Flow Dynamic Factors and Vectors of Neointimal Hyperplasia (NIH)
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