Dynamic flow alterations dictate leukocyte adhesion and response to endovascular interventions.
Dynamic flow alterations dictate leukocyte adhesion and response to endovascular interventions.
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DOI：
10.1172/jci21007
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发表时间：
2004-06
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影响因子：
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通讯作者：
Yoram Richter;Adam Groothuis;P. Seifert;E. Edelman
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文献类型：
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作者：
Yoram Richter;Adam Groothuis;P. Seifert;E. Edelman
虽然动脉分叉处是阻塞性动脉粥样硬化病变的常见部位，但治疗这些病变的最佳方法仍未得到解决。对动脉分叉的实验室模型进行了分析，以确定与血管疾病相关的血流扰动。这些模型具有可适应的几何形状，能够模拟动脉疾病的过程和动脉介入的影响。慢性体内研究评价了血流干扰对新生内膜增生模式的影响。急性体内研究有助于提出一种机制，桥梁早期的机械刺激和后期的组织效应。侧分支（SB）扩张对主分支（MB）的血流模式产生不利影响，因此，影响植入猪动脉的支架的长期MB通畅性。这种影响的关键是慢性MB重塑，似乎弥补了闭塞SB。急性白细胞募集直接影响的流量模式的变化，这表明一方面和白细胞募集和内膜增生的另一方面之间的联系流动障碍。通常不可能同时最大化两个分支的总横截面积并最小化MB中的流动扰动。这两个临床理想目标之间的明显权衡可以解释分叉支架植入术的许多常见失效模式。
Although arterial bifurcations are frequent sites for obstructive atherosclerotic lesions, the optimal approach to these lesions remains unresolved. Benchtop models of arterial bifurcations were analyzed for flow disturbances known to correlate with vascular disease. These models possess an adaptable geometry capable of simulating the course of arterial disease and the effects of arterial interventions. Chronic in vivo studies evaluated the effect of flow disturbances on the pattern of neointimal hyperplasia. Acute in vivo studies helped propose a mechanism that bridges the early mechanical stimulus and the late tissue effect. Side-branch (SB) dilation adversely affected flow patterns in the main branch (MB) and, as a result, the long-term MB patency of stents implanted in pig arteries. Critical to this effect is chronic MB remodeling that seems to compensate for an occluded SB. Acute leukocyte recruitment was directly influenced by the changes in flow patterns, suggesting a link between flow disturbance on the one hand and leukocyte recruitment and intimal hyperplasia on the other. It is often impossible to simultaneously maximize the total cross-sectional area of both branches and to minimize flow disturbance in the MB. The apparent trade-off between these two clinically desirable goals may explain many of the common failure modes of bifurcation stenting.