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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
High shear stress after successful balloon angioplasty is associated with restenosis and target lesion
Attila Thury1, Glenn van Langenhove, Stephane G Carlier
1Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, The Netherlands.
Insights
Wall shear stress (WSS) after balloon angioplasty predicts restenosis. Proximal WSS is an independent predictor of target lesion revascularization, aiding treatment decisions.
Area of Science:
- Cardiovascular medicine
- Medical imaging
- Biophysics
Background:
- Vascular wall shear stress (WSS) is implicated in atherosclerosis and vascular remodeling.
- Assessing WSS post-angioplasty may predict long-term outcomes.
Purpose of the Study:
- To calculate WSS after balloon angioplasty.
- To evaluate WSS's predictive value for long-term outcomes.
Main Methods:
- Calculated WSS proximal, in, and distal to the lesion using the Hagen-Poiseuille formula in 202 patients.
- Derived volumetric blood flow (Q) and lumen radius (R) from Doppler velocities and cross-sectional areas.
Main Results:
- Postprocedural in-lesion WSS was higher in patients who developed restenosis (3.61 N/m2) compared to those who did not (2.46 N/m2).
- In-lesion WSS predicted restenosis (OR=1.42), and proximal WSS predicted target lesion revascularization (OR=2.33).
- Proximal WSS was the sole independent predictor in a multivariate model including diameter stenosis and coronary flow reserve (OR=2.15).
Conclusions:
- WSS within the lesion after balloon angioplasty predicts angiographic restenosis.
- Proximal WSS independently predicts target lesion revascularization.
- WSS offers a combined anatomical and physiological parameter for assessing the need for adjunctive therapy post-angioplasty.
Background:
Vascular wall shear stress (WSS) has been implied in the pathogenesis of atherosclerosis and vascular remodeling. Our aim was to calculate WSS after balloon angioplasty and evaluate its predictive value for long-term outcome.
Methods:
WSS was calculated proximal to, in, and distal to the lesion after angiographically successful balloon dilatation and at follow-up with the Hagen-Poiseuille formula (WSS = 4 microQ/piR3) in 202 patients. Volumetric blood flow (Q) and lumen radius (R) were derived from Doppler scanning velocities and videodensitometric cross-sectional areas.
Results:
Postprocedural proximal and in-lesion values were higher in vessels that developed restenosis (n = 72; 1.22 +/- 0.61 N/m2 and 3.61 +/- 2.38 N/m2, respectively) than in those without restenosis (n = 130, 1.05 +/- 0.51 N/m2 and 2.46 +/- 1.39 N/m2, respectively; P <.05). In-lesion WSS was revealed to be predictive of restenosis by means of logistic regression analysis (odds ratio [OR] = 1.42, P <.05), whereas WSS of the proximal segment was associated with an increased rate of target lesion revascularization (OR = 2.33, P <.005). In the multivariate regression model, WSS of the proximal segment was the only independent predictor when entered with known predictors such as diameter stenosis and coronary flow reserve (OR = 2.15, P <.05).
Conclusions:
WSS in the lesion after balloon angioplasty is predictive of angiographic restenosis. Moreover, the proximal value is an independent predictor of target lesion revascularization. This study opens perspectives for the on-line use of WSS as a combined parameter of anatomy and physiology to assess the necessity of adjunctive therapy after successful balloon dilatation.
