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Getting stents to go with the flow
R. Wayne Alexander
R. Wayne Alexander
Published June 1, 2004
Citation Information: J Clin Invest. 2004;113(11):1532-1534. https://doi.org/10.1172/JCI22000.
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Commentary

Getting stents to go with the flow

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Abstract

Implantation of expandable stents into stenotic arteries after percutaneous coronary intervention to relieve arterial narrowing has become a standard therapeutic tool. The improvement in vascular interventional technology, and especially stent technology, has, arguably, outstripped understanding of the biologic consequences of opening an obstructed artery. In the case of bifurcation stenoses, new evidence suggests that opening a stenotic subsidiary branch may create unfavorable hemodynamics in the stented main branch that can lead to in-stent restenosis.

Authors

R. Wayne Alexander

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Figure 1

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Potential influence of the status of a stenotic side branch on the heali...
Potential influence of the status of a stenotic side branch on the healing of a main branch stenosis treated with percutaneous intervention and stent placement. Simultaneous stenting of the side branch may create disturbed flow patterns at the lateral wall opposite the side branch orifice, which are associated with amplified inflammatory responses and restenosis (upper panel). In the continued presence of stenosis and decreased flow in the side branch, the hemodynamic environment in the stented main branch may be similar to that in a nonbranching arterial segment with nondisturbed, laminar flow (lower panel). Laminar flow, in general, has anti-inflammatory and growth-inhibiting effects on the arterial wall and facilitates healing. While hypothetical, this figure illustrates that opening of a side branch in the setting of a stented main branch may have untoward effects on the outcome of the primary treatment target.

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ISSN: 0021-9738 (print), 1558-8238 (online)

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