Stent underexpansion is associated with high wall shear stress: a biomechanical analysis of the shear stent study.
Intravascular ultrasound
Percutaneous coronary intervention
Underexpansion
Wall shear stress
Journal
The international journal of cardiovascular imaging
ISSN: 1875-8312
Titre abrégé: Int J Cardiovasc Imaging
Pays: United States
ID NLM: 100969716
Informations de publication
Date de publication:
Jul 2023
Jul 2023
Historique:
received:
23
06
2022
accepted:
15
03
2023
medline:
12
6
2023
pubmed:
29
4
2023
entrez:
29
4
2023
Statut:
ppublish
Résumé
Coronary stent underexpansion is associated with restenosis and stent thrombosis. In clinical studies of atherosclerosis, high wall shear stress (WSS) has been associated with activation of prothrombotic pathways, upregulation of matrix metalloproteinases, and future myocardial infarction. We hypothesized that stent underexpansion is predictive of high WSS. WSS distribution was investigated in patients enrolled in the prospective randomized controlled study of angulated coronary arteries randomized to undergo percutaneous coronary intervention with R-ZES or X-EES. WSS was calculated from 3D reconstructions of arteries from intravascular ultrasound (IVUS) and angiography using computational fluid dynamics. A logistic regression model investigated the relationship between WSS and underexpansion and the relationship between underexpansion and stent platform. Mean age was 63±11, 78% were male, 35% had diabetes, mean pre-stent angulation was 36.7°±14.7°. Underexpansion was assessed in 83 patients (6,181 IVUS frames). Frames with stent underexpansion were significantly more likely to exhibit high WSS (> 2.5 Pa) compared to those without underexpansion with an OR of 2.197 (95% CI = [1.233-3.913], p = 0.008). There was no significant association between underexpansion and low WSS (< 1.0 Pa) and no significant differences in underexpansion between R-ZES and X-EES. In the Shear Stent randomized controlled study, underexpanded IVUS frames were more than twice as likely to be associated with high WSS than frames without underexpansion.
Identifiants
pubmed: 37119348
doi: 10.1007/s10554-023-02838-6
pii: 10.1007/s10554-023-02838-6
doi:
Types de publication
Randomized Controlled Trial
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1375-1382Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer Nature B.V.
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