1
|
Pleouras DS, Karanasiou GS, Loukas VS, Semertzioglou A, Moulas AN, Fotiadis DI. Investigation of the drug release time from the biodegrading coating of an everolimus eluting stent. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:1698-1701. [PMID: 34891613 DOI: 10.1109/embc46164.2021.9629813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This case-study examines the release time of the everolimus drug from an experimental biodegrading coating of a Rontis corp. drug eluting stent (DES). The controlled drug release is achieved by the degradation of the coating, which consists of a mixture of polylactic co-glycolic acid (PLGA) and everolimus (55:45). In our analysis, we used the outcome of another study, which contains the geometry of an in-silico deployed Rontis corp. stent in a 3D reconstructed coney arterial segment. Using this geometry as input, the everolimus release was simulated using a computational model that includes: i) modeling of the blood flow dynamics, ii) modeling of PLGA degradation, and iii) modeling of the everolimus advection and diffusion towards both the lumen and the arterial wall. The results show the rapid release of everolimus. This is justified due to the high porosity of the coating, which is caused by the initial high concentration of everolimus in the coating.Clinical Relevance - The methodology presented in this work is an additional step towards predicting accurately drug release from DES. Also, the results of our work prove that high drug concentration in the coating causes its rapid release, which could be used as input in the design of new DES.
Collapse
|
2
|
Pan C, Han Y, Lu J. Structural Design of Vascular Stents: A Review. MICROMACHINES 2021; 12:mi12070770. [PMID: 34210099 PMCID: PMC8305143 DOI: 10.3390/mi12070770] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/16/2021] [Accepted: 06/24/2021] [Indexed: 11/18/2022]
Abstract
Percutaneous Coronary Intervention (PCI) is currently the most conventional and effective method for clinically treating cardiovascular diseases such as atherosclerosis. Stent implantation, as one of the ways of PCI in the treatment of coronary artery diseases, has become a hot spot in scientific research with more and more patients suffering from cardiovascular diseases. However, vascular stent implanted into vessels of patients often causes complications such as In-Stent Restenosis (ISR). The vascular stent is one of the sophisticated medical devices, a reasonable structure of stent can effectively reduce the complications. In this paper, we introduce the evolution, performance evaluation standards, delivery and deployment, and manufacturing methods of vascular stents. Based on a large number of literature pieces, this paper focuses on designing structures of vascular stents in terms of “bridge (or link)” type, representative volume unit (RVE)/representative unit cell (RUC), and patient-specific stent. Finally, this paper gives an outlook on the future development of designing vascular stents.
Collapse
Affiliation(s)
- Chen Pan
- School of Mechanical Engineering, Beijing Institute of Technology, Zhongguancun South Street No. 5, Haidian District, Beijing 100081, China; (C.P.); (J.L.)
- Institute of Engineering Medicine, Beijing Institute of Technology, Zhongguancun South Street No. 5, Haidian District, Beijing 100081, China
| | - Yafeng Han
- School of Mechanical Engineering, Beijing Institute of Technology, Zhongguancun South Street No. 5, Haidian District, Beijing 100081, China; (C.P.); (J.L.)
- Correspondence:
| | - Jiping Lu
- School of Mechanical Engineering, Beijing Institute of Technology, Zhongguancun South Street No. 5, Haidian District, Beijing 100081, China; (C.P.); (J.L.)
| |
Collapse
|
3
|
Vardhan M, Randles A. Application of physics-based flow models in cardiovascular medicine: Current practices and challenges. BIOPHYSICS REVIEWS 2021; 2:011302. [PMID: 38505399 PMCID: PMC10903374 DOI: 10.1063/5.0040315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/18/2021] [Indexed: 03/21/2024]
Abstract
Personalized physics-based flow models are becoming increasingly important in cardiovascular medicine. They are a powerful complement to traditional methods of clinical decision-making and offer a wealth of physiological information beyond conventional anatomic viewing using medical imaging data. These models have been used to identify key hemodynamic biomarkers, such as pressure gradient and wall shear stress, which are associated with determining the functional severity of cardiovascular diseases. Importantly, simulation-driven diagnostics can help researchers understand the complex interplay between geometric and fluid dynamic parameters, which can ultimately improve patient outcomes and treatment planning. The possibility to compute and predict diagnostic variables and hemodynamics biomarkers can therefore play a pivotal role in reducing adverse treatment outcomes and accelerate development of novel strategies for cardiovascular disease management.
Collapse
Affiliation(s)
- M. Vardhan
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708, USA
| | - A. Randles
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708, USA
| |
Collapse
|
4
|
Pleouras DS, Sakellarios AI, Tsompou P, Kigka V, Kyriakidis S, Rocchiccioli S, Neglia D, Knuuti J, Pelosi G, Michalis LK, Fotiadis DI. Simulation of atherosclerotic plaque growth using computational biomechanics and patient-specific data. Sci Rep 2020; 10:17409. [PMID: 33060746 PMCID: PMC7562914 DOI: 10.1038/s41598-020-74583-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 09/24/2020] [Indexed: 11/08/2022] Open
Abstract
Atherosclerosis is the one of the major causes of mortality worldwide, urging the need for prevention strategies. In this work, a novel computational model is developed, which is used for simulation of plaque growth to 94 realistic 3D reconstructed coronary arteries. This model considers several factors of the atherosclerotic process even mechanical factors such as the effect of endothelial shear stress, responsible for the initiation of atherosclerosis, and biological factors such as the accumulation of low and high density lipoproteins (LDL and HDL), monocytes, macrophages, cytokines, nitric oxide and formation of foams cells or proliferation of contractile and synthetic smooth muscle cells (SMCs). The model is validated using the serial imaging of CTCA comparing the simulated geometries with the real follow-up arteries. Additionally, we examine the predictive capability of the model to identify regions prone of disease progression. The results presented good correlation between the simulated lumen area (P < 0.0001), plaque area (P < 0.0001) and plaque burden (P < 0.0001) with the realistic ones. Finally, disease progression is achieved with 80% accuracy with many of the computational results being independent predictors.
Collapse
Affiliation(s)
- Dimitrios S Pleouras
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology - FORTH, University Campus of Ioannina, 45110, Ioannina, Greece
| | - Antonis I Sakellarios
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology - FORTH, University Campus of Ioannina, 45110, Ioannina, Greece
| | - Panagiota Tsompou
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology - FORTH, University Campus of Ioannina, 45110, Ioannina, Greece
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, PO BOX 1186, 45110, Ioannina, Greece
| | - Vassiliki Kigka
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology - FORTH, University Campus of Ioannina, 45110, Ioannina, Greece
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, PO BOX 1186, 45110, Ioannina, Greece
| | - Savvas Kyriakidis
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology - FORTH, University Campus of Ioannina, 45110, Ioannina, Greece
| | - Silvia Rocchiccioli
- Institute of Clinical Physiology, National Research Council, 56124, Pisa, Italy
| | - Danilo Neglia
- Fondazione Toscana G. Monasterio, 56124, Pisa, Italy
| | - Juhani Knuuti
- Turku PET Centre, University of Turku, and Turku University Hospital, Turku, Finland
| | - Gualtiero Pelosi
- Institute of Clinical Physiology, National Research Council, 56124, Pisa, Italy
| | - Lampros K Michalis
- Department of Cardiology, Medical School, University of Ioannina, 45110, Ioannina, Greece
| | - Dimitrios I Fotiadis
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology - FORTH, University Campus of Ioannina, 45110, Ioannina, Greece.
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, PO BOX 1186, 45110, Ioannina, Greece.
| |
Collapse
|
5
|
Fractional Flow Reserve following Percutaneous Coronary Intervention. J Interv Cardiol 2020; 2020:7467943. [PMID: 32565755 PMCID: PMC7293753 DOI: 10.1155/2020/7467943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/05/2020] [Accepted: 05/11/2020] [Indexed: 11/18/2022] Open
Abstract
Fractional flow reserve (FFR) is routinely used to determine lesion severity prior to percutaneous coronary intervention (PCI). However, there is an increasing recognition that FFR may also be useful following PCI to identify mechanisms leading to restenosis and the need for repeat revascularization. Post-PCI FFR is associated with the presence and severity of stent under-expansion and may help identify peri-stent-related complications. FFR pullback may also unmask other functionally significant lesions within the target vessel that were not appreciable on angiography. Recent studies have confirmed the prognostic utility of performing routine post-PCI FFR and suggest possible interventional targets that would improve stent durability. In this review, we detail the theoretical basis underlying post-PCI FFR, provide practical tips to facilitate measurement, and discuss the growing evidence supporting its use.
Collapse
|
6
|
Liu CD, Chen F. Increase of wall shear stress caused by arteriovenous fistula reduces neointimal hyperplasia after stent implantation in healthy arteries. Vascular 2020; 28:396-404. [PMID: 32228224 DOI: 10.1177/1708538120913748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Wall shear stress plays a critical role in neointimal hyperplasia after stent implantation. It has been found that there is an inverse relation between wall shear stress and neointimal hyperplasia. This study hypothesized that the increase of arterial wall shear stress caused by arteriovenous fistula could reduce neointimal hyperplasia after stents implantation. METHODS AND RESULTS Thirty-six male rabbits were randomly divided into three groups: STENT, rabbits received stent implantation into right common carotid artery; STENT/arteriovenous fistula, rabbits received stent implantation into right common carotid artery and carotid-jugular arteriovenous fistula; Control, rabbits received no treatment. After 21 days, stented common carotid artery specimens were harvested for histological staining and protein expression analysis. In STENT group, wall shear stress maintained at a low level from 43.2 to 48.9% of baseline. In STENT/arteriovenous fistula group, wall shear stress gradually increased to 86% over baseline. There was a more significant neointimal hyperplasia in group STENT compared with the STENT/arteriovenous fistula group (neointima area: 0.87 mm2 versus 0.19 mm2; neointima-to-media area ratio: 1.13 versus 0.18). Western blot analysis demonstrated that the protein level of endothelial nitric oxide synthase in STENT group was significantly lower than that in STENT/arteriovenous fistula group, but the protein levels of proliferating cell nuclear antigen, vascular cell adhesion molecule 1, phospho-p38 mitogen-activated protein kinase (Pp38), and phospho-c-Jun N-terminal kinase in STENT group were significantly higher than that in the STENT group. CONCLUSION High wall shear stress caused by arteriovenous fistula as associated with the induction in neointimal hyperplasia after stent implantation. The underlying mechanisms may be related to modulating the expression and activation of endothelial nitric oxide synthase, vascular cell adhesion molecule 1, p38, and c-Jun N-terminal kinase.
Collapse
Affiliation(s)
- Chong Dong Liu
- Department of Vascular Surgery, the Second Affiliated Hospital, Nanchang University, Nanchang, China
| | - Feng Chen
- Department of Vascular Surgery, the Second Affiliated Hospital, Nanchang University, Nanchang, China
| |
Collapse
|
7
|
Ekizler FA, Cay S, Tak BT, Kanat S, Kafes H, Cetin EHO, Ozeke O, Ozcan F, Topaloglu S, Aras D. Usefulness of the whole blood viscosity to predict stent thrombosis in ST-elevation myocardial infarction. Biomark Med 2019; 13:1307-1320. [PMID: 31429589 DOI: 10.2217/bmm-2019-0246] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This study sought to investigate the predictive value of estimated whole blood viscosity (WBV) for stent thrombosis (ST) in ST-elevation myocardial infarction (STEMI) patients who underwent percutaneous coronary intervention. Materials & methods: A total of 1720 STEMI patients treated with primary percutaneous coronary intervention were followed up for median 36.0 months. WBV was calculated according to the Simone's formula. Results: During follow-up period, 119 patients were diagnosed as 'definite' ST. The rate of ST was significantly higher in the high WBV group. In multivariate analysis, adjusted for other factors, higher WBV significantly increased risk of ST at both shear rates. Conclusion: Being an easily accessible and costless parameter, WBV seems to be an emerging predictor of ST in patients with STEMI.
Collapse
Affiliation(s)
- Firdevs Aysenur Ekizler
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Serkan Cay
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Bahar Tekin Tak
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Selcuk Kanat
- Department of Cardiology, Bursa Education & Research Hospital, Health Sciences University Bursa, Turkey
| | - Habibe Kafes
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Elif Hande Ozcan Cetin
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Ozcan Ozeke
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Firat Ozcan
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Serkan Topaloglu
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Dursun Aras
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| |
Collapse
|
8
|
Prithipaul PKM, Kokkolaras M, Pasini D. Assessment of structural and hemodynamic performance of vascular stents modelled as periodic lattices. Med Eng Phys 2018; 57:11-18. [PMID: 29759946 DOI: 10.1016/j.medengphy.2018.04.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 03/17/2018] [Accepted: 04/16/2018] [Indexed: 11/16/2022]
Abstract
This work considers vascular stents with tubular geometry assumed to follow a periodic arrangement of repeating unit cells. Structural and hemodynamic metrics are presented to assess alternative stent geometries, each defined by the topology of the unit cell. Structural metrics include foreshortening, elastic recoil and radial stiffness, whereas hemodynamic performance is described by a wall shear stress index quantifying the impact of in-stent restenosis. A representative volume element (RVE) modelling approach is used, and results are compared to those obtained from full simulations of entire stents. We demonstrate that the RVE approach can be used to quantify the impact of the topology of the repeating unit on the structural and hemodynamic properties of a stent, and thus support clinicians in making proper choices among alternative stent geometries.
Collapse
Affiliation(s)
- Purnendu K M Prithipaul
- Department of Mechanical Engineering, McGill University, 817 Sherbrook St. West, Montreal, Quebec, H3A 0C3, Canada.
| | - Michael Kokkolaras
- Department of Mechanical Engineering, McGill University, 817 Sherbrook St. West, Montreal, Quebec, H3A 0C3, Canada.
| | - Damiano Pasini
- Department of Mechanical Engineering, McGill University, 817 Sherbrook St. West, Montreal, Quebec, H3A 0C3, Canada.
| |
Collapse
|
9
|
Tenekecioglu E, Torii R, Bourantas CV, Cavalcante R, Sotomi Y, Zeng Y, Collet C, Crake T, Abizaid A, Onuma Y, Su S, Santoso T, Serruys PW. Hemodynamic analysis of a novel bioresorbable scaffold in porcine coronary artery model. Catheter Cardiovasc Interv 2018; 91:1084-1091. [PMID: 28843033 DOI: 10.1002/ccd.27253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 07/04/2017] [Accepted: 07/22/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND The shear stress distribution assessment can provide useful insights for the hemodynamic performance of the implanted stent/scaffold. Our aim was to investigate the effect of a novel bioresorbable scaffold, Mirage on local hemodynamics in animal models. METHOD The main epicardial coronary arteries of 7 healthy mini-pigs were implanted with 11 Mirage Microfiber sirolimus-eluting Bioresorbable Scaffolds (MMSES). Optical coherence tomography (OCT) was performed post scaffold implantation and the obtained images were fused with angiographic data to reconstruct the coronary artery anatomy. Blood flow simulation was performed and Endothelial Shear Stress(ESS) distribution was estimated for each of the 11 scaffolds. ESS data were extracted in each circumferential 5-degree subunit of each cross-section in the scaffolded segment. The generalized linear mixed-effect analysis was implemented for the comparison of ESS in two scaffold groups; 150-µm strut thickness MMSES and 125-µm strut thickness MMSES. RESULTS ESS was significantly higher in MMSES (150 µm) [0.85(0.49-1.40) Pa], compared to MMSES (125 µm) [0.68(0.35-1.18) Pa]. Both MMSES (150 µm) and MMSES (125 µm) revealed low recirculation zone percentages per luminal surface area [3.17% ± 1.97% in MMSES (150 µm), 2.71% ± 1.32% in MMSES (125 µm)]. CONCLUSION Thinner strut Mirage scaffolds induced lower shear stress due to the small size vessels treated as compared to the thick strut version of the Mirage which was implanted in relatively bigger size vessels. Vessel size should be taken into account in planning BRS implantation. Small vessels may not get benefit from BRS implantation even with a streamlined strut profile. This pilot study warrants comparative assessment with commercially available bioresorbable scaffolds.
Collapse
Affiliation(s)
- Erhan Tenekecioglu
- Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Christos V Bourantas
- Department of Cardiology, University College of London Hospitals, London, United Kingdom
| | - Rafael Cavalcante
- Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands
| | - Yohei Sotomi
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Yaping Zeng
- Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands
| | - Carlos Collet
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Tom Crake
- Department of Cardiology, University College of London Hospitals, London, United Kingdom
| | - Alexandre Abizaid
- Department of Invasive Cardiology, Institute Dante Pazzanese of Cardiology, São Paulo, Brazil
| | - Yoshinobu Onuma
- Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands
| | | | - Teguh Santoso
- Department of Internal Medicine, Faculty of Medicine, Dr. Cipto Mangunkusumo and Medistra Hospitals, University of Indonesia, Jakarta, Indonesia
| | - Patrick W Serruys
- Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, The Netherlands.,Department of Cardiology, International Centre for Circulatory Health, Imperial College, London, United Kingdom
| |
Collapse
|
10
|
Tenekecioglu E, Torii R, Bourantas C, Sotomi Y, Cavalcante R, Zeng Y, Collet C, Crake T, Suwannasom P, Onuma Y, Serruys P. Difference in haemodynamic microenvironment in vessels scaffolded with Absorb BVS and Mirage BRMS: insights from a preclinical endothelial shear stress study. EUROINTERVENTION 2017; 13:1327-1335. [DOI: 10.4244/eij-d-17-00283] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
11
|
Ng J, Bourantas CV, Torii R, Ang HY, Tenekecioglu E, Serruys PW, Foin N. Local Hemodynamic Forces After Stenting: Implications on Restenosis and Thrombosis. Arterioscler Thromb Vasc Biol 2017; 37:2231-2242. [PMID: 29122816 DOI: 10.1161/atvbaha.117.309728] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 10/13/2017] [Indexed: 12/19/2022]
Abstract
Local hemodynamic forces are well-known to modulate atherosclerotic evolution, which remains one of the largest cause of death worldwide. Percutaneous coronary interventions with stent implantation restores blood flow to the downstream myocardium and is only limited by stent failure caused by restenosis, stent thrombosis, or neoatherosclerosis. Cumulative evidence has shown that local hemodynamic forces affect restenosis and the platelet activation process, modulating the pathophysiological mechanisms that lead to stent failure. This article first covers the pathophysiological mechanisms through which wall shear stress regulates arterial disease formation/neointima proliferation and the role of shear rate on stent thrombosis. Subsequently, the article reviews the current evidence on (1) the implications of stent design on the local hemodynamic forces, and (2) how stent/scaffold expansion can influence local flow, thereby affecting the risk of adverse events.
Collapse
Affiliation(s)
- Jaryl Ng
- From the National Heart Centre Singapore (J.N., H.Y.A., N.F.); Department of Biomedical Engineering, National University of Singapore, Singapore (J.N.); Departments of Cardiovascular Sciences (C.V.B.) and Mechanical Engineering (R.T.), University College London, United Kingdom; Department of Cardiology, Barts Health NHS Trust, London, United Kingdom (C.V.B.); Thoraxcenter, Erasmus MC, Rotterdam Erasmus University, The Netherlands (E.T., P.W.S.); National Heart & Lung Institute, Imperial College London, United Kingdom (P.W.S.); and Duke-NUS Medical School, National University of Singapore (N.F.)
| | - Christos V Bourantas
- From the National Heart Centre Singapore (J.N., H.Y.A., N.F.); Department of Biomedical Engineering, National University of Singapore, Singapore (J.N.); Departments of Cardiovascular Sciences (C.V.B.) and Mechanical Engineering (R.T.), University College London, United Kingdom; Department of Cardiology, Barts Health NHS Trust, London, United Kingdom (C.V.B.); Thoraxcenter, Erasmus MC, Rotterdam Erasmus University, The Netherlands (E.T., P.W.S.); National Heart & Lung Institute, Imperial College London, United Kingdom (P.W.S.); and Duke-NUS Medical School, National University of Singapore (N.F.)
| | - Ryo Torii
- From the National Heart Centre Singapore (J.N., H.Y.A., N.F.); Department of Biomedical Engineering, National University of Singapore, Singapore (J.N.); Departments of Cardiovascular Sciences (C.V.B.) and Mechanical Engineering (R.T.), University College London, United Kingdom; Department of Cardiology, Barts Health NHS Trust, London, United Kingdom (C.V.B.); Thoraxcenter, Erasmus MC, Rotterdam Erasmus University, The Netherlands (E.T., P.W.S.); National Heart & Lung Institute, Imperial College London, United Kingdom (P.W.S.); and Duke-NUS Medical School, National University of Singapore (N.F.)
| | - Hui Ying Ang
- From the National Heart Centre Singapore (J.N., H.Y.A., N.F.); Department of Biomedical Engineering, National University of Singapore, Singapore (J.N.); Departments of Cardiovascular Sciences (C.V.B.) and Mechanical Engineering (R.T.), University College London, United Kingdom; Department of Cardiology, Barts Health NHS Trust, London, United Kingdom (C.V.B.); Thoraxcenter, Erasmus MC, Rotterdam Erasmus University, The Netherlands (E.T., P.W.S.); National Heart & Lung Institute, Imperial College London, United Kingdom (P.W.S.); and Duke-NUS Medical School, National University of Singapore (N.F.)
| | - Erhan Tenekecioglu
- From the National Heart Centre Singapore (J.N., H.Y.A., N.F.); Department of Biomedical Engineering, National University of Singapore, Singapore (J.N.); Departments of Cardiovascular Sciences (C.V.B.) and Mechanical Engineering (R.T.), University College London, United Kingdom; Department of Cardiology, Barts Health NHS Trust, London, United Kingdom (C.V.B.); Thoraxcenter, Erasmus MC, Rotterdam Erasmus University, The Netherlands (E.T., P.W.S.); National Heart & Lung Institute, Imperial College London, United Kingdom (P.W.S.); and Duke-NUS Medical School, National University of Singapore (N.F.)
| | - Patrick W Serruys
- From the National Heart Centre Singapore (J.N., H.Y.A., N.F.); Department of Biomedical Engineering, National University of Singapore, Singapore (J.N.); Departments of Cardiovascular Sciences (C.V.B.) and Mechanical Engineering (R.T.), University College London, United Kingdom; Department of Cardiology, Barts Health NHS Trust, London, United Kingdom (C.V.B.); Thoraxcenter, Erasmus MC, Rotterdam Erasmus University, The Netherlands (E.T., P.W.S.); National Heart & Lung Institute, Imperial College London, United Kingdom (P.W.S.); and Duke-NUS Medical School, National University of Singapore (N.F.)
| | - Nicolas Foin
- From the National Heart Centre Singapore (J.N., H.Y.A., N.F.); Department of Biomedical Engineering, National University of Singapore, Singapore (J.N.); Departments of Cardiovascular Sciences (C.V.B.) and Mechanical Engineering (R.T.), University College London, United Kingdom; Department of Cardiology, Barts Health NHS Trust, London, United Kingdom (C.V.B.); Thoraxcenter, Erasmus MC, Rotterdam Erasmus University, The Netherlands (E.T., P.W.S.); National Heart & Lung Institute, Imperial College London, United Kingdom (P.W.S.); and Duke-NUS Medical School, National University of Singapore (N.F.).
| |
Collapse
|
12
|
Stents: Biomechanics, Biomaterials, and Insights from Computational Modeling. Ann Biomed Eng 2017; 45:853-872. [PMID: 28160103 DOI: 10.1007/s10439-017-1806-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/28/2017] [Indexed: 01/02/2023]
|
13
|
Tenekecioglu E, Torii R, Bourantas C, Abdelghani M, Cavalcante R, Sotomi Y, Crake T, Su S, Santoso T, Onuma Y, Serruys PW. Assessment of the hemodynamic characteristics of Absorb BVS in a porcine coronary artery model. Int J Cardiol 2017; 227:467-473. [DOI: 10.1016/j.ijcard.2016.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 10/30/2016] [Accepted: 11/01/2016] [Indexed: 11/30/2022]
|
14
|
Shishido K, Antoniadis AP, Takahashi S, Tsuda M, Mizuno S, Andreou I, Papafaklis MI, Coskun AU, O'Brien C, Feldman CL, Saito S, Edelman ER, Stone PH. Effects of Low Endothelial Shear Stress After Stent Implantation on Subsequent Neointimal Hyperplasia and Clinical Outcomes in Humans. J Am Heart Assoc 2016; 5:JAHA.115.002949. [PMID: 27628570 PMCID: PMC5079004 DOI: 10.1161/jaha.115.002949] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
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.
Collapse
Affiliation(s)
- Koki Shishido
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Antonios P Antoniadis
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Saeko Takahashi
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | | | - Shingo Mizuno
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Ioannis Andreou
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Michail I Papafaklis
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ahmet U Coskun
- Mechanical and Industrial Engineering, Northeastern University, Boston, MA
| | - Caroline O'Brien
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA
| | - Charles L Feldman
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Shigeru Saito
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Elazer R Edelman
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA
| | - Peter H Stone
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
15
|
Ren X, Qiao A, Song H, Song G, Jiao L. Influence of Bifurcation Angle on In-Stent Restenosis at the Vertebral Artery Origin: A Simulation Study of Hemodynamics. J Med Biol Eng 2016. [DOI: 10.1007/s40846-016-0155-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
16
|
Chawla V, Simionescu A, Langan EM, LaBerge M. Influence of Clinically Relevant Mechanical Forces on Vascular Smooth Muscle Cells Under Chronic High Glucose: An In Vitro Dynamic Disease Model. Ann Vasc Surg 2016; 34:212-26. [PMID: 27126714 DOI: 10.1016/j.avsg.2016.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 02/12/2016] [Accepted: 04/14/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND In this study, we subjected vascular smooth muscle cells (VSMC) to acute and chronic high glucose conditions under physiologically relevant levels of cyclic strain and low wall shear forces to compare phenotypic modulation and thus conceptualize a dynamic-disease test model which captures cellular response more accurately in comparison with static cultures. METHODS P2-P6 rat aortic smooth muscle cells were seeded on type I collagen-coated silicone membranes and subjected to 0-7% cyclic strain at 1 Hz and 0.3 dynes/cm(2) shear stress from flow for 24 hr under acute (25 mM d-glucose, 84 hr) and chronic high glucose conditions (25 mM d-glucose, 3-4 weeks). Samples were analyzed for cell proliferation, percent apoptosis, cellular hypertrophy, and expression levels of smooth muscle contractile state-associated markers with 0.05 level of significance. RESULTS Concomitant application of cyclic strain and flow shear resulted in an overall increase in proliferation of VSMCs under both acute and chronic high glucose conditions as compared with normal glucose control (P < 0.0001). Application of both cyclic strain and cyclic strain shear resulted in a significant increase in percent apoptosis with chronic high glucose treatment in comparison with both normal glucose controls (P < 0.0001) and acute high glucose (P < 0.0001). Cellular hypertrophy as estimated by measuring cell area and aspect ratio revealed a significantly altered morphology due to concomitant loading under chronic high glucose conditions with significantly higher cell area (P < 0.0001) and lower aspect ratio (P < 0.0001) indicative of a relatively rounded morphology as compared with normal glucose controls. Western blot analysis demonstrated reduced expression of SM α-actin (P < 0.0001), calponin (P < 0.0001), and SM22α (P = 0.0008) for concomitant loading under chronic high glucose treatment as compared with normal glucose controls. CONCLUSIONS Concomitant application of cyclic strain and low wall shear stress resulted in greater phenotypic modulation of VSMCs due to chronic high glucose treatment as compared with normal glucose controls, thus implicating cellular-response differences which may impact progression of in-stent restenosis in diabetic patients with poorly controlled hyperglycemia. Similarity of VSMC response from our study to existing preclinical models of diabetes and reports of altered phenotype of VSMCs isolated from diabetic patients substantiate the relevance of our dynamic disease test model.
Collapse
Affiliation(s)
- Varun Chawla
- Department of Bioengineering, Clemson University, Clemson, SC
| | | | - Eugene M Langan
- Department of Vascular Surgery, Greenville Health System, Greenville, SC
| | - Martine LaBerge
- Department of Bioengineering, Clemson University, Clemson, SC.
| |
Collapse
|
17
|
Raben JS, Hariharan P, Robinson R, Malinauskas R, Vlachos PP. Time-Resolved Particle Image Velocimetry Measurements with Wall Shear Stress and Uncertainty Quantification for the FDA Nozzle Model. Cardiovasc Eng Technol 2015; 7:7-22. [DOI: 10.1007/s13239-015-0251-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022]
|
18
|
Bourantas CV, Papafaklis MI, Athanasiou L, Kalatzis FG, Naka KK, Siogkas PK, Takahashi S, Saito S, Fotiadis DI, Feldman CL, Stone PH, Michalis LK. A new methodology for accurate 3-dimensional coronary artery reconstruction using routine intravascular ultrasound and angiographic data: implications for widespread assessment of endothelial shear stress in humans. EUROINTERVENTION 2015; 9:582-93. [PMID: 23608530 DOI: 10.4244/eijv9i5a94] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS To develop and validate a new methodology that allows accurate 3-dimensional (3-D) coronary artery reconstruction using standard, simple angiographic and intravascular ultrasound (IVUS) data acquired during routine catheterisation enabling reliable assessment of the endothelial shear stress (ESS) distribution. METHODS AND RESULTS Twenty-two patients (22 arteries: 7 LAD; 7 LCx; 8 RCA) who underwent angiography and IVUS examination were included. The acquired data were used for 3-D reconstruction using a conventional method and a new methodology that utilised the luminal 3-D centreline to place the detected IVUS borders and anatomical landmarks to estimate their orientation. The local ESS distribution was assessed by computational fluid dynamics. In corresponding consecutive 3 mm segments, lumen, plaque and ESS measurements in the 3-D models derived by the centreline approach were highly correlated to those derived from the conventional method (r>0.98 for all). The centreline methodology had a 99.5% diagnostic accuracy for identifying segments exposed to low ESS and provided similar estimations to the conventional method for the association between the change in plaque burden and ESS (centreline method: slope= -1.65%/Pa, p=0.078; conventional method: slope= -1.64%/Pa, p=0.084; p =0.69 for difference between the two methodologies). CONCLUSIONS The centreline methodology provides geometrically correct models and permits reliable ESS computation. The ability to utilise data acquired during routine coronary angiography and IVUS examination will facilitate clinical investigation of the role of local ESS patterns in the natural history of coronary atherosclerosis.
Collapse
Affiliation(s)
- Christos V Bourantas
- Department of Cardiology, Academic Unit, University of Hull, Kingston-upon-Hull, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Bourantas CV, Räber L, Zaugg S, Sakellarios A, Taniwaki M, Heg D, Moschovitis A, Radu M, Papafaklis MI, Kalatzis F, Naka KK, Fotiadis DI, Michalis LK, Serruys PW, Garcia Garcia HM, Windecker S. Impact of local endothelial shear stress on neointima and plaque following stent implantation in patients with ST-elevation myocardial infarction: A subgroup-analysis of the COMFORTABLE AMI–IBIS 4 trial. Int J Cardiol 2015; 186:178-85. [PMID: 25828109 DOI: 10.1016/j.ijcard.2015.03.160] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 03/02/2015] [Accepted: 03/15/2015] [Indexed: 10/23/2022]
|
20
|
Mortier P, Wentzel JJ, De Santis G, Chiastra C, Migliavacca F, De Beule M, Louvard Y, Dubini G. Patient-specific computer modelling of coronary bifurcation stenting: the John Doe programme. EUROINTERVENTION 2015; 11 Suppl V:V35-9. [DOI: 10.4244/eijv11sva8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
21
|
Vergallo R, Papafaklis MI, Yonetsu T, Bourantas CV, Andreou I, Wang Z, Fujimoto JG, McNulty I, Lee H, Biasucci LM, Crea F, Feldman CL, Michalis LK, Stone PH, Jang IK. Endothelial Shear Stress and Coronary Plaque Characteristics in Humans. Circ Cardiovasc Imaging 2014; 7:905-11. [PMID: 25190591 DOI: 10.1161/circimaging.114.001932] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background—
Despite the exposure of the entire vasculature to the atherogenic effects of systemic risk factors, atherosclerotic plaques preferentially develop at sites with disturbed flow. This study aimed at exploring in vivo the relationship between local endothelial shear stress (ESS) and coronary plaque characteristics in humans using computational fluid dynamics and frequency-domain optical coherence tomography.
Methods and Results—
Three-dimensional coronary artery reconstruction was performed in 21 patients (24 arteries) presenting with acute coronary syndrome using frequency-domain optical coherence tomography and coronary angiography. Each coronary artery was divided into sequential 3-mm segments and analyzed for the assessment of local ESS and plaque characteristics. A total of 146 nonculprit segments were evaluated. Compared with segments with higher ESS [≥1 Pascal (Pa)], those with low ESS (<1 Pa) showed higher prevalence of lipid-rich plaques (37.5% versus 20.0%;
P
=0.019) and thin-cap fibroatheroma (12.5% versus 2.0%;
P
=0.037). Overall, lipid plaques in segments with low ESS had thinner fibrous cap (115 μm [63–166] versus 170 μm [107–219];
P
=0.004) and higher macrophage density (normalized standard deviation: 8.4% [4.8–12.6] versus 6.2% [4.2–8.8];
P
=0.017). Segments with low ESS showed more superficial calcifications (minimum calcification depth: 93 μm [50–140] versus 152 μm [105–258];
P
=0.049) and tended to have higher prevalence of spotty calcifications (26.0% versus 12.0%;
P
=0.076).
Conclusions—
Coronary regions exposed to low ESS are associated with larger lipid burden, thinner fibrous cap, and higher prevalence of thin-cap fibroatheroma in humans. Frequency-domain optical coherence tomography–based assessment of ESS and wall characteristics may be useful in identifying vulnerable coronary regions.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01110538.
Collapse
Affiliation(s)
- Rocco Vergallo
- From the Department of Medicine, Cardiology Division (R.V., T.Y., I.M., I.-K.J.) and Department of Medicine, Biostatistics Center (H.L.), Massachusetts General Hospital, and Department of Medicine, Cardiovascular Division, Brigham & Women’s Hospital (M.I.P., I.A., C.L.F., P.H.S.), Harvard Medical School, Boston, MA; Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (C.V.B.); Department of Electrical Engineering and Computer Science, and
| | - Michail I. Papafaklis
- From the Department of Medicine, Cardiology Division (R.V., T.Y., I.M., I.-K.J.) and Department of Medicine, Biostatistics Center (H.L.), Massachusetts General Hospital, and Department of Medicine, Cardiovascular Division, Brigham & Women’s Hospital (M.I.P., I.A., C.L.F., P.H.S.), Harvard Medical School, Boston, MA; Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (C.V.B.); Department of Electrical Engineering and Computer Science, and
| | - Taishi Yonetsu
- From the Department of Medicine, Cardiology Division (R.V., T.Y., I.M., I.-K.J.) and Department of Medicine, Biostatistics Center (H.L.), Massachusetts General Hospital, and Department of Medicine, Cardiovascular Division, Brigham & Women’s Hospital (M.I.P., I.A., C.L.F., P.H.S.), Harvard Medical School, Boston, MA; Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (C.V.B.); Department of Electrical Engineering and Computer Science, and
| | - Christos V. Bourantas
- From the Department of Medicine, Cardiology Division (R.V., T.Y., I.M., I.-K.J.) and Department of Medicine, Biostatistics Center (H.L.), Massachusetts General Hospital, and Department of Medicine, Cardiovascular Division, Brigham & Women’s Hospital (M.I.P., I.A., C.L.F., P.H.S.), Harvard Medical School, Boston, MA; Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (C.V.B.); Department of Electrical Engineering and Computer Science, and
| | - Ioannis Andreou
- From the Department of Medicine, Cardiology Division (R.V., T.Y., I.M., I.-K.J.) and Department of Medicine, Biostatistics Center (H.L.), Massachusetts General Hospital, and Department of Medicine, Cardiovascular Division, Brigham & Women’s Hospital (M.I.P., I.A., C.L.F., P.H.S.), Harvard Medical School, Boston, MA; Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (C.V.B.); Department of Electrical Engineering and Computer Science, and
| | - Zhao Wang
- From the Department of Medicine, Cardiology Division (R.V., T.Y., I.M., I.-K.J.) and Department of Medicine, Biostatistics Center (H.L.), Massachusetts General Hospital, and Department of Medicine, Cardiovascular Division, Brigham & Women’s Hospital (M.I.P., I.A., C.L.F., P.H.S.), Harvard Medical School, Boston, MA; Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (C.V.B.); Department of Electrical Engineering and Computer Science, and
| | - James G. Fujimoto
- From the Department of Medicine, Cardiology Division (R.V., T.Y., I.M., I.-K.J.) and Department of Medicine, Biostatistics Center (H.L.), Massachusetts General Hospital, and Department of Medicine, Cardiovascular Division, Brigham & Women’s Hospital (M.I.P., I.A., C.L.F., P.H.S.), Harvard Medical School, Boston, MA; Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (C.V.B.); Department of Electrical Engineering and Computer Science, and
| | - Iris McNulty
- From the Department of Medicine, Cardiology Division (R.V., T.Y., I.M., I.-K.J.) and Department of Medicine, Biostatistics Center (H.L.), Massachusetts General Hospital, and Department of Medicine, Cardiovascular Division, Brigham & Women’s Hospital (M.I.P., I.A., C.L.F., P.H.S.), Harvard Medical School, Boston, MA; Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (C.V.B.); Department of Electrical Engineering and Computer Science, and
| | - Hang Lee
- From the Department of Medicine, Cardiology Division (R.V., T.Y., I.M., I.-K.J.) and Department of Medicine, Biostatistics Center (H.L.), Massachusetts General Hospital, and Department of Medicine, Cardiovascular Division, Brigham & Women’s Hospital (M.I.P., I.A., C.L.F., P.H.S.), Harvard Medical School, Boston, MA; Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (C.V.B.); Department of Electrical Engineering and Computer Science, and
| | - Luigi M. Biasucci
- From the Department of Medicine, Cardiology Division (R.V., T.Y., I.M., I.-K.J.) and Department of Medicine, Biostatistics Center (H.L.), Massachusetts General Hospital, and Department of Medicine, Cardiovascular Division, Brigham & Women’s Hospital (M.I.P., I.A., C.L.F., P.H.S.), Harvard Medical School, Boston, MA; Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (C.V.B.); Department of Electrical Engineering and Computer Science, and
| | - Filippo Crea
- From the Department of Medicine, Cardiology Division (R.V., T.Y., I.M., I.-K.J.) and Department of Medicine, Biostatistics Center (H.L.), Massachusetts General Hospital, and Department of Medicine, Cardiovascular Division, Brigham & Women’s Hospital (M.I.P., I.A., C.L.F., P.H.S.), Harvard Medical School, Boston, MA; Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (C.V.B.); Department of Electrical Engineering and Computer Science, and
| | - Charles L. Feldman
- From the Department of Medicine, Cardiology Division (R.V., T.Y., I.M., I.-K.J.) and Department of Medicine, Biostatistics Center (H.L.), Massachusetts General Hospital, and Department of Medicine, Cardiovascular Division, Brigham & Women’s Hospital (M.I.P., I.A., C.L.F., P.H.S.), Harvard Medical School, Boston, MA; Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (C.V.B.); Department of Electrical Engineering and Computer Science, and
| | - Lampros K. Michalis
- From the Department of Medicine, Cardiology Division (R.V., T.Y., I.M., I.-K.J.) and Department of Medicine, Biostatistics Center (H.L.), Massachusetts General Hospital, and Department of Medicine, Cardiovascular Division, Brigham & Women’s Hospital (M.I.P., I.A., C.L.F., P.H.S.), Harvard Medical School, Boston, MA; Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (C.V.B.); Department of Electrical Engineering and Computer Science, and
| | - Peter H. Stone
- From the Department of Medicine, Cardiology Division (R.V., T.Y., I.M., I.-K.J.) and Department of Medicine, Biostatistics Center (H.L.), Massachusetts General Hospital, and Department of Medicine, Cardiovascular Division, Brigham & Women’s Hospital (M.I.P., I.A., C.L.F., P.H.S.), Harvard Medical School, Boston, MA; Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (C.V.B.); Department of Electrical Engineering and Computer Science, and
| | - Ik-Kyung Jang
- From the Department of Medicine, Cardiology Division (R.V., T.Y., I.M., I.-K.J.) and Department of Medicine, Biostatistics Center (H.L.), Massachusetts General Hospital, and Department of Medicine, Cardiovascular Division, Brigham & Women’s Hospital (M.I.P., I.A., C.L.F., P.H.S.), Harvard Medical School, Boston, MA; Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (C.V.B.); Department of Electrical Engineering and Computer Science, and
| |
Collapse
|
22
|
Chiastra C, Migliavacca F, Martínez MÁ, Malvè M. On the necessity of modelling fluid–structure interaction for stented coronary arteries. J Mech Behav Biomed Mater 2014; 34:217-30. [DOI: 10.1016/j.jmbbm.2014.02.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 01/23/2014] [Accepted: 02/05/2014] [Indexed: 01/17/2023]
|
23
|
The influence of vascular anatomy on carotid artery stenting: A parametric study for damage assessment. J Biomech 2014; 47:890-8. [DOI: 10.1016/j.jbiomech.2014.01.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2014] [Indexed: 11/24/2022]
|
24
|
Bourantas CV, Papafaklis MI, Kotsia A, Farooq V, Muramatsu T, Gomez-Lara J, Zhang YJ, Iqbal J, Kalatzis FG, Naka KK, Fotiadis DI, Dorange C, Wang J, Rapoza R, Garcia-Garcia HM, Onuma Y, Michalis LK, Serruys PW. Effect of the endothelial shear stress patterns on neointimal proliferation following drug-eluting bioresorbable vascular scaffold implantation: an optical coherence tomography study. JACC Cardiovasc Interv 2014; 7:315-24. [PMID: 24529931 DOI: 10.1016/j.jcin.2013.05.034] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 04/26/2013] [Accepted: 05/09/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This study sought to investigate the effect of endothelial shear stress (ESS) on neointimal formation following an Absorb bioresorbable vascular scaffold (BVS) (Abbott Vascular, Santa Clara, California) implantation. BACKGROUND Cumulative evidence, derived from intravascular ultrasound-based studies, has demonstrated a strong association between local ESS patterns and neointimal formation in bare-metal stents, whereas in drug-eluting stents, there are contradictory data about the effect of ESS on the vessel wall healing process. The effect of ESS on neointimal development following a bioresorbable scaffold implantation remains unclear. METHODS Twelve patients with an obstructive lesion in a relatively straight arterial segment, who were treated with an Absorb BVS and had serial optical coherence tomographic examination at baseline and 1-year follow-up, were included in the current analysis. The optical coherence tomographic data acquired at follow-up were used to reconstruct the scaffolded segment. Blood flow simulation was performed on the luminal surface at baseline defined by the Absorb BVS struts, and the computed ESS was related to the neointima thickness measured at 1-year follow-up. RESULTS At baseline, the scaffolded segments were exposed to a predominantly low ESS environment (61% of the measured ESS was <1 Pa). At follow-up, the mean neointima thickness was 113 ± 45 μm, whereas the percentage scaffold volume obstruction was 13.1 ± 6.6%. A statistically significant inverse correlation was noted between baseline logarithmic transformed ESS and neointima thickness at 1-year follow-up in all studied segments (correlation coefficient range -0.140 to -0.662). Mixed linear regression analysis between baseline logarithmic transformed ESS and neointima thickness at follow-up yielded a slope of -31 μm/ln(Pa) and a y-intercept of 99 μm. CONCLUSIONS The hemodynamic microenvironment appears to regulate neointimal response following an Absorb BVS implantation. These findings underline the role of the ESS patterns on vessel wall healing and should be taken into consideration in the design of bioresorbable devices.
Collapse
Affiliation(s)
- Christos V Bourantas
- Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, the Netherlands
| | - Michail I Papafaklis
- Cardiovascular Division, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anna Kotsia
- Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Vasim Farooq
- Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, the Netherlands
| | - Takashi Muramatsu
- Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, the Netherlands
| | - Josep Gomez-Lara
- Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, the Netherlands
| | - Yao-Jun Zhang
- Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, the Netherlands
| | - Javaid Iqbal
- Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, the Netherlands
| | - Fanis G Kalatzis
- Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Katerina K Naka
- Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Dimitrios I Fotiadis
- Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | | | - Jin Wang
- Abbott Vascular, Santa Clara, California
| | | | - Hector M Garcia-Garcia
- Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, the Netherlands
| | - Yoshinobu Onuma
- Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, the Netherlands
| | - Lampros K Michalis
- Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Patrick W Serruys
- Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, the Netherlands.
| |
Collapse
|
25
|
Bourantas CV, Papafaklis MI, Lakkas L, Sakellarios A, Onuma Y, Zhang YJ, Muramatsu T, Diletti R, Bizopoulos P, Kalatzis F, Naka KK, Fotiadis DI, Wang J, Garcia Garcia HM, Kimura T, Michalis LK, Serruys PW. Fusion of optical coherence tomographic and angiographic data for more accurate evaluation of the endothelial shear stress patterns and neointimal distribution after bioresorbable scaffold implantation: comparison with intravascular ultrasound-derived reconstructions. Int J Cardiovasc Imaging 2014; 30:485-94. [PMID: 24458955 DOI: 10.1007/s10554-014-0374-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 01/15/2014] [Indexed: 10/25/2022]
Abstract
Intravascular ultrasound (IVUS)-based reconstructions have been traditionally used to examine the effect of endothelial shear stress (ESS) on neointimal formation. The aim of this analysis is to compare the association between ESS and neointimal thickness (NT) in models obtained by the fusion of optical coherence tomography (OCT) and coronary angiography and in the reconstructions derived by the integration of IVUS and coronary angiography. We analyzed data from six patients implanted with an Absorb bioresorbable vascular scaffold that had biplane angiography, IVUS and OCT investigation at baseline and 6 or 12 months follow-up. The IVUS and OCT follow-up data were fused separately with the angiographic data to reconstruct the luminal morphology at baseline and follow-up. Blood flow simulation was performed on the baseline reconstructions and the ESS was related to NT. In the OCT-based reconstructions the ESS were lower compared to the IVUS-based models (1.29 ± 0.66 vs. 1.87 ± 0.66 Pa, P = 0.030). An inverse correlation was noted between the logarithmic transformed ESS and the measured NT in all the OCT-based models which was higher than the correlation reported in five of the six IVUS-derived models (-0.52 ± 0.19 Pa vs. -0.10 ± 0.04, P = 0.028). Fusion of OCT and coronary angiography appears superior to IVUS-based reconstructions; therefore it should be the method of choice for the study of the effect of the ESS on neointimal proliferation.
Collapse
Affiliation(s)
- Christos V Bourantas
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Papafaklis MI, Bourantas CV, Farooq V, Diletti R, Muramatsu T, Zhang Y, Fotiadis DI, Onuma Y, Garcia Garcia HM, Michalis LK, Serruys PW. In vivo assessment of the three-dimensional haemodynamic micro-environment following drug-eluting bioresorbable vascular scaffold implantation in a human coronary artery: fusion of frequency domain optical coherence tomography and angiography. EUROINTERVENTION 2013; 9:890-890. [PMID: 23856322 DOI: 10.4244/eijv9i7a147] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
|
27
|
Imbalzano E, Trapani G, Creazzo M, Lizio G, Saitta A. Coronary artery disease in radiotherapy. Int J Cardiol 2013; 168:e125-6. [PMID: 23993725 DOI: 10.1016/j.ijcard.2013.08.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 08/03/2013] [Indexed: 02/08/2023]
Affiliation(s)
- E Imbalzano
- Department of Internal Medicine and Medical Therapy, University of Messina, Italy.
| | | | | | | | | |
Collapse
|
28
|
Sakellarios AI, Papafaklis MI, Siogkas P, Athanasiou LS, Exarchos TP, Stefanou K, Bourantas CV, Naka KK, Michalis LK, Parodi O, Fotiadis DI. Patient-specific computational modeling of subendothelial LDL accumulation in a stenosed right coronary artery: effect of hemodynamic and biological factors. Am J Physiol Heart Circ Physiol 2013; 304:H1455-70. [PMID: 23504178 DOI: 10.1152/ajpheart.00539.2012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Atherosclerosis is a systemic disease with local manifestations. Low-density lipoprotein (LDL) accumulation in the subendothelial layer is one of the hallmarks of atherosclerosis onset and ignites plaque development and progression. Blood flow-induced endothelial shear stress (ESS) is causally related to the heterogenic distribution of atherosclerotic lesions and critically affects LDL deposition in the vessel wall. In this work we modeled blood flow and LDL transport in the coronary arterial wall and investigated the influence of several hemodynamic and biological factors that may regulate LDL accumulation. We used a three-dimensional model of a stenosed right coronary artery reconstructed from angiographic and intravascular ultrasound patient data. We also reconstructed a second model after restoring the patency of the stenosed lumen to its nondiseased state to assess the effect of the stenosis on LDL accumulation. Furthermore, we implemented a new model for LDL penetration across the endothelial membrane, assuming that endothelial permeability depends on the local lumen LDL concentration. The results showed that the presence of the stenosis had a dramatic effect on the local ESS distribution and LDL accumulation along the artery, and areas of increased LDL accumulation were observed in the downstream region where flow recirculation and low ESS were present. Of the studied factors influencing LDL accumulation, 1) hypertension, 2) increased endothelial permeability (a surrogate of endothelial dysfunction), and 3) increased serum LDL levels, especially when the new model of variable endothelial permeability was applied, had the largest effects, thereby supporting their role as major cardiovascular risk factors.
Collapse
Affiliation(s)
- Antonis I. Sakellarios
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Michail I. Papafaklis
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Panagiotis Siogkas
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Lambros S. Athanasiou
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | | | - Konstantinos Stefanou
- Biomedical Research Institute-FORTH, University Campus of Ioannina, Ioannina, Greece
| | - Christos V. Bourantas
- Department of Interventional Cardiology, Erasmus MC, Thoraxcenter, Rotterdam, The Netherlands
| | - Katerina K. Naka
- Michailideion Cardiac Center, University of Ioannina, Ioannina, Greece
- Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece; and
| | - Lampros K. Michalis
- Michailideion Cardiac Center, University of Ioannina, Ioannina, Greece
- Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece; and
| | - Oberdan Parodi
- Instituto di Fisiologia Clinica, Consiglio Nazionale delle Ricerche, Pisa, Italy
| | - Dimitrios I. Fotiadis
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
- Biomedical Research Institute-FORTH, University Campus of Ioannina, Ioannina, Greece
- Michailideion Cardiac Center, University of Ioannina, Ioannina, Greece
| |
Collapse
|
29
|
|
30
|
Koskinas KC, Chatzizisis YS, Antoniadis AP, Giannoglou GD. Role of endothelial shear stress in stent restenosis and thrombosis: pathophysiologic mechanisms and implications for clinical translation. J Am Coll Cardiol 2012; 59:1337-49. [PMID: 22480478 DOI: 10.1016/j.jacc.2011.10.903] [Citation(s) in RCA: 220] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 09/13/2011] [Accepted: 10/27/2011] [Indexed: 10/28/2022]
Abstract
Restenosis and thrombosis are potentially fatal complications of coronary stenting with a recognized multifactorial etiology. The effect of documented risk factors, however, cannot explain the preponderance of certain lesion types, stent designs, and implantation configurations for the development of these complications. Local hemodynamic factors, low endothelial shear stress (ESS) in particular, are long known to critically affect the natural history of atherosclerosis. Increasing evidence now suggests that ESS may also contribute to the development of restenosis and thrombosis upon stenting of atherosclerotic plaques, in conjunction with well-appreciated risk factors. In this review, we present in vivo and mechanistic evidence associating ESS with the localization and progression of neointimal hyperplasia and in-stent clotting. Clinical studies have associated stent design features with the risk of restenosis. Importantly, computational simulations extend these observations by directly linking specific stent geometry and positioning characteristics with the post-stenting hemodynamic milieu and with the stent's thrombogenicity and pro-restenotic potential, thereby indicating ways to clinical translation. An enhanced understanding of the pathophysiologic role of ESS in restenosis and thrombosis might dictate hemodynamically favorable stent designs and deployment configurations to reduce the potential for late lumen loss and thrombotic obstruction. Recent methodologies for in vivo ESS profiling at a clinical level might allow for early identification of patients at high risk for the development of restenosis or thrombosis and might thereby guide individualized, risk-tailored treatment strategies to prevent devastating complications of endovascular interventions.
Collapse
Affiliation(s)
- Konstantinos C Koskinas
- 1st Cardiology Department, AHEPA University Hospital, Aristole University Medical School, Thessaloniki, Greece
| | | | | | | |
Collapse
|
31
|
Papafaklis MI, Chatzizisis YS, Naka KK, Giannoglou GD, Michalis LK. Drug-eluting stent restenosis: effect of drug type, release kinetics, hemodynamics and coating strategy. Pharmacol Ther 2011; 134:43-53. [PMID: 22212618 DOI: 10.1016/j.pharmthera.2011.12.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 12/07/2011] [Indexed: 11/26/2022]
Abstract
Restenosis following stent implantation diminishes the procedure's efficacy influencing long-term clinical outcomes. Stent-based drug delivery emerged a decade ago as an effective means of reducing neointimal hyperplasia by providing localized pharmacotherapy during the acute phase of the stent-induced injury and the ensuing pathobiological mechanisms. However, drug-eluting stent (DES) restenosis may still occur especially when stents are used in complex anatomical and clinical scenarios. A DES consists of an intravascular metallic frame and carriers which allow controlled release of active pharmaceutical agents; all these components are critical in determining drug distribution locally and thus anti-restenotic efficacy. Furthermore, dynamic flow phenomena characterizing the vascular environment, and shear stress distribution, are greatly influenced by stent implantation and play a significant role in drug deposition and bioavailability within local vascular tissue. In this review, we discuss the performance of DES and the interaction of the different DES components with the hemodynamic milieu emphasizing on the inhibition of clinical restenosis.
Collapse
Affiliation(s)
- Michail I Papafaklis
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02120, USA.
| | | | | | | | | |
Collapse
|
32
|
Papafaklis MI, Bourantas CV, Theodorakis PE, Katsouras CS, Naka KK, Fotiadis DI, Michalis LK. The effect of shear stress on neointimal response following sirolimus- and paclitaxel-eluting stent implantation compared with bare-metal stents in humans. JACC Cardiovasc Interv 2011; 3:1181-9. [PMID: 21087755 DOI: 10.1016/j.jcin.2010.08.018] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2010] [Revised: 06/29/2010] [Accepted: 08/20/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We aimed to explore the relationship of neointimal thickness (NT) to shear stress (SS) after implantation of sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) compared with bare-metal stents (BMS). We then tested the hypothesis that drug elution attenuates the SS effect. BACKGROUND Neointimal thickness after BMS implantation has been associated with SS; pertinent data for drug-eluting stents (DES) are limited. METHODS Three-dimensional coronary artery and stent reconstruction was performed in 30 patients at 6-month follow-up after SES (n = 10), PES (n = 10), or BMS (n = 10) implantation. Baseline SS at the stent surface was calculated using computational fluid dynamics and NT at follow-up was computed in 3-dimensional space. RESULTS Neointimal thickness was lower in DES versus BMS (0.03 ± 0.07 mm vs. 0.16 ± 0.08 mm, p < 0.001) and maximum NT was reduced in SES versus PES (0.33 ± 0.13 mm vs. 0.46 ± 0.13 mm, p = 0.025). In the total population, both SS (slope: -0.05 mm/Pa, p < 0.001) and DES (coefficient for DES vs. BMS: -0.17 mm, p = 0.003) were independent predictors of NT. Subgroup analysis demonstrated a significant negative relationship of NT to SS in PES (slope: -0.05 mm/Pa, p = 0.016) and BMS (slope: -0.05 mm/Pa, p = 0.001). Sirolimus elution significantly attenuated the effect of SS on NT (interaction coefficient for SES vs. BMS: 0.04 mm/Pa, p = 0.023), whereas the SS effect remained unchanged in PES (interaction coefficient for PES vs. BMS: 0.01 mm/Pa, p = 0.71). CONCLUSIONS Neointimal thickness is significantly correlated (inversely) to SS in PES as in BMS. Sirolimus elution abrogates the SS effect on the neointimal response following stent implantation, whereas the SS effect is unchanged in PES.
Collapse
|
33
|
Bourantas CV, Garg S, Naka KK, Thury A, Hoye A, Michalis LK. Focus on the research utility of intravascular ultrasound - comparison with other invasive modalities. Cardiovasc Ultrasound 2011; 9:2. [PMID: 21276268 PMCID: PMC3039561 DOI: 10.1186/1476-7120-9-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Accepted: 01/30/2011] [Indexed: 01/08/2023] Open
Abstract
Intravascular ultrasound (IVUS) is an invasive modality which provides cross-sectional images of a coronary artery. In these images both the lumen and outer vessel wall can be identified and accurate estimations of their dimensions and of the plaque burden can be obtained. In addition, further processing of the IVUS backscatter signal helps in the characterization of the type of the plaque and thus it has been used to study the natural history of the atherosclerotic evolution. On the other hand its indigenous limitations do not allow IVUS to assess accurately stent struts coverage, existence of thrombus or exact site of plaque rupture and to identify some of the features associated with increased plaque vulnerability. In order this information to be obtained, other modalities such as optical coherence tomography, angioscopy, near infrared spectroscopy and intravascular magnetic resonance imaging have either been utilized or are under evaluation. The aim of this review article is to present the current utilities of IVUS in research and to discuss its advantages and disadvantages over the other imaging techniques.
Collapse
|