Implications of the local hemodynamic forces on the formation and destabilization of neoatherosclerotic lesions

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:272

Article

Torii, Ryo¹  Stettler, Rodrigue²  Raber, Lorenz³  Zhang, Yao-Jun^4,10  Karanasos, Antonis⁵  Dijkstra, Jouke⁶  Patel, Kush²  Crake, Tom²  Hamshere, Steve²  Garcia-Garcia, Hector M.⁵  Tenekecioglu, Erhan⁵  Ozkor, Muhiddin²  Baumbach, Andreas^2,7  Windecker, Stephan³  Serruys, Patrick W.^5,8  Regar, Evelyn¹¹  Mathur, Anthony^2,7  Bourantas, Christos, V^2,7,9 

[1] UCL, Dept Mech Engn, London, England

[2] Barts Hlth NHS, Bans Heart Ctr, London, England

[3] Bern Univ Hosp, Bern, Switzerland

[4] Jiangsu Univ, Xuzhou Peoples Hosp 3, Xuzhou, Jiangsu, Peoples R China

[5] Erasmus MC, Thoraxctr, Rotterdam, Netherlands

[6] Leiden Univ, Med Ctr, Leiden, Netherlands

[7] Queen Mary Univ London, London, England

[8] Imperial Coll London, Fac Med, Natl Heart & Lung Inst, London, England

[9] UCL, Inst Cardiovasc Sci, London, England

[10] Nanjing Med Univ, Nanjing Hosp 1, Nanjing, Jiangsu, Peoples R China

[11] Univ Hosp Zurich, Dept Cardiovasc Surg, Zurich, Switzerland

关键词: Neoatherosclerosis;    Endothelial shear stress;    Optical coherence tomography;   

DOI  :  10.1016/j.ijcard.2018.06.065

来源: Elsevier

【 摘 要 】

Objective: To examine the implications of endothelial shear stress (ESS) distribution in the formation of neoalherosclerotic lesions. Methods: Thirty six patients with neoatherosclerotic lesions on optical coherence tomography (OCT) were included in this study. The OCT data were used to reconstruct coronary anatomy. Blood flow simulation was performed in the models reconstructed from the stent borders which it was assumed that represented the lumen surface at baseline, immediate after stent implantation, and the estimated ESS was associated with the neointima burden, neoatherosclerotic burden and neointima characteristics. In segments with neointima rupture blood flow simulation was also performed in the model representing the lumen surface before rupture and the ESS was estimated at the ruptured site. Results: An inverse association was noted between baseline ESS and the incidence and the burden of neoatherosclerotic (beta = -0.60, P < 0.001, and beta = -4.05, P < 0.001, respectively) and lipid-rich neoatherosclerotic tissue ( beta = - 0.54, P < 0.001, and beta = -3.60, P < 0.001, respectively). Segments exposed to low ESS (<1 Pa) were more likely to exhibit macrophages accumulation (282% vs 10.9%, P < 0.001), thrombus (11.0% vs 2.6%, P < 0.001) and evidence of neointima discontinuities (8.1% vs 0.9%, P < 0.001) compared to those exposed to normal or high ESS. In segments with neointima rupture the ESS was high at the rupture site compared to the average ESS over the culprit lesion (4.00 +/- 3.65 Pa vs 3.14 +/- 2.90 Pa, P < 0.001). Conclusions: Local EES is associated with neoatherosclerotic lesion characteristics, which suggests involvement of ESS in the formation of vulnerable plaques in stented segments. (C) 2018 Elsevier B.V. All rights reserved.

【 授权许可】

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