Document Detail


Mis-sizing of stent promotes intimal hyperplasia: impact of endothelial shear and intramural stress.
MedLine Citation:
PMID:  21926337     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Stent can cause flow disturbances on the endothelium and compliance mismatch and increased stress on the vessel wall. These effects can cause low wall shear stress (WSS), high wall shear stress gradient (WSSG), oscillatory shear index (OSI), and circumferential wall stress (CWS), which may promote neointimal hyperplasia (IH). The hypothesis is that stent-induced abnormal fluid and solid mechanics contribute to IH. To vary the range of WSS, WSSG, OSI, and CWS, we intentionally mismatched the size of stents to that of the vessel lumen. Stents were implanted in coronary arteries of 10 swine. Intravascular ultrasound (IVUS) was used to size the coronary arteries and stents. After 4 wk of stent implantation, IVUS was performed again to determine the extent of IH. In conjunction, computational models of actual stents, the artery, and non-Newtonian blood were created in a computer simulation to yield the distribution of WSS, WSSG, OSI, and CWS in the stented vessel wall. An inverse relation (R(2) = 0.59, P < 0.005) between WSS and IH was found based on a linear regression analysis. Linear relations between WSSG, OSI, and IH were observed (R(2) = 0.48 and 0.50, respectively, P < 0.005). A linear relation (R(2) = 0.58, P < 0.005) between CWS and IH was also found. More statistically significant linear relations between the ratio of CWS to WSS (CWS/WSS), the products CWS × WSSG and CWS × OSI, and IH were observed (R(2) = 0.67, 0.54, and 0.56, respectively, P < 0.005), suggesting that both fluid and solid mechanics influence the extent of IH. Stents create endothelial flow disturbances and intramural wall stress concentrations, which correlate with the extent of IH formation, and these effects were exaggerated with mismatch of stent/vessel size. These findings reveal the importance of reliable vessel and stent sizing to improve the mechanics on the vessel wall and minimize IH.
Authors:
Henry Y Chen; Anjan K Sinha; Jenny S Choy; Hai Zheng; Michael Sturek; Brian Bigelow; Deepak L Bhatt; Ghassan S Kassab
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2011-09-16
Journal Detail:
Title:  American journal of physiology. Heart and circulatory physiology     Volume:  301     ISSN:  1522-1539     ISO Abbreviation:  Am. J. Physiol. Heart Circ. Physiol.     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-12-06     Completed Date:  2012-01-23     Revised Date:  2013-06-27    
Medline Journal Info:
Nlm Unique ID:  100901228     Medline TA:  Am J Physiol Heart Circ Physiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  H2254-63     Citation Subset:  IM    
Affiliation:
Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA.
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MeSH Terms
Descriptor/Qualifier:
Angioplasty, Balloon, Coronary / adverse effects*,  instrumentation
Animals
Biomechanics
Cell Proliferation*
Computer Simulation
Coronary Circulation*
Coronary Restenosis / etiology*,  pathology,  physiopathology,  ultrasonography
Coronary Vessels / pathology*,  physiopathology,  ultrasonography
Endothelium, Vascular / pathology*,  physiopathology,  ultrasonography
Hyperplasia
Linear Models
Male
Metals
Models, Animal
Models, Cardiovascular
Prosthesis Design
Stents / adverse effects*
Stress, Mechanical
Swine
Ultrasonography, Interventional
Grant Support
ID/Acronym/Agency:
HL-062552/HL/NHLBI NIH HHS; HL-084529/HL/NHLBI NIH HHS; HL-087235/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Metals
Comments/Corrections

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


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