the artery in accurate 3D space and determined detailed characteristics of ESS and arterial wall/plaque morphology. Patients who underwent stent implantation and who had another artery with luminal obstruction <50% underwent intravascular profiling initially and after 6-month follow-up. Twelve arteries in 8 patients were studied: 6 native and 6 stented arteries. In native arteries, regions of abnormally low baseline ESS exhibited a significant increase in plaque thickness and enlargement of the outer vessel wall, such that lumen radius remained unchanged (outward remodeling). Regions of physiological ESS showed little change. Regions with increased ESS exhibited outward remodeling with normalization of ESS. In stented arteries, there was an increase in intima-medial thickness, a decrease in lumen radius, and an increase in ESS at all levels of baseline ESS. CONCLUSIONS: The present study represents the first experience in humans relating ESS to subsequent outcomes in native and stented arteries. Regions of low ESS develop progressive atherosclerosis and outward remodeling, areas of physiological ESS remain quiescent, and areas of increased ESS exhibit outward remodeling. ESS may have a limited role in in-stent restenosis. This technology can predict areas of minor plaque likely to exhibit progression of atherosclerosis.
Peter H Stone; Ahmet U Coskun; Scott Kinlay; Maureen E Clark; Milan Sonka; Andreas Wahle; Olusegun J Ilegbusi; Yerem Yeghiazarians; Jeffrey J Popma; John Orav; Richard E Kuntz; Charles L Feldman
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, U.S. Gov't, P.H.S.     Date:  2003-07-14
Journal Detail:
Title:  Circulation     Volume:  108     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2003 Jul 
Date Detail:
Created Date:  2003-07-29     Completed Date:  2003-09-09     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  438-44     Citation Subset:  AIM; IM    
Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, Mass 02115, USA.
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MeSH Terms
Aged, 80 and over
Blood Flow Velocity
Blood Vessel Prosthesis Implantation / adverse effects
Coronary Angiography
Coronary Artery Disease / diagnosis,  physiopathology*,  surgery
Coronary Circulation
Coronary Restenosis / diagnosis,  etiology,  physiopathology*
Coronary Vessels / surgery,  ultrasonography
Disease Progression
Endothelium, Vascular / physiopathology*
Feasibility Studies
Follow-Up Studies
Imaging, Three-Dimensional
Middle Aged
Pilot Projects
Stents* / adverse effects
Stress, Mechanical
Treatment Outcome
Ultrasonography, Interventional
Vascular Patency
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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