title: Impact of local endothelial shear stress on neointima and plaque following stent implantation in patients with ST-elevation myocardial infarction: A subgroup-analysis of the COMFORTABLE AMI-IBIS 4 trial.
abstract: BACKGROUND
  Numerous studies have demonstrated an association between endothelial shear stress (ESS) and neointimal formation after stent implantation. However, the role of ESS on the composition of neointima and underlying plaque remains unclear.
  
  
  METHODS
  Patients recruited in the Comfortable AMI-IBIS 4 study implanted with bare metal stents (BMS) or biolimus eluting stents (BES) that had biplane coronary angiography at 13 month follow-up were included in the analysis. The intravascular ultrasound virtual-histology (IVUS-VH) and the angiographic data were used to reconstruct the luminal surface, and the stent in the stented segments. Blood flow simulation was performed in the stent surface, which was assumed to represent the luminal surface at baseline, to assess the association between ESS and neointima thickness. The predominant ESS was estimated in 3-mm segments and was correlated with the amount of neointima, neointimal tissue composition, and with the changes in the underlying plaque burden and composition.
  
  
  RESULTS
  Forty three patients (18 implanted with BMS and 25 with BES) were studied. In both stent groups negative correlations were noted between ESS and neointima thickness in BMS (P < 0.001) and BES (P = 0.002). In BMS there was a negative correlation between predominant ESS and the percentage of the neointimal necrotic core component (P = 0.015). In BES group, the limited neointima formation did not allow evaluation of the effect of ESS on its tissue characteristics. ESS did not affect vessel wall remodeling and the plaque burden and composition behind BMS (P > 0.10) and BES (P > 0.45).
  
  
  CONCLUSIONS
  ESS determines neointimal formation in both BMS and BES and affects the composition of the neointima in BMS. Conversely, ESS does not impact the plaque behind struts irrespective of stent type throughout 13 months of follow-up.
authors.affiliation: Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands; University College of London, London, United Kingdom.
authors.forename: Christos V
authors.initials: CV
authors.lastname: Bourantas
authors.affiliation: Department of Interventional Cardiology, Bern University Hospital, Bern, Switzerland.
authors.forename: Lorenz
authors.initials: L
authors.lastname: Räber
authors.affiliation: Clinical Trials Unit, Bern University, Bern, Switzerland.
authors.forename: Serge
authors.initials: S
authors.lastname: Zaugg
authors.affiliation: Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece.
authors.forename: Antonis
authors.initials: A
authors.lastname: Sakellarios
authors.affiliation: Department of Interventional Cardiology, Bern University Hospital, Bern, Switzerland.
authors.forename: Masanori
authors.initials: M
authors.lastname: Taniwaki
authors.affiliation: Clinical Trials Unit, Bern University, Bern, Switzerland; Institute of Social and Preventive Medicine, Bern University, Bern, Switzerland.
authors.forename: Dik
authors.initials: D
authors.lastname: Heg
authors.affiliation: Department of Interventional Cardiology, Bern University Hospital, Bern, Switzerland.
authors.forename: Aris
authors.initials: A
authors.lastname: Moschovitis
authors.affiliation: The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Maria
authors.initials: M
authors.lastname: Radu
authors.affiliation: Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece.
authors.forename: Michail I
authors.initials: MI
authors.lastname: Papafaklis
authors.affiliation: Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece.
authors.forename: Fanis
authors.initials: F
authors.lastname: Kalatzis
authors.affiliation: Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece.
authors.forename: Katerina K
authors.initials: KK
authors.lastname: Naka
authors.affiliation: Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece.
authors.forename: Dimitrios I
authors.initials: DI
authors.lastname: Fotiadis
authors.affiliation: Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece.
authors.forename: Lampros K
authors.initials: LK
authors.lastname: Michalis
authors.affiliation: Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.affiliation: Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands.
authors.forename: Hector M
authors.initials: HM
authors.lastname: Garcia Garcia
authors.affiliation: Department of Interventional Cardiology, Bern University Hospital, Bern, Switzerland. Electronic address: stephan.windecker@insel.ch.
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
mesh_terms: D000368:Aged; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D017023:Coronary Angiography; D004311:Double-Blind Method; D054855:Drug-Eluting Stents; D004562:Electrocardiography; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery*; D058426:Neointima / Q000503:physiopathology*; D015607:Stents; D013314:Stress, Mechanical
keywords: Endothelial shear stress; Neo-atherosclerosis; Neointimal formation