Circulation, Vol 89, 2809-2815, Copyright © 1994 by American Heart Association
T Kakuta, JW Currier, CC Haudenschild, TJ Ryan and DP Faxon
BACKGROUND: In de novo human atherosclerosis, compensatory vessel
enlargement limits the effect of intimal plaque formation on lumen
narrowing. We hypothesized that arterial remodeling may also play an
important role in determining the chronic lumen size after angioplasty and
tested this hypothesis using the hypercholesterolemic rabbit iliac artery
angioplasty model. METHODS AND RESULTS: Morphometric analysis of
histological cross-sectional areas of vessels from animals killed
immediately after angioplasty (acute group, n = 11) were compared with the
same areas from animals killed 4 weeks after the procedure (chronic group,
n = 37), when restenosis occurs in this model. The area circumscribed by
the internal elastic lamina (IEL) increased by 20% from acute to 4 week
follow-up after angioplasty (acute group, 2.36 +/- 0.45 mm2, chronic group,
2.84 +/- 0.89 mm2). Over the same time period, intimal area increased by
0.82 mm2. Despite this increase in intimal area, lumen area decreased by
only 0.34 mm2 because of the compensatory enlargement of the IEL area. In
the chronic group, polynomial regression analysis revealed a quadratic
relation between intimal area and lumen area (R2 = .35, P < .001). A
lumen area of 0.45 mm2 (the nadir of the quadratic relation) was used to
divide the chronic group into two subgroups: restenotic (n = 21; lumen
area, < 0.45 mm2) and nonrestenotic (n = 16; lumen area, > 0.45 mm2).
By definition, there was a significant difference in lumen area between the
two subgroups (0.15 +/- 0.15 mm2 for restenotic; 0.73 +/- 0.18 mm2 for
nonrestenotic). Surprisingly, the intimal areas in the two subgroups were
virtually identical (2.41 +/- 0.92 mm2 for restenotic, 2.49 +/- 0.69 mm2
for nonrestenotic, P = NS). The difference in the lumen area between
restenotic and nonrestenotic vessels was a result of the significantly
greater IEL area in the nonrestenotic subgroup (3.22 +/- 0.83 mm2 for
nonrestenotic, 2.56 +/- 0.84 mm2 for restenotic, P < .05). In both
restenotic and nonrestenotic vessels, the IEL area increased with increases
in intimal area. In the restenotic arteries, the slope of this correlation
was < 1, showing inadequate compensatory enlargement for the intimal
plaque. In the nonrestenotic vessels, the slope was > 1, limiting the
effect of intimal plaque on luminal narrowing. CONCLUSIONS: These data
indicate that the iliac artery in an atherosclerotic rabbit model
compensates for intimal formation after angioplasty by vessel enlargement.
Furthermore, the degree of vessel enlargement is more important than
intimal area in determining the chronic lumen size.
ARTICLES
Differences in compensatory vessel enlargement, not intimal formation, account for restenosis after angioplasty in the hypercholesterolemic rabbit model
Department of Medicine, University of Southern California, Los Angeles 90033.
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S.D. Gertz, W. L Barry, L. W Gimple, Shmuel Banai, L. S Perez, C. A McNamara, E. R Powers, M. Ragosta, G. K Owens, W. C Roberts, et al. Predictors of luminal narrowing by neointima after angioplasty in atherosclerotic rabbits Cardiovasc Res, December 1, 1997; 36(3): 396 - 407. [Abstract] [Full Text] [PDF] |
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J.-M. Lablanche, E. P. McFadden, N. Meneveau, J. R. Lusson, B. Bertrand, J.-P. Metzger, V. Legrand, G. Grollier, C. Macaya, B. de Bruyne, et al. Effect of Nadroparin, a Low-Molecular-Weight Heparin, on Clinical and Angiographic Restenosis After Coronary Balloon Angioplasty : The FACT Study Circulation, November 18, 1997; 96(10): 3396 - 3402. [Abstract] [Full Text] |
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M. C.J Persoons, M. J.A.P Daemen, E. M van Kleef, G. E.L.M Grauls, E. Wijers, and C. A Bruggeman Neointimal smooth muscle cell phenotype is important in its susceptibility to cytomegalovirus (CMV) infection: a study in rat Cardiovasc Res, November 1, 1997; 36(2): 282 - 288. [Abstract] [Full Text] [PDF] |
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J. K. Miyashiro, V. Poppa, and B. C. Berk Flow-Induced Vascular Remodeling in the Rat Carotid Artery Diminishes With Age Circ. Res., September 19, 1997; 81(3): 311 - 319. [Abstract] [Full Text] |
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R. Waksman, J. C. Rodriguez, K. A. Robinson, G. D. Cipolla, I. R. Crocker, N. A. Scott, S. B. King III, and J. N. Wilcox Effect of Intravascular Irradiation on Cell Proliferation, Apoptosis, and Vascular Remodeling After Balloon Overstretch Injury of Porcine Coronary Arteries Circulation, September 16, 1997; 96(6): 1944 - 1952. [Abstract] [Full Text] |
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E. Van Belle, C. Bauters, E. Hubert, J.-C. Bodart, K. Abolmaali, T. Meurice, E. P. McFadden, J.-M. Lablanche, and M. E. Bertrand Restenosis Rates in Diabetic Patients : A Comparison of Coronary Stenting and Balloon Angioplasty in Native Coronary Vessels Circulation, September 2, 1997; 96(5): 1454 - 1460. [Abstract] [Full Text] |
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M. E. Staab, R. D. Simari, S. S. Srivatsa, D. Hasdai, V. J. Pompili, D. R. Holmes, R. S. Schwartz, and R. S. Schwartz Enhanced Angiogenesis and Unfavorable Remodeling in Injured Porcine Coronary Artery Lesions: Effects of Local Basic Fibroblast Growth Factor Delivery Angiology, September 1, 1997; 48(9): 753 - 760. [Abstract] [PDF] |
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T. Kimura, S. Kaburagi, T. Tamura, H. Yokoi, Y. Nakagawa, H. Yokoi, N. Hamasaki, H. Nosaka, M. Nobuyoshi, G. S. Mintz, et al. Remodeling of Human Coronary Arteries Undergoing Coronary Angioplasty or Atherectomy Circulation, July 15, 1997; 96(2): 475 - 483. [Abstract] [Full Text] |
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J. E. O'Brien Jr., Y. Shi, A. Fard, T. Bauer, A. Zalewski, and J. D. Mannion WOUND HEALING AROUND AND WITHIN SAPHENOUS VEIN BYPASS GRAFTS J. Thorac. Cardiovasc. Surg., July 1, 1997; 114(1): 38 - 45. [Abstract] [Full Text] |
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C. Amant, C. Bauters, J.-C. Bodart, J.-M. Lablanche, G. Grollier, N. Danchin, M. Hamon, F. Richard, N. Helbecque, E. P. McFadden, et al. D Allele of the Angiotensin I–Converting Enzyme Is a Major Risk Factor for Restenosis After Coronary Stenting Circulation, July 1, 1997; 96(1): 56 - 60. [Abstract] [Full Text] |
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D. P. Faxon Identifying the Predictors of Restenosis: Do We Need New Glasses? Circulation, May 6, 1997; 95(9): 2244 - 2246. [Full Text] |
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G. S. Mintz, K. M. Kent, A. D. Pichard, L. F. Satler, J. J. Popma, and M. B. Leon Contribution of Inadequate Arterial Remodeling to the Development of Focal Coronary Artery Stenoses : An Intravascular Ultrasound Study Circulation, April 1, 1997; 95(7): 1791 - 1798. [Abstract] [Full Text] |
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S. P. Schwarzacher, T. T. Lim, B. Wang, R. S. Kernoff, J. Niebauer, J. P. Cooke, and A. C. Yeung Local Intramural Delivery of L-Arginine Enhances Nitric Oxide Generation and Inhibits Lesion Formation After Balloon Angioplasty Circulation, April 1, 1997; 95(7): 1863 - 1869. [Abstract] [Full Text] |
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W. D. Coats, P. Whittaker, D. T. Cheung, J. W. Currier, B. Han, and D. P. Faxon Collagen Content Is Significantly Lower in Restenotic Versus Nonrestenotic Vessels After Balloon Angioplasty in the Atherosclerotic Rabbit Model Circulation, March 4, 1997; 95(5): 1293 - 1300. [Abstract] [Full Text] |
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T. T. Lim, D. H. Liang, J. Botas, J. S. Schroeder, S. N. Oesterle, and A. C. Yeung Role of Compensatory Enlargement and Shrinkage in Transplant Coronary Artery Disease: Serial Intravascular Ultrasound Study Circulation, February 18, 1997; 95(4): 855 - 859. [Abstract] [Full Text] |
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Y. Shi, J. E. O'Brien, L. Ala-Kokko, W. Chung, J. D. Mannion, and A. Zalewski Origin of Extracellular Matrix Synthesis During Coronary Repair Circulation, February 18, 1997; 95(4): 997 - 1006. [Abstract] [Full Text] |
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M. K. Hong, K. M. Kent, R. Mehran, G. S. Mintz, F. O. Tio, M. Foegh, S. C. Wong, S. S. Cathapermal, and M. B. Leon Continuous Subcutaneous Angiopeptin Treatment Significantly Reduces Neointimal Hyperplasia in a Porcine Coronary In-Stent Restenosis Model Circulation, January 21, 1997; 95(2): 449 - 454. [Abstract] [Full Text] |
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H. Luo, T. Nishioka, N. L. Eigler, J. S. Forrester, M. C. Fishbein, H. Berglund, and R. J. Siegel Coronary Artery Restenosis After Balloon Angioplasty in Humans Is Associated With Circumferential Coronary Constriction Arterioscler Thromb Vasc Biol, November 1, 1996; 16(11): 1393 - 1398. [Abstract] [Full Text] |
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J. A. Bittl Advances in Coronary Angioplasty N. Engl. J. Med., October 24, 1996; 335(17): 1290 - 1302. [Full Text] [PDF] |
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Y. Shi, J. E. O'Brien, A. Fard, and A. Zalewski Transforming Growth Factor-ß1 Expression and Myofibroblast Formation During Arterial Repair Arterioscler Thromb Vasc Biol, October 1, 1996; 16(10): 1298 - 1305. [Abstract] [Full Text] |
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Y. Shi, J. E. O'Brien, A. Fard, J. D. Mannion, D. Wang, and A. Zalewski Adventitial Myofibroblasts Contribute to Neointimal Formation in Injured Porcine Coronary Arteries Circulation, October 1, 1996; 94(7): 1655 - 1664. [Abstract] [Full Text] |
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L. A. Guzman, V. Labhasetwar, C. Song, Y. Jang, A. M. Lincoff, R. Levy, and E. J. Topol Local Intraluminal Infusion of Biodegradable Polymeric Nanoparticles: A Novel Approach for Prolonged Drug Delivery After Balloon Angioplasty Circulation, September 15, 1996; 94(6): 1441 - 1448. [Abstract] [Full Text] |
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G. S. Mintz, J. J. Popma, A. D. Pichard, K. M. Kent, L. F. Satler, S. Chiu Wong, M. K. Hong, J. A. Kovach, and M. B. Leon Arterial Remodeling After Coronary Angioplasty : A Serial Intravascular Ultrasound Study Circulation, July 1, 1996; 94(1): 35 - 43. [Abstract] [Full Text] |
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H. Rud Andersen, M. Mæng, M. Thorwest, and E. Falk Remodeling Rather Than Neointimal Formation Explains Luminal Narrowing After Deep Vessel Wall Injury : Insights From a Porcine Coronary (Re)stenosis Model Circulation, May 1, 1996; 93(9): 1716 - 1724. [Abstract] [Full Text] |
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R. R. Makkar, N. Eigler, F. Litvack, and J. S. Forrester Prevention of Restenosis by Local Drug Delivery Journal of Cardiovascular Pharmacology and Therapeutics, April 1, 1996; 1(2): 177 - 188. [Abstract] [PDF] |
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R. Riessen, T. N. Wight, C. Pastore, C. Henley, and J. M. Isner Distribution of Hyaluronan During Extracellular Matrix Remodeling in Human Restenotic Arteries and Balloon-Injured Rat Carotid Arteries Circulation, March 15, 1996; 93(6): 1141 - 1147. [Abstract] [Full Text] |
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L. A. Guzman, M. J. Mick, A. M. Arnold, F. Forudi, and P. L. Whitlow Role of Intimal Hyperplasia and Arterial Remodeling After Balloon Angioplasty : An Experimental Study in the Atherosclerotic Rabbit Model Arterioscler Thromb Vasc Biol, March 1, 1996; 16(3): 479 - 487. [Abstract] [Full Text] |
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Y. Shi, M. Pieniek, A. Fard, J. O'Brien, J. D. Mannion, and A. Zalewski Adventitial Remodeling After Coronary Arterial Injury Circulation, January 15, 1996; 93(2): 340 - 348. [Abstract] [Full Text] |
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R. L. Geary, J. K. Williams, D. Golden, D. G. Brown, M. E. Benjamin, and M. R. Adams Time Course of Cellular Proliferation, Intimal Hyperplasia, and Remodeling Following Angioplasty in Monkeys With Established Atherosclerosis : A Nonhuman Primate Model of Restenosis Arterioscler Thromb Vasc Biol, January 1, 1996; 16(1): 34 - 43. [Abstract] [Full Text] |
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R. L. Wilensky, K. L. March, I. Gradus-Pizlo, G. Sandusky, N. Fineberg, and D. R. Hathaway Vascular Injury, Repair, and Restenosis After Percutaneous Transluminal Angioplasty in the Atherosclerotic Rabbit Circulation, November 15, 1995; 92(10): 2995 - 3005. [Abstract] [Full Text] |
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P. G. Steg, M. Ziol, O. Tahlil, C. Robert, P. Masson, D. Pruneau, P. Bruneval, and P. Belichard Reduction of Intimal Hyperplasia by Naroparcil, a 4-Methylumbelliferyl ß-D-Xyloside Analogue, After Arterial Injury in the Hypercholesterolemic Rabbit Circ. Res., November 1, 1995; 77(5): 919 - 926. [Abstract] [Full Text] |
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M. R. Bennett and S. M. Schwartz Antisense Therapy for Angioplasty Restenosis : Some Critical Considerations Circulation, October 1, 1995; 92(7): 1981 - 1993. [Full Text] |
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