| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
© 1996 American Heart Association, Inc.
Articles |
Coronary Artery Restenosis After Balloon Angioplasty in Humans Is Associated With Circumferential Coronary Constriction
the Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, Calif.
Correspondence to Robert J. Siegel, MD, Division of Cardiology, Room 5335, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048.
Therapies that inhibit intimal hyperplasia do not prevent restenosis after coronary artery balloon angioplasty, suggesting that additional mechanisms may be responsible for restenosis in humans. Using an intravascular ultrasound (Hewlett-Packard Sonos Intravascular Imaging System), 3.5F, 30-MHz (Boston Scientific) monorail imaging catheter, we studied 17 patients with clinical and angiographic restenosis at an average (mean±SD) of 7±6 months after balloon angioplasty (13 men: age, 71±10 years; 12 left anterior descending coronary arteries, 4 right coronary arteries, and 1 left circumflex coronary artery). The lumen area (LA), vessel wall area (VWA), and total cross-sectional area (CSA) within the external elastic lamina were measured at the restenosis site and at proximal and distal reference sites, which were defined as adjacent segments with the least amount of plaque. Consistent with coronary angiography findings, decreased LA at the restenotic site was detected in all 17 patients. The unique finding was that total CSA at the restenotic site was significantly decreased compared with both proximal and distal reference sites (10.1±2.4 versus 14.8±3.2 mm2 and 10.1±2.4 versus 13.8±3.1 mm2, respectively, P<.001), whereas VWA (intima plus media) was slightly increased at the angioplasty site compared with both proximal and distal reference sites (8.0±2.3 versus 7.6±2.3 mm2 and 8.0±2.3 versus 6.7±2.3 mm2, respectively, P=NS). Eighty-three percent of the loss in LA at the restenotic site was due to constriction of the total CSA, while the increase in VWA at the restenotic site accounted for only a 17% loss in LA. We then compared these results with the morphology of coronary artery segments in 14 patients without restenosis. These coronary artery segments had been previously treated with balloon angioplasty (7±5 months). Unlike that in restenotic lesions, the total CSA within the external elastic lamina at the sites of previous angioplasty was similar to that in distal and proximal reference sites (P=NS). Significant and consistent reduction in arterial CSA, with a minor increase in VWA, characterizes human coronary lesions that cause angiographic restenosis. These data suggest that in humans, "recoil" and/or vascular contraction with healing in response to balloon injury is a major contributor to restenosis after balloon angioplasty.
Key Words: coronary restenosis • balloon angioplasty • intravascular ultrasound
This article has been cited by other articles:
 |
|
 |
|
  K. Krueger, P. Landwehr, M. Bendel, M. Nolte, H. Stuetzer, R. Bongartz, M. Zaehringer, G. Winnekendonk, A. Gossmann, R.-P. Mueller, et al. Endovascular Gamma Irradiation of Femoropopliteal de Novo Stenoses Immediately after PTA: Interim Results of Prospective Randomized Controlled Trial Radiology, August 1, 2002; 224(2): 519 - 528. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Durand, Z. Mallat, F. Addad, F. Vilde, M. Desnos, C. Guerot, A. Tedgui, and A. Lafont Time courses of apoptosis and cell proliferation and their relationship to arterial remodeling and restenosis after angioplasty in an atherosclerotic rabbit model J. Am. Coll. Cardiol., May 15, 2002; 39(10): 1680 - 1685. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Yamasaki, K. Miyoshi, N. Oda, M. Watanabe, H. Miyake, J. Chan, X. Wang, L. Sun, C. Tang, G. McMahon, et al. Weekly Dosing With the Platelet-Derived Growth Factor Receptor Tyrosine Kinase Inhibitor SU9518 Significantly Inhibits Arterial Stenosis Circ. Res., March 30, 2001; 88(6): 630 - 636. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C Hehrlein, A Kovacs, G.K Wolf, N Yue, and R Nath A novel balloon angioplasty catheter impregnated with beta-particle emitting radioisotopes for vascular brachytherapy to prevent restenosis. First in vivo results Eur. Heart J., December 2, 2000; 21(24): 2056 - 2062. [Abstract] [PDF]
|
|
|
|
 |
|
 E. Sasaki, Y. Tanahashi, Y. Yamasaki, N. Oda, Y. Nozawa, H. Terakawa, K. Miyoshi, Y. Muranaka, H. Miyake, and N. Matsuura Inhibitory Effect of TAS-301, a New Synthesized Constrictive Remodeling Regulator, on Renarrowing after Balloon Overstretch Injury of Porcine Coronary Artery J. Pharmacol. Exp. Ther., December 1, 2000; 295(3): 1043 - 1050. [Abstract] [Full Text]
|
|
|
|
|
|
K. G. Lehmann, J. J. Popma, J. A. Werner, A. J. Lansky, and R. L. Wilensky Vascular remodeling and the local delivery of cytochalasin B after coronary angioplasty in humans J. Am. Coll. Cardiol., March 1, 2000; 35(3): 583 - 591. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Nishioka, A. M. Amanullah, H. Luo, H. Berglund, C.-J. Kim, T. Nagai, N. Hakamata, S. Katsushika, A. Uehata, B. Takase, et al. Clinical validation of intravascular ultrasound imaging for assessment of coronary stenosis severity: Comparison with stress myocardial perfusion imaging J. Am. Coll. Cardiol., June 1, 1999; 33(7): 1870 - 1878. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Muranaka, Y. Yamasaki, Y. Nozawa, H. Terakawa, Y. Tanahashi, N. Oda, A. Satoh, T. Asao, H. Miyake, and N. Matsuura TAS-301, an Inhibitor of Smooth Muscle Cell Migration and Proliferation, Inhibits Intimal Thickening after Balloon Injury to Rat Carotid Arteries J. Pharmacol. Exp. Ther., June 1, 1998; 285(3): 1280 - 1286. [Abstract] [Full Text]
|
|