Papafaklis Michail I, Katsouras Christos S, Theodorakis Panagiotis E, Bourantas Christos V, Fotiadis Dimitrios I, Michalis Lampros K
Michaelideion Cardiac Center, University of Ioannina, Greece.
Heart Vessels. 2007 Jul;22(4):268-73. doi: 10.1007/s00380-006-0970-9. Epub 2007 Jul 20.
We report a patient with coronary dilatation 10 weeks after paclitaxel-eluting stent implantation in the right coronary artery (RCA). Coronary angiography demonstrated a double-locular lumen dilatation in the body of the stented segment of the RCA, and intravascular ultrasound interrogation revealed the corresponding region with evidence of tissue regression behind the stent struts, incomplete stent apposition, and lumen enlargement. After three-dimensionally (3D) reconstructing the RCA, we applied computational fluid dynamics to the 3D RCA model, representing the lumen of the artery at the moment of stent implantation, and investigated the correlation of both neointimal thickness and tissue regression depth with shear stress in the stent. Neointimal thickness was found to be inversely related to shear stress, but there was no significant association of tissue regression depth with shear stress. Post-procedural stent malapposition, thrombus dissolution, and less possibly, a localized hypersensitivity reaction are potential mechanisms for the lumen enlargement in this case.
我们报告了1例在右冠状动脉（RCA）植入紫杉醇洗脱支架10周后出现冠状动脉扩张的患者。冠状动脉造影显示RCA支架植入段体部存在双腔扩张，血管内超声检查显示支架支柱后方相应区域有组织消退、支架贴壁不全及管腔扩大的证据。在对RCA进行三维（3D）重建后，我们将计算流体动力学应用于代表支架植入时动脉管腔的3D RCA模型，研究新生内膜厚度和组织消退深度与支架内剪切应力的相关性。发现新生内膜厚度与剪切应力呈负相关，但组织消退深度与剪切应力无显著关联。术后支架贴壁不良、血栓溶解以及可能性较小的局部过敏反应是该病例管腔扩大的潜在机制。
