title: Effect of the endothelial shear stress patterns on neointimal proliferation following drug-eluting bioresorbable vascular scaffold implantation: an optical coherence tomography study.
abstract: OBJECTIVE
  This study sought to investigate the effect of endothelial shear stress (ESS) on neointimal formation following an Absorb bioresorbable vascular scaffold (BVS) (Abbott Vascular, Santa Clara, California) implantation.
  
  
  BACKGROUND
  Cumulative evidence, derived from intravascular ultrasound-based studies, has demonstrated a strong association between local ESS patterns and neointimal formation in bare-metal stents, whereas in drug-eluting stents, there are contradictory data about the effect of ESS on the vessel wall healing process. The effect of ESS on neointimal development following a bioresorbable scaffold implantation remains unclear.
  
  
  METHODS
  Twelve patients with an obstructive lesion in a relatively straight arterial segment, who were treated with an Absorb BVS and had serial optical coherence tomographic examination at baseline and 1-year follow-up, were included in the current analysis. The optical coherence tomographic data acquired at follow-up were used to reconstruct the scaffolded segment. Blood flow simulation was performed on the luminal surface at baseline defined by the Absorb BVS struts, and the computed ESS was related to the neointima thickness measured at 1-year follow-up.
  
  
  RESULTS
  At baseline, the scaffolded segments were exposed to a predominantly low ESS environment (61% of the measured ESS was <1 Pa). At follow-up, the mean neointima thickness was 113 ± 45 μm, whereas the percentage scaffold volume obstruction was 13.1 ± 6.6%. A statistically significant inverse correlation was noted between baseline logarithmic transformed ESS and neointima thickness at 1-year follow-up in all studied segments (correlation coefficient range -0.140 to -0.662). Mixed linear regression analysis between baseline logarithmic transformed ESS and neointima thickness at follow-up yielded a slope of -31 μm/ln(Pa) and a y-intercept of 99 μm.
  
  
  CONCLUSIONS
  The hemodynamic microenvironment appears to regulate neointimal response following an Absorb BVS implantation. These findings underline the role of the ESS patterns on vessel wall healing and should be taken into consideration in the design of bioresorbable devices.
authors: Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, the Netherlands.
authors: Christos V
authors: CV
authors: Bourantas
authors: Cardiovascular Division, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Michail I
authors: MI
authors: Papafaklis
authors: Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece.
authors: Anna
authors: A
authors: Kotsia
authors: Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, the Netherlands.
authors: Vasim
authors: V
authors: Farooq
authors: Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, the Netherlands.
authors: Takashi
authors: T
authors: Muramatsu
authors: Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, the Netherlands.
authors: Josep
authors: J
authors: Gomez-Lara
authors: Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, the Netherlands.
authors: Yao-Jun
authors: YJ
authors: Zhang
authors: Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, the Netherlands.
authors: Javaid
authors: J
authors: Iqbal
authors: Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece.
authors: Fanis G
authors: FG
authors: Kalatzis
authors: Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece.
authors: Katerina K
authors: KK
authors: Naka
authors: Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece.
authors: Dimitrios I
authors: DI
authors: Fotiadis
authors: Abbott Vascular, Diegem, Belgium.
authors: Cecile
authors: C
authors: Dorange
authors: Abbott Vascular, Santa Clara, California.
authors: Jin
authors: J
authors: Wang
authors: Abbott Vascular, Santa Clara, California.
authors: Richard
authors: R
authors: Rapoza
authors: Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, the Netherlands.
authors: Hector M
authors: HM
authors: Garcia-Garcia
authors: Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, the Netherlands.
authors: Yoshinobu
authors: Y
authors: Onuma
authors: Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece.
authors: Lampros K
authors: LK
authors: Michalis
authors: Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, the Netherlands. Electronic address: p.w.j.c.serruys@erasmusmc.nl.
authors: Patrick W
authors: PW
authors: Serruys
mesh_terms: D020341:Absorbable Implants / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D049109:Cell Proliferation; D023921:Coronary Stenosis / Q000175:diagnosis / Q000601:surgery*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D004730:Endothelium, Vascular / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D058426:Neointima / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology*; D054457:Tissue Scaffolds / Q000009:adverse effects*; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
keywords: bioresorbable scaffold; endothelial shear stress; neointimal formation; optical coherence tomography