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Endothelial shear stress and vascular remodeling in bioresorbable scaffold and metallic stent

Tenekecioglu, E; Katagiri, Y; Takahashi, K; Tomaniak, M; Dudek, D; Cequier, A; Carrie, D; ... Serruys, PW; + view all (2020) Endothelial shear stress and vascular remodeling in bioresorbable scaffold and metallic stent. Atherosclerosis , 312 pp. 79-89. 10.1016/j.atherosclerosis.2020.08.031. Green open access

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Abstract

BACKGROUND AND AIMS: The impact of endothelial shear stress (ESS) on vessel remodeling in vessels implanted with bioresorbable scaffold (BRS) as compared to metallic drug-eluting stent (DES) remains elusive. The aim of this study was to determine whether the relationship between ESS and remodeling patterns differs in BRS from those seen in metallic DES at 3-year follow-up. METHODS: In the ABSORB II randomized trial, lesions were investigated by serial coronary angiography and intravascular ultrasound (IVUS). Three-dimensional reconstructions of coronary arteries post-procedure and at 3 years were performed. ESS was quantified using non-Newtonian steady flow simulation. IVUS cross-sections in device segment were matched using identical landmarks. RESULTS: Paired ESS calculations post-procedure and at 3 years were feasible in 57 lesions in 56 patients. Post-procedure, median ESS at frame level was higher in BRS than in DES, with marginal statistical significance (0.97 ± 0.48 vs. 0.75 ± 0.39 Pa, p = 0.063). In the BRS arm, vessel area and lumen area showed larger increases in the highest tercile of median ESS post-procedure as compared to the lowest tercile. In contrast, in DES, no significant relationship between median ESS post-procedure and remodeling was observed. In multivariate analysis, smaller vessel area, larger lumen area, higher plaque burden post-procedure, and higher median ESS post-procedure were independently associated with expansive remodeling in matched frames. Only in BRS, younger age was an additional significant predictor of expansive remodeling. CONCLUSIONS: In a subset of lesions with large plaque burden, shear stress could be associated with expansive remodeling and late lumen enlargement in BRS, while ESS had no impact on vessel dimension in metallic DES.

Type: Article
Title: Endothelial shear stress and vascular remodeling in bioresorbable scaffold and metallic stent
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.atherosclerosis.2020.08.031
Publisher version: https://doi.org/10.1016/j.atherosclerosis.2020.08....
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions.
Keywords: Stenting, Bioresorbable scaffold, Vessel remodeling, Shear stress
UCL classification: UCL
UCL > Provost and Vice Provost Offices > UCL BEAMS
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science > Dept of Mechanical Engineering
URI: https://discovery.ucl.ac.uk/id/eprint/10117257
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