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Circulation. 1994;89:2809-2815

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Circulation, Vol 89, 2809-2815, Copyright © 1994 by American Heart Association


ARTICLES

Differences in compensatory vessel enlargement, not intimal formation, account for restenosis after angioplasty in the hypercholesterolemic rabbit model

T Kakuta, JW Currier, CC Haudenschild, TJ Ryan and DP Faxon
Department of Medicine, University of Southern California, Los Angeles 90033.

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.


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Use of Nuclear Magnetic Resonance Imaging Angiography to Follow-Up Arterial Remodeling in an Animal Model
Angiology, April 1, 1998; 49(4): 251 - 258.
[Abstract] [PDF]


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Cardiovasc ResHome page
E. Van Belle, C. Bauters, T. Asahara, and J. M. Isner
Endothelial regrowth after arterial injury: from vascular repair to therapeutics
Cardiovasc Res, April 1, 1998; 38(1): 54 - 68.
[Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
P. Holvoet, G. Theilmeier, B. Shivalkar, W. Flameng, and D. Collen
LDL Hypercholesterolemia Is Associated With Accumulation of Oxidized LDL, Atherosclerotic Plaque Growth, and Compensatory Vessel Enlargement in Coronary Arteries of Miniature Pigs
Arterioscler Thromb Vasc Biol, March 1, 1998; 18(3): 415 - 422.
[Abstract] [Full Text] [PDF]


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Circ. Res.Home page
P. Libby
Gene Therapy of Restenosis : Promise and Perils
Circ. Res., February 23, 1998; 82(3): 404 - 406.
[Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
M. Challah, E. Villard, M. Philippe, A. Ribadeau-Dumas, B. Giraudeau, P. Janiak, J.-P. Vilaine, F. Soubrier, and J.-B. Michel
Angiotensin I-Converting Enzyme Genotype Influences Arterial Response to Injury in Normotensive Rats
Arterioscler Thromb Vasc Biol, February 1, 1998; 18(2): 235 - 243.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
T. Kakuta, M. Usui, W. D. Coats Jr, J. W. Currier, F. Numano, and D. P. Faxon
Arterial Remodeling at the Reference Site After Angioplasty in the Atherosclerotic Rabbit Model
Arterioscler Thromb Vasc Biol, January 1, 1998; 18(1): 47 - 51.
[Abstract] [Full Text] [PDF]


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CirculationHome page
A. Kumar, J. L. Hoover, C. A. Simmons, V. Lindner, and R. J. Shebuski
Remodeling and Neointimal Formation in the Carotid Artery of Normal and P-Selectin–Deficient Mice
Circulation, December 16, 1997; 96(12): 4333 - 4342.
[Abstract] [Full Text]


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Arterioscler. Thromb. Vasc. Bio.Home page
H. S. Seo, D. M. Lombardi, P. Polinsky, L. Powell-Braxton, S. Bunting, S. M. Schwartz, and M. E. Rosenfeld
Peripheral Vascular Stenosis in Apolipoprotein E-Deficient Mice : Potential Roles of Lipid Deposition, Medial Atrophy, and Adventitial Inflammation
Arterioscler Thromb Vasc Biol, December 1, 1997; 17(12): 3593 - 3601.
[Abstract] [Full Text]


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Arterioscler. Thromb. Vasc. Bio.Home page
M. Takagi, M. Ueda, A. E. Becker, K. Takeuchi, and T. Takeda
The Watanabe Heritable Hyperlipidemic Rabbit Is a Suitable Experimental Model to Study Differences in Tissue Response Between Intimal and Medial Injury After Balloon Angioplasty
Arterioscler Thromb Vasc Biol, December 1, 1997; 17(12): 3611 - 3619.
[Abstract] [Full Text]


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Cardiovasc ResHome page
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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CirculationHome page
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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Cardiovasc ResHome page
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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Circ. Res.Home page
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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CirculationHome page
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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CirculationHome page
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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ANGIOLOGYHome page
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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CirculationHome page
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. Thorac. Cardiovasc. Surg.Home page
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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CirculationHome page
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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CirculationHome page
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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CirculationHome page
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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CirculationHome page
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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CirculationHome page
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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CirculationHome page
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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CirculationHome page
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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CirculationHome page
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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Arterioscler. Thromb. Vasc. Bio.Home page
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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NEJMHome page
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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Arterioscler. Thromb. Vasc. Bio.Home page
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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CirculationHome page
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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CirculationHome page
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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CirculationHome page
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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CirculationHome page
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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J CARDIOVASC PHARMACOL THERHome page
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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CirculationHome page
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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Arterioscler. Thromb. Vasc. Bio.Home page
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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CirculationHome page
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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Arterioscler. Thromb. Vasc. Bio.Home page
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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CirculationHome page
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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Circ. Res.Home page
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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CirculationHome page
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]