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Flow Dynamic Factors and Vectors of Neointimal Hyperplasia (NIH)

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European Bifurcation Club 2010 – EBC 2010 – Budapest, Hungary

From bench to simulation

Flow Dynamic Factors and Vectors of Neointimal Hyperplasia (NIH)

Author: Yiannis S. Chatzizisis, MD, PhD, Cardiovascular Engineering and Atherosclerosis Lab, AHEPA University Hospital Thessaloniki, GREECE

 

CONCLUSION

  • Atherosclerosis occurs in the lateral walls of bifurcations
  • Carina is free of de novo atherosclerosis.
  • Bifurcation plaques may extend circumferentially  (towards carina) and downstream
  • Increased bifurcation angle amplifies the low ESS environment in the lateral walls promoting atherosclerosis
  • In-stent NIH and restenosis rates depend on various contributing factors, including:
    • Stent type (BMS more susceptible to NIH)
    • Struts design and geometry
    • Stenting technique e.g. side branch dilatation
    • Stent under-sizing
  • Need for developing new stent geometries and stent implantation techniques aiming to minimize regions of low ESS after stent implantation and limit NIH and restenosis rates
  • Need to develop realistic bifurcation models to investigate the effect of flow on plaque formation and in-stent restenosis

 

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