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Stent underexpansion is associated with high wall shear stress: a biomechanical analysis of the shear stent study

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Author(s)
Sonali KumarDavid MolonySameer KhawajaKaylyn CrawfordElizabeth W ThompsonOlivia HungImran ShahJessica Navas-SimbanaArlen HoArnav KumarYi-An KoHossein HosseiniAdrien LefieuxJoo Myung LeeJoo-Yong HahnShao-Liang ChenHiromasa OtakeTakashi AkasakaEun-Seok ShinBon-Kwon KooGoran StankovicDejan MilasinovicChang-Wook NamKi-Bum WonJavier EscanedAndrejs ErglisYoshinobu MurasatoAlessandro VenezianiHabib Samady
Keimyung Author(s)
Nam, Chang Wook
Department
Dept. of Internal Medicine (내과학)
Journal Title
Int J Cardiovasc Imaging
Issued Date
2023
Volume
39
Issue
7
Keyword
Intravascular ultrasoundPercutaneous coronary interventionUnderexpansionWall shear stress
Abstract
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.
Keimyung Author(s)(Kor)
남창욱
Publisher
School of Medicine (의과대학)
Type
Article
ISSN
1875-8312
Source
https://link.springer.com/article/10.1007/s10554-023-02838-6
DOI
10.1007/s10554-023-02838-6
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/44981
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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