| Mis-Sizing of Stent Promotes Intimal Hyperplasia: Impact of Endothelial Shear and Intramural Stress. | |
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MedLine Citation:
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PMID: 21926337 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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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 vessel lumen. Stents were implanted in coronary arteries of ten swine. Intravascular ultrasound (IVUS) was used to size the coronary arteries and stents. After four weeks of stent implant, IVUS was performed again to determine the extent of IH. In conjunction, computational models of actual stents, 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 and OSI, and IH were observed (R(2) = 0.48 and 0.50 respectively, P < 0.005). A linear relation (R2 = 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), products CWS*WSSG, 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. |
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Authors:
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Henry Y Chen; Anjan K Sinha; Jenny S Choy; Hai Zheng; Michael Sturek; Brian Bigelow; Deepak Bhatt; Ghassan S Kassab |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-9-16 |
Journal Detail:
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Title: American journal of physiology. Heart and circulatory physiology Volume: - ISSN: 1522-1539 ISO Abbreviation: - Publication Date: 2011 Sep |
Date Detail:
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Created Date: 2011-9-19 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100901228 Medline TA: Am J Physiol Heart Circ Physiol Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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1Purdue University. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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