Abstract
A recent randomized clinical trial on intracranial atherosclerosis was discontinued because of the higher frequency of stroke and death in the angioplasty and stent placement group than in the medical treatment group. An in-depth understanding of the relationship between biologic responses and flow dynamics is still required to identify the current limitations of intracranial stent placement. Five Wingspan stents were deployed in tapered swine ascending pharyngeal arteries. Temporal wall shear stress distributions and in-stent stenosis were evaluated at days 0, 7, 14, and 28 after stent placement. The physiologic role of wall shear stress was analyzed regarding its correlation with in-stent stenosis. In-stent stenosis reached a peak of nearly 40% at day 14 and decreased mainly at the distal stent segment until day 28. The wall shear stress demonstrated a characteristic pattern with time on the basis of the in-stent stenosis change. The wall shear stress gradient increased from the proximal to distal segment until day 14. At day 28, the trend was reversed dramatically, decreasing from the proximal to the distal segment. A significant correlation between the in-stent stenosis growth until day 14 and low wall shear stress values just after stent placement was detected. In-stent stenosis regression between days 14 and 28 was also associated with the high wall shear stress values at day 14. These data suggest that the physiologic wall shear stress can control the biphasic in-stent stenosis change in tapered arteries.
Highlights
BACKGROUND AND PURPOSEA recent randomized clinical trial on intracranial atherosclerosis was discontinued because of the higher frequency of stroke and death in the angioplasty and stent placement group than in the medical treatment group
In-stent stenosis regression between days 14 and 28 was associated with the high wall shear stress values at day 14. These data suggest that the physiologic wall shear stress can control the biphasic in-stent stenosis change in tapered arteries
The Wingspan Stent System (Stryker, Kalamazoo, Michigan) is the only endovascular device for symptomatic intracranial atherosclerosis approved by the US Food and Drug Administration.[1]
Summary
Five Wingspan stents were deployed in tapered swine ascending pharyngeal arteries. Temporal wall shear stress distributions and in-stent stenosis were evaluated at days 0, 7, 14, and 28 after stent placement. The physiologic role of wall shear stress was analyzed regarding its correlation with in-stent stenosis. A total of 5 ascending pharyngeal arteries in 3 healthy Yorkshire swine (age range, 3– 4 months; weight range, 30 – 40 kg) were included in this study. Special interest was paid to the ascending pharyngeal artery, which corresponds to the human internal carotid artery. The stent diameter was followed to the manufacturer’s recommendation to exceed the diameter of the referenced arterial diameter by 0 – 0.5 mm. Three-dimensional rotational angiography was conducted before and after stent placement to construct the arterial models. A total of 122 isocentric images were generated, resulting in a 2563 isotropic image volume
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