Biomechanics of vascular-stent interaction and in-stent restenosis: The key role of shear stress
The implantation of coronary stents is an integral part of most interventional procedures for percutaneous revascularization. However, restenosis is the most common complication associated with coronary stent placement, mainly caused by the formation of a neointima that re-narrows the arterial lumen. The incidence of restenosis is influenced by many factors including patient selection, morphological characteristics of the lesion, stent design and deployment, local hemodynamics, clinical and genetic factors. Several mechanical characteristics of stents are related with neointima formation and with in-stent restenosis. In the present review the most important biomechanical features of stent design and deployment are discussed in relation to their effects on neontima formation and in-stent restenosis, without however focusing on newly developed stents where such data are lacking. The underlying role of shear stress is further discussed.
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