Stent-Induced Arterial Flow Disturbance: Whole Vessel and Cellular Considerations

Although the use of endovascular stents has significantly reduced the incidence of restenosis following balloon angioplasty, restenosis rates remain unacceptably high (20–35% of all angioplasty procedures [1]). Placement of a stent within an arterial segment locally injures vascular endothelium thereby stimulating thrombotic responses that contribute to the development of in-stent restenosis. Recent research suggests that the local fluid mechanical environment in the vicinity of a stent impacts the rate of vessel re-endothelialization following stent-induced injury [2]. This is supported by in vitro data demonstrating that endothelial repair after injury is sensitive to fluid mechanical forces [3]. Recent in vivo data suggest that in-stent restenosis preferentially develops in arterial regions exposed to low and/or oscillatory shear stress [1]. Therefore, it is essential to establish the detailed flow environment in the vicinity of a stent and to investigate the impact of this environment on EC function.