Stent implantation alters coronary artery hemodynamics and wall shear stress during maximal vasodilation
Stent implantation alters coronary artery hemodynamics and wall shear stress during maximal vasodilation
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DOI：
10.1152/japplphysiol.00544.2002
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发表时间：
2002-12-01
影响因子：
3.3
通讯作者：
Pagel, PS
中科院分区：
文献类型：
--
作者：
LaDisa, JF;Hettrick, DA;Pagel, PS
冠状动脉支架可以改善血管狭窄时的静息血流量和血流储备，但在深度血管舒张过程中，这些装置对流体动力学的影响在很大程度上是未知的。我们验证了支架植入影响麻醉犬（n = 6）冠状动脉血流动力学和管壁剪切应力改变的假设，该假设用于测量左冠状动脉前降支（LAD）血流、速度、直径和曲率半径。在没有腺苷输注（1.0 mg/min）和有腺苷输注的情况下，测定开槽管支架放置前后的流体动力学和剪切应力指标。腺苷增加血流、雷诺数（Re）和迪安数（De）以及区域和振荡剪切应力，同时降低支架植入前LAD血管阻力和节段顺应性。支架置放后LAD血流量、Re、De、剪切应力等指标均升高（P < 0.05）。支架植入将LAD节段顺应性降低到零，并增强了腺苷期间节段和冠状血管阻力的增加。腺苷引起的冠状动脉血流量和储备、Re、De、区域剪应力和振荡剪应力的增加在支架植入后减弱。结果表明，支架植入钝化了体内冠状动脉血管舒张过程中流体动力学的改变。
Coronary stents improve resting blood flow and flow reserve in the presence of stenoses, but the impact of these devices on fluid dynamics during profound vasodilation is largely unknown. We tested the hypothesis that stent implantation affects adenosine-induced alterations in coronary hemodynamics and wall shear stress in anesthetized dogs (n = 6) instrumented for measurement of left anterior descending coronary artery (LAD) blood flow, velocity, diameter, and radius of curvature. Indexes of fluid dynamics and shear stress were determined before and after placement of a slotted-tube stent in the absence and presence of an adenosine infusion (1.0 mg/min). Adenosine increased blood flow, Reynolds (Re) and Dean numbers (De), and regional and oscillatory shear stress concomitant with reductions in LAD vascular resistance and segmental compliance before stent implantation. Increases in LAD blood flow, Re, De, and indexes of shear stress were observed after stent deployment (P < 0.05). Stent implantation reduced LAD segmental compliance to zero and potentiated increases in segmental and coronary vascular resistance during adenosine. Adenosine-induced increases in coronary blood flow and reserve, Re, De, and regional and oscillatory shear stress were attenuated after the stent was implanted. The results indicate that stent implantation blunts alterations in fluid dynamics during coronary vasodilation in vivo.