Focal In-Stent Restenosis Near Step-Up
2002; Lippincott Williams & Wilkins; Volume: 105; Issue: 23 Linguagem: Inglês
10.1161/01.cir.0000018282.32332.13
ISSN1524-4539
AutoresAttila Thury, Jolanda J. Wentzel, Ruud Vinke, Frank Gijsen, Johan C.H. Schuurbiers, Rob Krams, Pim J. de Feyter, Patrick W. Serruys, Cornelis J. Slager,
Tópico(s)Coronary Artery Anomalies
ResumoHomeCirculationVol. 105, No. 23Focal In-Stent Restenosis Near Step-Up Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBFocal In-Stent Restenosis Near Step-UpRoles of Low and Oscillating Shear Stress? Attila Thury, MD, Jolanda J. Wentzel, PhD, Ruud V.H. Vinke, MSc, Frank J.H. Gijsen, PhD, Johan C.H. Schuurbiers, BSc, Rob Krams, MD, PhD, Pim J. de Feyter, MD, PhD, Patrick W. Serruys, MD, PhD and Cornelis J. Slager, PhD Attila ThuryAttila Thury From the Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam (A.T., J.J.W., R.V.H.V., F.J.H.G., J.C.H.S., R.K., P.J.d.F., P.W.S., C.J.S.), and Interuniversity Cardiology Institute, Utrecht (J.J.W.), the Netherlands. Dr Thury's current affiliation is Cardiology Center, University of Sciences, Szeged, Hungary. , Jolanda J. WentzelJolanda J. Wentzel From the Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam (A.T., J.J.W., R.V.H.V., F.J.H.G., J.C.H.S., R.K., P.J.d.F., P.W.S., C.J.S.), and Interuniversity Cardiology Institute, Utrecht (J.J.W.), the Netherlands. Dr Thury's current affiliation is Cardiology Center, University of Sciences, Szeged, Hungary. , Ruud V.H. VinkeRuud V.H. Vinke From the Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam (A.T., J.J.W., R.V.H.V., F.J.H.G., J.C.H.S., R.K., P.J.d.F., P.W.S., C.J.S.), and Interuniversity Cardiology Institute, Utrecht (J.J.W.), the Netherlands. Dr Thury's current affiliation is Cardiology Center, University of Sciences, Szeged, Hungary. , Frank J.H. GijsenFrank J.H. Gijsen From the Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam (A.T., J.J.W., R.V.H.V., F.J.H.G., J.C.H.S., R.K., P.J.d.F., P.W.S., C.J.S.), and Interuniversity Cardiology Institute, Utrecht (J.J.W.), the Netherlands. Dr Thury's current affiliation is Cardiology Center, University of Sciences, Szeged, Hungary. , Johan C.H. SchuurbiersJohan C.H. Schuurbiers From the Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam (A.T., J.J.W., R.V.H.V., F.J.H.G., J.C.H.S., R.K., P.J.d.F., P.W.S., C.J.S.), and Interuniversity Cardiology Institute, Utrecht (J.J.W.), the Netherlands. Dr Thury's current affiliation is Cardiology Center, University of Sciences, Szeged, Hungary. , Rob KramsRob Krams From the Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam (A.T., J.J.W., R.V.H.V., F.J.H.G., J.C.H.S., R.K., P.J.d.F., P.W.S., C.J.S.), and Interuniversity Cardiology Institute, Utrecht (J.J.W.), the Netherlands. Dr Thury's current affiliation is Cardiology Center, University of Sciences, Szeged, Hungary. , Pim J. de FeyterPim J. de Feyter From the Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam (A.T., J.J.W., R.V.H.V., F.J.H.G., J.C.H.S., R.K., P.J.d.F., P.W.S., C.J.S.), and Interuniversity Cardiology Institute, Utrecht (J.J.W.), the Netherlands. Dr Thury's current affiliation is Cardiology Center, University of Sciences, Szeged, Hungary. , Patrick W. SerruysPatrick W. Serruys From the Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam (A.T., J.J.W., R.V.H.V., F.J.H.G., J.C.H.S., R.K., P.J.d.F., P.W.S., C.J.S.), and Interuniversity Cardiology Institute, Utrecht (J.J.W.), the Netherlands. Dr Thury's current affiliation is Cardiology Center, University of Sciences, Szeged, Hungary. and Cornelis J. SlagerCornelis J. Slager From the Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam (A.T., J.J.W., R.V.H.V., F.J.H.G., J.C.H.S., R.K., P.J.d.F., P.W.S., C.J.S.), and Interuniversity Cardiology Institute, Utrecht (J.J.W.), the Netherlands. Dr Thury's current affiliation is Cardiology Center, University of Sciences, Szeged, Hungary. Originally published11 Jun 2002https://doi.org/10.1161/01.CIR.0000018282.32332.13Circulation. 2002;105:e185–e187A 64-year-old man with exercise-induced chest pain underwent coronary angioplasty of his stenosed left anterior descending coronary artery (segments 6 and 7). We recanalized the artery and placed a 3.0×18-mm stent distally and a 3.0×28-mm stent proximally. The residual diameter stenosis at the proximal edge was 26% on quantitative coronary angiography (QCA). Intravascular ultrasound (IVUS) showed an in-stent lumen area of 7.5 mm2, which exceeded that immediate proximal of the stent (5.6±0.8 mm2) and caused a so-called "step-up" phenomenon (Figure 1A and 1B, open arrow). Although the stent was well apposed and deployed as indicated by IVUS, the patient presented with worsening anginal symptoms 4 months later; both the angiogram and IVUS showed focal in-stent restenosis at the proximal edge of the proximal stent (78% on QCA) and mild diffuse neointimal hyperplasia (NIH) through the entire length of the stent. Download figureDownload PowerPointFigure 1. A, Lateral angiographic view of the left anterior descending coronary artery after stent placement. Open arrow indicates location of step-up. B, 3D (ANGUS) reconstruction of the coronary artery shown in A, clearly showing the step-up phenomenon at the proximal edge of the stent (open arrow). C, Segment in which detailed analysis of the temporal shear stress variations is performed. D, Cartoon showing the existence of a region with retrograde velocities and flow separation. E, Averaged shear stress over the cardiac cycle color-coded at the surface of the stented region of the 3D reconstruction. F, Neointimal thickness color coded at the lumen surface of the stented region. G, In-stent average neointimal thickness per cross section versus the shear stress averaged over the cardiac cycle and per cross section showing a non-linear inverse relationship (NIH=0.3+0.2×SS−1 [mm]; r2=0.34, P<0.01).The mechanism of in-stent restenosis has not been fully elucidated, despite numerous animal and human investigations. Stent placement may cause changes in 3D geometry, coronary flow velocity profile, and, as a consequence, in shear stress (SS). It is known that low oscillating SS gives rise to the expression of several growth factors. No clinical evidence has been provided for the potential importance of oscillating SS and its localizing role in in-stent restenosis. Because this patient had been included in a prospective 6-month follow-up study to investigate the association between (oscillating) SS and NIH, angiography and IVUS (ANGUS) had been performed to 3-dimensionally reconstruct the lumen of the stented coronary artery (Figure 1B). Doppler flow (Figure 2B) and blood viscosity measurements were used as input conditions for application of computational fluid dynamics in this 3D reconstruction. The result of these calculations was the SS at the wall as a function of time over the cardiac cycle. The ANGUS procedure was repeated when the patient presented at 4 months, and NIH was determined from this 3D reconstruction (Figure 1F). As found previously, NIH was highest near the locations where average SS was low (Figure 1E, 1F, and 1G). Subsequently, the temporal SS pattern in the region of the step-up (Figure 1C) was evaluated. This analysis showed that the SS vectors were either permanently or temporarily retrogradely directed near the "corner" of the step-up. This indicates the existence of a region of flow separation (Figure 1D). In Figure 2C, locations showing retrograde axial velocities are presented in black at 5 time points as indicated in the Doppler recordings (Figure 2B). At locations that temporarily experience retrograde velocities, SS alters direction periodically. Interestingly, those locations of oscillating SS were nearest to the area of highest NIH (Figure 2A). Our findings warrant further studies to clarify the benefits of the step-up phenomenon. Download figureDownload PowerPointFigure 2. A, Neointimal hyperplasia, which is color-coded at the 3-dimensionally reconstructed lumen at baseline. The perspective view of Figure 2A and 2C differs from Figure 1. B, Doppler measurements used for the time-dependent flow calculations. C, In black, locations in the stent that periodically experience retrograde axial velocities at 5 time points during the cardiac cycle. As can be seen in this view, the size of this area periodically changes, which implies that locations with temporary retrograde velocity experience oscillating shear stress.The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke's Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.FootnotesCorrespondence to J.J. Wentzel, PhD, Thoraxcenter Ee2322, Erasmus Medical Center Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Wei L, Wang J, Chen Q and Li Z (2021) Impact of stent malapposition on intracoronary flow dynamics: An optical coherence tomography-based patient-specific study, Medical Engineering & Physics, 10.1016/j.medengphy.2021.06.002, 94, (26-32), Online publication date: 1-Aug-2021. Chen Y, Yang Y, Tan W, Fu L, Deng X and Xing Y Hemodynamic effects of the human aorta arch with different inflow rate waveforms from the ascending aorta inlet: A numerical study, Biorheology, 10.3233/BIR-201009, 58:1-2, (27-38) Thakur U, Khav N, Comella A, Michail M, Ihdayhid A, Poon E, Nicholls S, Ko B and Brown A (2020) Fractional Flow Reserve following Percutaneous Coronary Intervention, Journal of Interventional Cardiology, 10.1155/2020/7467943, 2020, (1-12), Online publication date: 5-Jun-2020. Liu C and Chen F (2020) Increase of wall shear stress caused by arteriovenous fistula reduces neointimal hyperplasia after stent implantation in healthy arteries, Vascular, 10.1177/1708538120913748, 28:4, (396-404), Online publication date: 1-Aug-2020. Huang Zhang P, Tkatch C, Newman R, Grimme W, Vainchtein D and Kresh J (2019) The mechanics of spiral flow: Enhanced washout and transport, Artificial Organs, 10.1111/aor.13520, 43:12, (1144-1153), Online publication date: 1-Dec-2019. Gijsen F, Katagiri Y, Barlis P, Bourantas C, Collet C, Coskun U, Daemen J, Dijkstra J, Edelman E, Evans P, van der Heiden K, Hose R, Koo B, Krams R, Marsden A, Migliavacca F, Onuma Y, Ooi A, Poon E, Samady H, Stone P, Takahashi K, Tang D, Thondapu V, Tenekecioglu E, Timmins L, Torii R, Wentzel J and Serruys P (2019) Expert recommendations on the assessment of wall shear stress in human coronary arteries: existing methodologies, technical considerations, and clinical applications, European Heart Journal, 10.1093/eurheartj/ehz551, 40:41, (3421-3433), Online publication date: 1-Nov-2019. Smuclovisky C (2018) Cardiac CTA in the Evaluation of Stents Coronary Artery CTA, 10.1007/978-3-319-66988-5_9, (243-270), . Gutiérrez-Chico J (2018) Superficial wall stress: the long awaited comprehensive biomechanical parameter to objectify and quantify our intuition, The International Journal of Cardiovascular Imaging, 10.1007/s10554-018-1386-1, 34:6, (863-865), Online publication date: 1-Jun-2018. Prithipaul P, Kokkolaras M and Pasini D (2018) Assessment of structural and hemodynamic performance of vascular stents modelled as periodic lattices, Medical Engineering & Physics, 10.1016/j.medengphy.2018.04.017, 57, (11-18), Online publication date: 1-Jul-2018. Onuma Y, Grundeken M, Nakatani S, Asano T, Sotomi Y, Foin N, Ng J, Okamura T, Wykrzykowska J, de Winter R, van Geuns R, Koolen J, Christiansen E, Whitbourn R, McClean D, Smits P, Windecker S, Ormiston J and Serruys P (2017) Serial 5-Year Evaluation of Side Branches Jailed by Bioresorbable Vascular Scaffolds Using 3-Dimensional Optical Coherence Tomography, Circulation: Cardiovascular Interventions, 10:9, Online publication date: 1-Sep-2017.Zeller T, Gaines P, Ansel G and Caro C (2016) Helical Centerline Stent Improves Patency, Circulation: Cardiovascular Interventions, 9:6, Online publication date: 1-Jun-2016. Jenei C, Závodszky G, Paál G, Tar B and Kőszegi Z (2016) High shear stress on the background of clinical restenosis at the site of step-down phenomenon after drug eluting stent implantation, Cor et Vasa, 10.1016/j.crvasa.2015.08.005, 58:5, (e518-e521), Online publication date: 1-Oct-2016. Chen Z, Zhan F, Ding J, Zhang X and Deng X (2014) A new stent with streamlined cross-section can suppress monocyte cell adhesion in the flow disturbance zones of the endovascular stent, Computer Methods in Biomechanics and Biomedical Engineering, 10.1080/10255842.2014.984701, 19:1, (60-66), Online publication date: 2-Jan-2016. Li Y, Gutiérrez-Chico J, Holm N, Yang W, Hebsgaard L, Christiansen E, Mæng M, Lassen J, Yan F, Reiber J and Tu S (2015) Impact of Side Branch Modeling on Computation of Endothelial Shear Stress in Coronary Artery Disease, Journal of the American College of Cardiology, 10.1016/j.jacc.2015.05.008, 66:2, (125-135), Online publication date: 1-Jul-2015. Jiang Y, Zhang J and Zhao W (2015) Effects of the inlet conditions and blood models on accurate prediction of hemodynamics in the stented coronary arteries, AIP Advances, 10.1063/1.4919937, 5:5, (057109), Online publication date: 1-May-2015. Foin N, Gutiérrez-Chico J, Nakatani S, Torii R, Bourantas C, Sen S, Nijjer S, Petraco R, Kousera C, Ghione M, Onuma Y, Garcia-Garcia H, Francis D, Wong P, Di Mario C, Davies J and Serruys P (2014) Incomplete Stent Apposition Causes High Shear Flow Disturbances and Delay in Neointimal Coverage as a Function of Strut to Wall Detachment Distance, Circulation: Cardiovascular Interventions, 7:2, (180-189), Online publication date: 1-Apr-2014. Gogas B, Yang B, Passerini T, Veneziani A, Piccinelli M, Esposito G, Rasoul-Arzrumly E, Awad M, Mekonnen G, Hung O, Holloway B, McDaniel M, Giddens D, King S and Samady H (2014) Computational fluid dynamics applied to virtually deployed drug-eluting coronary bioresorbable scaffolds: Clinical translations derived from a proof-of-concept, Global Cardiology Science and Practice, 10.5339/gcsp.2014.56, 2014:4, (56), Online publication date: 1-Dec-2014. Keller B, Amatruda C, Hose D, Gunn J, Lawford P, Dubini G, Migliavacca F and Narracott A (2014) Contribution of Mechanical and Fluid Stresses to the Magnitude of In-stent Restenosis at the Level of Individual Stent Struts, Cardiovascular Engineering and Technology, 10.1007/s13239-014-0181-y, 5:2, (164-175), Online publication date: 1-Jun-2014. Gogas B (2014) Bioresorbable scaffolds for percutaneous coronary interventions, Global Cardiology Science and Practice, 10.5339/gcsp.2014.55, 2014:4, (55), Online publication date: 1-Dec-2014. Martin D, Murphy E and Boyle F (2014) Computational fluid dynamics analysis of balloon-expandable coronary stents: Influence of stent and vessel deformation, Medical Engineering & Physics, 10.1016/j.medengphy.2014.05.011, 36:8, (1047-1056), Online publication date: 1-Aug-2014. Chiastra C, Migliavacca F, Martínez M and Malvè M (2014) On the necessity of modelling fluid–structure interaction for stented coronary arteries, Journal of the Mechanical Behavior of Biomedical Materials, 10.1016/j.jmbbm.2014.02.009, 34, (217-230), Online publication date: 1-Jun-2014. Gogas B, Bourantas C, Garcia-Garcia H, Onuma Y, Muramatsu T, Farooq V, Diletti R, van Geuns R, De Bruyne B, Chevalier B, Thuesen L, Smits P, Dudek D, Koolen J, Windecker S, Whitbourn R, McClean D, Dorange C, Miquel-Hebert K, Veldhof S, Rapoza R, Ormiston J and Serruys P (2013) The edge vascular response following implantation of the Absorb everolimus-eluting bioresorbable vascular scaffold and the XIENCE V metallic everolimus-eluting stent. First serial follow-up assessment at six months and two years: insights from the first-in-man ABSORB Cohort B and SPIRIT II trials, EuroIntervention, 10.4244/EIJV9I6A115, 9:6, (709-720), Online publication date: 1-Oct-2013. Koskinas K, Chatzizisis Y, Antoniadis A and Giannoglou G (2012) Role of Endothelial Shear Stress in Stent Restenosis and Thrombosis, Journal of the American College of Cardiology, 10.1016/j.jacc.2011.10.903, 59:15, (1337-1349), Online publication date: 1-Apr-2012. Thury A, Garcia-Garcia H and Regar E Analysis of Radiofrequency Ultrasound Signals Intravascular Imaging, 10.4018/978-1-61350-095-8.ch004, (55-93) Onuma Y, Muramatsu T, Kharlamov A and Serruys P (2012) Freeing the vessel from metallic cage: what can we achieve with bioresorbable vascular scaffolds?, Cardiovascular Intervention and Therapeutics, 10.1007/s12928-012-0101-8, 27:3, (141-154), Online publication date: 1-Sep-2012. Gutiérrez-Chico J, Gijsen F, Regar E, Wentzel J, de Bruyne B, Thuesen L, Ormiston J, McClean D, Windecker S, Chevalier B, Dudek D, Whitbourn R, Brugaletta S, Onuma Y and Serruys P (2012) Differences in Neointimal Thickness Between the Adluminal and the Abluminal Sides of Malapposed and Side-Branch Struts in a Polylactide Bioresorbable Scaffold, JACC: Cardiovascular Interventions, 10.1016/j.jcin.2011.12.015, 5:4, (428-435), Online publication date: 1-Apr-2012. Papafaklis M and Michalis L Intravascular Imaging and Haemodynamics Intravascular Imaging, 10.4018/978-1-61350-095-8.ch019, (326-348) Serruys P, Garcia-Garcia H and Onuma Y (2011) From metallic cages to transient bioresorbable scaffolds: change in paradigm of coronary revascularization in the upcoming decade?, European Heart Journal, 10.1093/eurheartj/ehr384, 33:1, (16-25), Online publication date: 1-Jan-2012. Sun A, Fan Y and Deng X (2011) Intentionally induced swirling flow may improve the hemodynamic performance of coronary bifurcation stenting, Catheterization and Cardiovascular Interventions, 10.1002/ccd.22969, 79:3, (371-377), Online publication date: 15-Feb-2012. Wentzel J, Chatzizisis Y, Gijsen F, Giannoglou G, Feldman C and Stone P (2012) Endothelial shear stress in the evolution of coronary atherosclerotic plaque and vascular remodelling: current understanding and remaining questions, Cardiovascular Research, 10.1093/cvr/cvs217, 96:2, (234-243), Online publication date: 1-Nov-2012. Chen Z, Fan Y, Deng X and Xu Z (2011) A New Way to Reduce Flow Disturbance in Endovascular Stents: A Numerical Study, Artificial Organs, 10.1111/j.1525-1594.2010.01106.x, 35:4, (392-397), Online publication date: 1-Apr-2011. Liu X, Fan Y and Deng X (2011) Mechanotransduction of Flow-Induced Shear Stress by Endothelial Glycocalyx Fibers is Torque Determined, ASAIO Journal, 10.1097/MAT.0b013e318233b5ed, 57:6, (487-494), Online publication date: 1-Nov-2011. Chiu J and Chien S (2011) Effects of Disturbed Flow on Vascular Endothelium: Pathophysiological Basis and Clinical Perspectives, Physiological Reviews, 10.1152/physrev.00047.2009, 91:1, (327-387), Online publication date: 1-Jan-2011. Smuclovisky C (2009) Percutaneous Coronary Intervention Coronary Artery CTA, 10.1007/978-1-4419-0431-7_4, (69-89), . Murphy J and Boyle F (2010) A Numerical Methodology to Fully Elucidate the Altered Wall Shear Stress in a Stented Coronary Artery, Cardiovascular Engineering and Technology, 10.1007/s13239-010-0028-0, 1:4, (256-268), Online publication date: 1-Dec-2010. Chen Z, Fan Y, Deng X and Xu Z (2009) Swirling Flow Can Suppress Flow Disturbances in Endovascular Stents: A Numerical Study, ASAIO Journal, 10.1097/MAT.0b013e3181b78e46, 55:6, (543-549), Online publication date: 1-Nov-2009. Papafaklis M, Bourantas C, Theodorakis P, Katsouras C, Fotiadis D and Michalis L (2009) Relationship of shear stress with in-stent restenosis: Bare metal stenting and the effect of brachytherapy, International Journal of Cardiology, 10.1016/j.ijcard.2008.02.006, 134:1, (25-32), Online publication date: 1-May-2009. Thury A, Wentzel J, Gijsen F, Schuurbiers J, Krams R, de Feyter P, Serruys P and Slager C (2007) The Influence of Shear Stress on Restenosis Essentials of Restenosis, 10.1007/978-1-59745-001-0_5, (59-83), . Scott N (2006) Restenosis following implantation of bare metal coronary stents: Pathophysiology and pathways involved in the vascular response to injury, Advanced Drug Delivery Reviews, 10.1016/j.addr.2006.01.015, 58:3, (358-376), Online publication date: 1-Jun-2006. Carter A, Wei W, Gibson L, Collingwood R, Tio F, Dooley J and Kopia G (2005) Segmental vessel wall shear stress and neointimal formation after sirolimus-eluting stent implantation: physiological insights in a porcine coronary model, Cardiovascular Revascularization Medicine, 10.1016/j.carrev.2005.05.004, 6:2, (58-64), Online publication date: 1-Apr-2005. Wasserman S and Topper J (2016) Adaptation of the endothelium to fluid flow: in vitro analyses of gene expression and in vivo implications, Vascular Medicine, 10.1191/1358863x04vm521ra, 9:1, (35-45), Online publication date: 1-Feb-2004. Stone P, Coskun A, Kinlay S, Clark M, Sonka M, Wahle A, Ilegbusi O, Yeghiazarians Y, Popma J, Orav J, Kuntz R and Feldman C (2003) Effect of Endothelial Shear Stress on the Progression of Coronary Artery Disease, Vascular Remodeling, and In-Stent Restenosis in Humans, Circulation, 108:4, (438-444), Online publication date: 29-Jul-2003. WENTZEL J, AGUIAR S and FAYAD Z (2003) Vascular MRI in the Diagnosis and Therapy of the High Risk Atherosclerotic Plaque, Journal of Interventional Cardiology, 10.1046/j.1540-8183.2003.08024.x, 16:2, (129-142), Online publication date: 1-Apr-2003. Kilic Y, Safi H, Bajaj R, Serruys P, Kitslaar P, Ramasamy A, Tufaro V, Onuma Y, Mathur A, Torii R, Baumbach A and Bourantas C (2020) The Evolution of Data Fusion Methodologies Developed to Reconstruct Coronary Artery Geometry From Intravascular Imaging and Coronary Angiography Data: A Comprehensive Review, Frontiers in Cardiovascular Medicine, 10.3389/fcvm.2020.00033, 7 June 11, 2002Vol 105, Issue 23 Advertisement Article InformationMetrics https://doi.org/10.1161/01.CIR.0000018282.32332.13PMID: 12057999 Originally publishedJune 11, 2002 PDF download Advertisement
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