The Effect of Shear Stress on Neointimal Response Following Sirolimus- and Paclitaxel-Eluting Stent Implantation Compared With Bare-Metal Stents in Humans
The Effect of Shear Stress on Neointimal Response Following Sirolimus- and Paclitaxel-Eluting Stent Implantation Compared With Bare-Metal Stents in Humans
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DOI：
10.1016/j.jcin.2010.08.018
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发表时间：
2010-11-01
影响因子：
11.3
通讯作者：
Michalis, Lampros K.
中科院分区：
文献类型：
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作者：
Papafaklis, Michail I.;Bourantas, Christos V.;Michalis, Lampros K.
目的探讨西罗莫司洗脱支架（SES）和紫杉醇洗脱支架（PES）与裸金属支架（BMS）植入后新生内膜厚度（NT）与切应力（SS）的关系。然后，我们测试的假设，即药物洗脱衰减SS effect.Background BMS植入后的新生内膜厚度与SS相关;药物洗脱支架（DES）的相关数据是limited.Methods三维冠状动脉和支架重建30例患者在6个月后进行后续SES（n = 10），PES（n = 10），或BMS（n = 10）植入。支架表面的基线SS采用计算流体动力学方法计算，随访时NT采用三维空间计算。（0.03 +/-0.07 mm vs. 0.16 +/-0.08 mm，p <0.001），SES与PES的最大NT降低（0.33 +/-0.13 mm vs. 0.46 +/-0.13 mm，p = 0.025）。在总人群中，SS（斜率：-0.05 mm/Pa，p <0.001）和DES（DES与BMS的系数：-0.17 mm，p = 0.003）均为NT的独立预测因子。亚组分析显示PES（斜率：-0.05 mm/Pa，p = 0.016）和BMS（斜率：-0.05 mm/Pa，p = 0.001）中NT与SS呈显著负相关。西罗莫司洗脱显著减弱了SS对NT的影响（SES与BMS的相互作用系数：0.04 mm/Pa，p = 0.023），而PES中SS的影响保持不变（PES与BMS的相互作用系数：0.01 mm/Pa，p = 0.71）。西罗莫司洗脱消除了支架植入后SS对新生内膜反应的影响，而PES中的SS影响未发生变化。（J Am科尔Cardiol Intv 2010; 3：1181 - 9）（C）美国心脏病学会基金会2010年
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. (J Am Coll Cardiol Intv 2010;3:1181-9) (C) 2010 by the American College of Cardiology Foundation