Circulation, Vol 89, 2816-2821, Copyright © 1994 by American Heart Association
MJ Post, C Borst and RE Kuntz
BACKGROUND: Although arterial renarrowing after angioplasty has been
attributed largely to intimal hyperplasia, there has been no systematic
effort to correlate the actual hyperplastic tissue mass with angiographic
lumen reduction. Using balloon angioplasty in various animal restenosis
models, we quantitatively assessed the separate contributions of intimal
hyperplasia and arterial remodeling to angiographic late lumen loss.
METHODS AND RESULTS: Data used for this study were obtained from
experiments of conventional and thermal (37 degrees C or 55 degrees to 90
degrees C) balloon angioplasty-treated femoral and iliac arteries in normal
rabbits and conventional balloon angioplasty-treated iliac arteries in
Yucatan micropigs fed either a normal or an atherogenic diet. Quantitative
angiography was performed immediately before and after intervention and at
3 or 8 weeks thereafter, and late loss in lumen diameter was taken as the
difference between arterial diameter immediately after treatment and at 3
or 8 weeks of follow-up. Intimal hyperplasia was quantified histologically
as the area of tissue mass within the internal elastic lamina. We observed
a consistent discrepancy between the actual late loss seen with angiography
and the diameter reduction that could be explained by histological intimal
thickness alone in both animal models. This discrepancy ranged from 86 +/-
3% of the late loss in the 8 weeks/37 degrees C group to 77 +/- 22% in the
conventional group for rabbits and 52 +/- 23% in an atherogenic diet group
(n = 10) to 89 +/- 11% in a normal diet group (n = 6) for pigs. This
discrepancy appeared to be due predominantly to reduction of the area
circumscribed by the internal elastic membrane, a process that is
tentatively designated as arterial remodeling. In both the rabbit femoral
artery and in the Yucatan iliac artery, remodeling, not intimal
hyperplasia, correlated with angiographic late loss. CONCLUSIONS: In both
the normal rabbit and the normal and atherosclerotic pig, restenosis after
angioplasty results from both intimal hyperplasia and arterial remodeling.
The exact etiology of arterial renarrowing after angioplasty has important
implications on the design of antirestenosis drugs and new coronary
devices.
ARTICLES
The relative importance of arterial remodeling compared with intimal hyperplasia in lumen renarrowing after balloon angioplasty. A study in the normal rabbit and the hypercholesterolemic Yucatan micropig
Department of Cardiology, Utrecht University Hospital, The Netherlands.
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B. J. G. L. de Smet, G. Pasterkamp, Y. J. van der Helm, C. Borst, and M. J. Post The Relation Between De Novo Atherosclerosis Remodeling and Angioplasty-Induced Remodeling in an Atherosclerotic Yucatan Micropig Model Arterioscler Thromb Vasc Biol, May 1, 1998; 18(5): 702 - 707. [Abstract] [Full Text] [PDF]
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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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P C Smits, L Bos, M A Q. van Ufford, F D Eefting, G Pasterkamp, and C Borst Shrinkage of human coronary arteries is an important determinant of de novo atherosclerotic luminal stenosis: an in vivo intravascular ultrasound study Heart, February 1, 1998; 79(2): 143 - 147. [Abstract] [Full Text]
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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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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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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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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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M. K. Barron, R. S. Lake, A. J. Buda, and A. N. Tenaglia Intimal Hyperplasia After Balloon Injury Is Attenuated by Blocking Selectins Circulation, November 18, 1997; 96(10): 3587 - 3592. [Abstract] [Full Text]
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M. W. Liu, P. G. Anderson, J. F. Luo, and G. S. Roubin Local Delivery of Ethanol Inhibits Intimal Hyperplasia in Pig Coronary Arteries After Balloon Injury Circulation, October 7, 1997; 96(7): 2295 - 2301. [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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J. A. Ormiston, F. M. Stewart, A. H. G. Roche, B. J. Webber, R. M. L. Whitlock, and M. W. I. Webster Late Regression of the Dilated Site After Coronary Angioplasty : A 5-Year Quantitative Angiographic Study Circulation, July 15, 1997; 96(2): 468 - 474. [Abstract] [Full Text]
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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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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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A. Zalewski and Y. Shi Vascular Myofibroblasts : Lessons From Coronary Repair and Remodeling Arterioscler Thromb Vasc Biol, March 1, 1997; 17(3): 417 - 422. [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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E. Van Belle, F. O. Tio, T. Couffinhal, L. Maillard, J. Passeri, and J. M. Isner Stent Endothelialization: Time Course, Impact of Local Catheter Delivery, Feasibility of Recombinant Protein Administration, and Response to Cytokine Expedition Circulation, January 21, 1997; 95(2): 438 - 448. [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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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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R. Hoffmann, G. S. Mintz, G. R. Dussaillant, J. J. Popma, A. D. Pichard, L. F. Satler, K. M. Kent, J. Griffin, and M. B. Leon Patterns and Mechanisms of In-Stent Restenosis: A Serial Intravascular Ultrasound Study Circulation, September 15, 1996; 94(6): 1247 - 1254. [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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N. A. Scott, G. D. Cipolla, C. E. Ross, B. Dunn, F. H. Martin, L. Simonet, and J. N. Wilcox Identification of a Potential Role for the Adventitia in Vascular Lesion Formation After Balloon Overstretch Injury of Porcine Coronary Arteries Circulation, June 15, 1996; 93(12): 2178 - 2187. [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. 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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