title: Effects of Low Endothelial Shear Stress After Stent Implantation on Subsequent Neointimal Hyperplasia and Clinical Outcomes in Humans.
abstract: In-stent hyperplasia (ISH) may develop in regions of low endothelial shear stress (ESS), but the relationship between the magnitude of low ESS, the extent of ISH, and subsequent clinical events has not been investigated.
  
  
  
  We assessed the association of poststent ESS with neointimal ISH and clinical outcomes in patients treated with percutaneous coronary interventions (PCI). Three-dimensional coronary reconstruction was performed in 374 post-PCI patients at baseline and 6 to 10 months follow-up as part of the PREDICTION Study. Each vessel was divided into 1.5-mm-long segments, and we calculated the local ESS within each stented segment at baseline. At follow-up, we assessed ISH and the occurrence of a clinically indicated repeat PCI for in-stent restenosis. In 246 total stents (54 overlapping), 100 (40.7%) were bare-metal stents (BMS), 104 (42.3%) sirolimus-eluting stents, and 42 (17.1%) paclitaxel-eluting stents. In BMS, low ESS post-PCI at baseline was independently associated with ISH (β=1.47 mm(2) per 1-Pa decrease; 95% CI, 0.38-2.56; P<0.01). ISH was minimal in drug-eluting stents. During follow-up, repeat PCI in BMS was performed in 21 stents (8.5%). There was no significant association between post-PCI ESS and in-stent restenosis requiring PCI.
  
  
  
  Low ESS after BMS implantation is associated with subsequent ISH. ISH is strongly inhibited by drug-eluting stents. Post-PCI ESS is not associated with in-stent restenosis requiring repeat PCI. ESS is an important determinant of ISH in BMS, but ISH of large magnitude to require PCI for in-stent restenosis is likely attributed to factors other than ESS within the stent.
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan.
authors.forename: Koki
authors.initials: K
authors.lastname: Shishido
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Antonios P
authors.initials: AP
authors.lastname: Antoniadis
authors.affiliation: Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan.
authors.forename: Saeko
authors.initials: S
authors.lastname: Takahashi
authors.affiliation: Hakodate Municipal Hospital, Hakodate, Japan.
authors.forename: Masaya
authors.initials: M
authors.lastname: Tsuda
authors.affiliation: Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Mizuno
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Andreou
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Michail I
authors.initials: MI
authors.lastname: Papafaklis
authors.affiliation: Mechanical and Industrial Engineering, Northeastern University, Boston, MA.
authors.forename: Ahmet U
authors.initials: AU
authors.lastname: Coskun
authors.affiliation: Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA.
authors.forename: Caroline
authors.initials: C
authors.lastname: O'Brien
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Feldman
authors.affiliation: Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Saito
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA.
authors.forename: Elazer R
authors.initials: ER
authors.lastname: Edelman
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA pstone@partners.org.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Stone
mesh_terms: D000368:Aged; D023903:Coronary Restenosis / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D054855:Drug-Eluting Stents; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006965:Hyperplasia / Q000209:etiology* / Q000503:physiopathology; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D058426:Neointima / Q000473:pathology*; D062645:Percutaneous Coronary Intervention; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives; D015607:Stents / Q000009:adverse effects*; D013314:Stress, Mechanical; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; C489443:zotarolimus; D020123:Sirolimus
keywords: imaging; in‐stent restenosis; neointimal hyperplasia; percutaneous coronary intervention; shear stress