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Effects of local hemodynamics and plaque characteristics on neointimal response following bioresorbable scaffolds implantation in coronary bifurcations

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Abstract

Heterogeneous neointimal response has been observed after implantation of all generations of coronary stents. Our aim was assessing local factors of shear stress (SS) and plaque characteristics in neointimal response after implantation of bioresorbable scaffolds (BRS) in bifurcations. Ten patients from the BIFSORB pilot study were analysed. Follow-up optical frequency domain imaging (OFDI) was performed at 1 month and 2 years. Coronary lumen and BRS structure were reconstructed by fusion of OFDI and angiography and were used for subsequent flow simulation. Plaque arc degree and SS were quantified using post-procedural OFDI data and were matched with follow-up OFDI using anatomical landmarks. Strut-level and segment-level analysis were performed for 1-month and 2-year follow-up respectively. A total of 444 struts (54 jailing struts) were included at 1-month follow-up. Time-average SS (TASS) was significantly lower for covered struts than for uncovered struts in non-bifurcation segments (TASS: 1.81 ± 1.87 vs. 3.88 ± 3.72 Pa, p < 0.001). The trend remained the same for jailing struts, although statistically insignificant (TASS: 10.85 ± 13.12 vs. 13.64 ± 14.48 Pa, p = 0.328). For 2-year follow-up, a total of 66 sub-regions were analysed. Neointimal hyperplasia area (NTA) was negatively correlated with TASS in core-segments (ρ = − 0.389, p = 0.037) and positively correlated with plaque arc degree in non-core segments (ρ = 0.387, p = 0.018). Slightly stronger correlations with NTA were observed when combining TASS and plaque arc degree in both core segments (ρ = − 0.412, p = 0.026) and non-core segments (ρ = − 0.395, p = 0.015). Hemodynamic microenvironment and baseline plaque characteristics may regulate neointimal response after BRS implantation in bifurcation. These findings underline the combined role of plaque characteristics and local hemodynamics in vessel healing after stent implantation.

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Abbreviations

BMS:

Bare metal stents

BRS:

Bioresorbable scaffolds

CFD:

Computational fluid dynamics

DES:

Drug-eluting stents

ISR:

In-stent restenosis

IST:

In-stent thrombosis

IVUS:

Intravascular ultrasound

OFDI:

Optical frequency domain imaging

OCT:

Optical coherence tomography

PCI:

Percutaneous coronary intervention

SB:

Side branch

SS:

Shear stress

SSG:

Shear stress gradient

TASS:

Time-average shear stress

TASSG:

Time-average shear stress gradient

NTA:

Neointimal hyperplasia area

NHT:

Neointimal hyperplasia thickness

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Funding

The study was supported by the Natural Science Foundation of China (Grant No. 81871460) and Program of Shanghai Technology Research Leader.

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Authors and Affiliations

  1. School of Biomedical Engineering, Shanghai Jiao Tong University, Room 123, No. 1954, Huashan Road, Shanghai, 200030, People’s Republic of China

    Miao Chu, Su Zhang, Jiayue Huang, Zehang Li & Shengxian Tu

  2. Department of Cardiology, Campo de Gibraltar Health Trust, Algeciras (Cádiz), Spain

    Miao Chu & Juan Luis Gutiérrez-Chico

  3. Division of Image Processing, Leiden University Medical Center, Leiden, The Netherlands

    Yingguang Li & Jouke Dijkstra

  4. Department of Cardiology, Aarhus University Hospital, Skejby, Denmark

    Emil N. Holck, Evald H. Christiansen & Niels R. Holm

  5. Department of Cardiology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China

    Lianglong Chen

Authors
  1. Miao Chu
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  2. Juan Luis Gutiérrez-Chico
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  3. Yingguang Li
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  4. Emil N. Holck
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  5. Su Zhang
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  6. Jiayue Huang
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  7. Zehang Li
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  11. Niels R. Holm
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Corresponding author

Correspondence to Shengxian Tu.

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Conflict of interest

Yingguang Li is employed by Medis medical imaging systems bv and has a research appointment at the Leiden University Medical Center (LUMC). Shengxian Tu received a research grant from Medis medical imaging and Pulse medical imaging technology, and Niels R. Holm received research grants from Medis medical imaging, Abbot, and Boston Scientific. All other authors declare that they have no conflict of interest.

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Chu, M., Gutiérrez-Chico, J.L., Li, Y. et al. Effects of local hemodynamics and plaque characteristics on neointimal response following bioresorbable scaffolds implantation in coronary bifurcations. Int J Cardiovasc Imaging 36, 241–249 (2020). https://doi.org/10.1007/s10554-019-01721-7

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  • DOI: https://doi.org/10.1007/s10554-019-01721-7

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