Abstract 17675: The Relationship of Endothelial Shear Stress after Stent Implantation with In-Stent Neointimal Hyperplasia and Clinical Outcomes in Humans
Background: Neointimal in-stent hyperplasia (ISH) is a frequent complication of percutaneous coronary interventions (PCI), and ultimately may lead to in-stent restenosis (ISR). ISH may develop in regions of low endothelial shear stress (ESS) within the stent, but the relationship between ESS magnitude, the extent of ISH and subsequent clinical events has not been investigated. In patients with an acute coronary syndrome treated with PCI, we assessed the impact of post-PCI ESS on the ISH and ISR requiring repeat PCI.
Methods: We investigated the PREDICTION Study database with focus on stents. 3D coronary reconstruction by angiography & intravascular ultrasound was performed in 374 patients after stent implantation (baseline, BL) and at 6-10 month follow-up (FU). Each stent was divided into 1.5mm-long segments, within which we calculated ESS at BL with computational fluid dynamics. At FU, we assessed percent ISH (ISH area/stent area) and the occurrence of a clinically indicated PCI in the same locations.
Results: We analyzed 246 total stents: 100 (40.7%) bare-metal stents (BMS), 104 (42.3%) sirolimus-eluting stents (SES) and 42 (17.1%) paclitaxel-eluting stents (PES). Low BL ESS (per 1-Pa decrease) was independently associated with FU ISH in BMS (β=1.47, 95%CI 0.38 to 2.56, p<0.01) and PES (β=0.96, 95%CI 0.25 to 1.67, p<0.01), but not in SES. Subsequent repeat PCI for ISR was performed in 21 stents (8.5%). Independent baseline predictors of repeat PCI were stent area (per 1-mm2 decrease, odds ratio [OR] 1.39; 95% CI, 1.01 to1.89, p<0.05) and high plaque burden behind the stent (per 1-mm2 increase, OR 2.65; 95% CI, 1.56 to 4.48, p<0.001). There was no significant relationship between BL ESS and repeat PCI. Stent type was not significantly associated with repeat PCI, either.
Conclusions: ISH after BMS and PES implantation is associated with preceding local low ESS, but the same does not apply for SES. Within this limited FU duration low ESS is associated with ISH but probably not to an extent which would require a repeat intervention. ESS is likely an important component of stent behavior which may drive the subsequent natural history of stented lesions in humans.
Author Disclosures: K. Shishido: None. A. Antoniadis: None. S. Takahashi: None. M. Tsuda: None. M.I. Papafaklis: None. I. Andreou: None. A.U. Coskun: None. S. Saito: None. C.L. Feldman: None. P.H. Stone: None.
- © 2014 by American Heart Association, Inc.