Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, the Netherlands.
Cardiovascular Division, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts.
JACC Cardiovasc Interv. 2014 Mar;7(3):315-24. doi: 10.1016/j.jcin.2013.05.034. Epub 2014 Feb 13.
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.
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.
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.
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.
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.
本研究旨在探讨内皮剪切应力（ESS）对 Absorb 生物可吸收血管支架（BVS）（雅培血管，圣克拉拉，加利福尼亚）植入后新生内膜形成的影响。
基于血管内超声的研究结果表明，局部 ESS 模式与裸金属支架中的新生内膜形成之间存在很强的关联，而在药物洗脱支架中，关于 ESS 对血管壁愈合过程的影响存在矛盾的数据。生物可吸收支架植入后 ESS 对新生内膜形成的影响尚不清楚。
本研究纳入了 12 例存在相对直段阻塞性病变的患者，这些患者接受了 Absorb BVS 治疗，并在基线和 1 年随访时进行了连续光学相干断层扫描检查。在随访时获取的光学相干断层扫描数据用于重建支架段。在基线时，基于 Absorb BVS 支架对管腔表面进行血流模拟，并将计算得出的 ESS 与 1 年随访时测量的新生内膜厚度相关联。
在基线时，支架段暴露在主要为低 ESS 的环境中（61%的测量 ESS<1 Pa）。在随访时，平均新生内膜厚度为 113±45 μm，而支架体积阻塞率为 13.1±6.6%。在所有研究的节段中，均观察到基线对数 ESS 与 1 年随访时新生内膜厚度之间存在显著的负相关（相关系数范围为-0.140 至-0.662）。在基线对数 ESS 与随访时新生内膜厚度之间进行混合线性回归分析得出斜率为-31 μm/ln(Pa)，截距为 99 μm。
血流动力学微环境似乎调节了 Absorb BVS 植入后的新生内膜反应。这些发现强调了 ESS 模式对血管壁愈合的作用，在设计生物可吸收装置时应考虑到这一点。
