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Circulation, Vol 85, 1012-1025, Copyright © 1992 by American Heart Association
J Honye, DJ Mahon, A Jain, CJ White, SR Ramee, JB Wallis, A al-Zarka and JM Tobis
BACKGROUND. Histological examination of the effects of balloon angioplasty
have been described from in vitro experiments and a limited number of
pathologic specimens. Intravascular ultrasound imaging permits real time
cross-sectional observation of the effect of balloon dilation on the
atherosclerotic plaque in vivo. METHODS AND RESULTS. The morphological
effects of coronary angioplasty were visualized at 66 lesions in 47
patients immediately after balloon dilatation with an intravascular
ultrasound imaging catheter. Cross-sectional images were obtained at 30
frames per second as the catheter passed along the length of the artery.
Quantitative and qualitative assessments of the dilated atherosclerotic
plaque were made from the angiograms and the ultrasound images. Six
morphological patterns after angioplasty were appreciated by ultrasound
imaging. Type A consists of a linear, partial tear of the plaque from the
lumen toward the media (seven lesions); Type B is defined by a split in the
plaque that extends to the media (12 lesions); Type C demonstrates a
dissection behind the plaque that subtends an arc of up to 180 degrees
around the circumference (18 lesions); Type D was a more extensive
dissection that encompasses an arc of more than 180 degrees (four lesions);
and Type E may be present in either concentric (Type E1, 14 lesions) or
eccentric (Type E2, 11 lesions) plaque and is defined as an ultrasound
study without any evidence of a fracture or a dissection in the plaque.
There was a large amount of residual atheroma in each type of morphology
(7.8 +/- 2.9 mm2, 61.6 +/- 15.4% of cross-sectional area); there was no
difference, however, in lumen or atheroma cross-sectional area among these
six patterns. There was a good correlation between ultrasound and
angiography for the recognition of a dissection. Calcification was seen in
only 14% of lesions on angiography, whereas most lesions (83%) revealed
calcification on ultrasound imaging. As determined by intravascular
ultrasound, calcified plaque was more likely to fracture in response to
balloon dilatation than noncalcified plaque (p less than 0.01). Thirteen of
66 lesions (20%) developed clinical and angiographic restenosis. Restenosis
was more likely to occur when the original dilatation left a concentric
plaque without a fracture or dissection (Type E1, 50% incidence) compared
with a mean restenosis rate of 12% in the remaining morphological patterns
(p = 0.053). CONCLUSIONS. Intravascular ultrasound provides a more complete
quantitative and qualitative description of plaque geometry and composition
than angiography after balloon angioplasty. In addition, intravascular
ultrasound identified a subset of atherosclerotic plaque that has a higher
incidence of restenosis. This information could be used prospectively to
consider other therapeutic options in this subset. Intravascular ultrasound
provides a method to describe the effects of angioplasty that will be
useful in comparing future coronary intervention studies.
ARTICLES
Morphological effects of coronary balloon angioplasty in vivo assessed by intravascular ultrasound imaging
Division of Cardiology, University of California, Irvine, Orange 92668.
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