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Low coronary flow velocity and shear stress predict restenosis after sirolimus-eluting stent implantation
Hiroyuki Hikita1, Akira Sato, Toshihiro Nozato
1Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Kanagawa, Japan. hhikita-circ@umin.ac.jp
Insights
Lowered coronary flow velocity and shear stress after sirolimus-eluting stent implantation may predict restenosis risk. These findings are crucial for identifying patients at higher risk following the procedure.
Area of Science:
- Cardiovascular medicine
- Interventional cardiology
- Biomedical engineering
Background:
- Sirolimus-eluting stents are widely used to treat coronary artery disease.
- Restenosis remains a significant complication after stent implantation.
- Predictive markers for restenosis are essential for patient management.
Purpose of the Study:
- To evaluate the predictive value of coronary flow velocity and shear stress for angiographic restenosis.
- To assess the relationship between these hemodynamic parameters and restenosis after sirolimus-eluting stent implantation.
Main Methods:
- Successful sirolimus-eluting stent implantation for de novo coronary lesions.
- Follow-up angiography performed 6-9 months post-procedure.
- Measurement of coronary flow velocity and Reynolds number (shear stress index) using quantitative digital angiography.
Main Results:
- Analysis of 267 patients, with 21 in the Restenosis group and 246 in the Non-Restenosis group.
- Significantly lower coronary flow velocity in the Restenosis group (137.7 mm/sec) compared to the Non-Restenosis group (241.1 mm/sec).
- Significantly lower Reynolds number (shear stress index) in the Restenosis group (107.0) versus the Non-Restenosis group (199.2).
Conclusions:
- Reduced coronary flow velocity and shear stress are potential predictors of restenosis after sirolimus-eluting stenting.
- These hemodynamic factors may help identify patients at increased risk for restenosis.
- Further research can explore incorporating these measures into clinical risk stratification.
Objectives:
This study sought to assess predictive values of coronary flow velocity and an index of shear stress throughout the vessel for angiographic restenosis after sirolimus-eluting stent implantation.
Design:
The study patients underwent successful implantation of a sirolimus-eluting stent for de novo lesions located in native coronary vessels and underwent follow-up angiography 6-9 months later. The TIMI frame count method and quantitative digital angiographic analysis were performed based on the post-stenting angiogram. Coronary flow velocity and Reynolds number, an index of shear stress, were measured.
Results:
Post-stenting digital angiograms from 267 patients were analyzed. We divided the study patients into two groups: a Restenosis group with 21 patients and a Non-Restenosis group with 246 patients. The Restenosis group indicated significantly lower coronary flow velocity (137.7+/-35.6 mm/sec versus 241.1+/-72.9 mm/sec, p = 0.0001) and lower Reynolds number (107.0+/-35.8 versus 199.2+/-67.1, p = 0.0001) than did the Non-Restenosis group.
Conclusions:
Lowered coronary flow velocity and shear stress after sirolimus-eluting stenting may predict the risk of restenosis.
