Endothelial shear stress and vascular remodeling in bioresorbable scaffold and metallic stent

Erhan Tenekecioğlu ,Steffen Helqvist ,Johan H C Reiber ,Manel Sabaté ,Bernard Chevalier ,Pieter H Kitslaar ,Frank Gijsen ,Dilek Ural ,Didier Carrié ,Mariusz Tomaniak ,Christos V Bourantas ,Andreas Baumbach ,Yoshinobu Onuma ,Kerem Pekkan ,Ángel Cequier ,Andrés Íñiguez ,Yuki Katagiri ,Rinse Johannes Van Der Schaaf ,Jan J Piek ,Ryo Torii ,Ad J Van Boven ,Kuniaki Takahashi ,Jouke Dijkstra ,Marcello Dominici ,Dariusz Dudek ,Patrick W Serruys

doi:10.1016/j.atherosclerosis.2020.08.031

Abstract

Background and aimsThe impact of endothelial shear stress (ESS) on vessel remodeling in vessels implanted with bioresorbable scaffold (BRS) as compared to metallic drug-eluting stent (DES) remains elusive. The aim of this study was to determine whether the relationship between ESS and remodeling patterns differs in BRS from those seen in metallic DES at 3-year follow-up. MethodsIn the ABSORB II randomized trial, lesions were investigated by serial coronary angiography and intravascular ultrasound (IVUS). Three-dimensional reconstructions of coronary arteries post-procedure and at 3 years were performed. ESS was quantified using non-Newtonian steady flow simulation. IVUS cross-sections in device segment were matched using identical landmarks. ResultsPaired ESS calculations post-procedure and at 3 years were feasible in 57 lesions in 56 patients. Post-procedure, median ESS at frame level was higher in BRS than in DES, with marginal statistical significance (0.97 ± 0.48 vs. 0.75 ± 0.39 Pa, p = 0.063). In the BRS arm, vessel area and lumen area showed larger increases in the highest tercile of median ESS post-procedure as compared to the lowest tercile. In contrast, in DES, no significant relationship between median ESS post-procedure and remodeling was observed. In multivariate analysis, smaller vessel area, larger lumen area, higher plaque burden post-procedure, and higher median ESS post-procedure were independently associated with expansive remodeling in matched frames. Only in BRS, younger age was an additional significant predictor of expansive remodeling. ConclusionsIn a subset of lesions with large plaque burden, shear stress could be associated with expansive remodeling and late lumen enlargement in BRS, while ESS had no impact on vessel dimension in metallic DES.

Highlights

Since the association of endothelial shear stress (ESS) with vessel remodeling is based on time-averaged data over 3 years, we focused on steady flow simulations [18]
Out of 546 lesions in 501 patients enrolled in ABSORB-II trial, paired ESS post-procedure and at 3 years were analyzable in 35 lesions in 35 patients in the bioresorbable scaffold (BRS) arm and 22 lesions in 21 patients in the drug-eluting stent (DES) arm
The main findings of the present study were: (1) The vessel segments implanted with BRS demonstrated a higher ESS as compared to those with DES both post-procedure and at 3 years; (2) overall, higher medianESS, smaller vessel area, larger lumen area, and higher plaque burden post-procedure were independently associated with expansive remod eling at long term follow-up; (3) only in BRS, younger age was an additional significant predictor of expansive remodeling

Summary

Introduction

Given the transient scaffolding and recovery of vasomotion in the instrumented vessels, bioresorbable scaffolds (BRS) have emerged as a potential solution for drawbacks of metallic drug-eluting stents (DES) that causes permanent vessel straightening and loss of compliance, dy namic vessel remodeling and mechanotransduction [1]. These short comings may influence vessel wall metabolism and contribute to late degeneration of intra-device neointima leading to neoatherosclerotic lesion formation. The impact of endothelial shear stress (ESS) on vessel remodeling in vessels implanted with bioresorbable scaffold (BRS) as compared to metallic drug-eluting stent (DES) remains elusive. In the BRS arm, vessel area and lumen area showed larger increases

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