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Circulation. 1996;94:35-43

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*Angioplasty

(Circulation. 1996;94:35-43.)
© 1996 American Heart Association, Inc.


Articles

Arterial Remodeling After Coronary Angioplasty

A Serial Intravascular Ultrasound Study

Gary S. Mintz, MD; Jeffrey J. Popma, MD; Augusto D. Pichard, MD; Kenneth M. Kent, MD, PhD; Lowell F. Satler, MD; S. Chiu Wong, MD; Mun K. Hong, MD; Julie A. Kovach, MD; Martin B. Leon, MD

From the Intravascular Ultrasound Imaging and Cardiac Catheterization Laboratories, the Washington Hospital Center, Washington, DC.

Correspondence to Martin B. Leon, MD, 110 Irving St NW (4B-1), Washington, DC 20010.

Background Restenosis occurs after 30% to 50% of transcatheter coronary procedures; however, the natural history and pathophysiology of restenosis are still incompletely understood.

Methods and Results Serial (postintervention and follow-up) intravascular ultrasound imaging was used to study 212 native coronary lesions in 209 patients after percutaneous transluminal coronary angioplasty, directional coronary atherectomy, rotational atherectomy, or excimer laser angioplasty. The external elastic membrane (EEM) and lumen cross-sectional areas (CSA) were measured; plaque plus media (P+M) CSA was calculated as EEM minus lumen CSA. The anatomic slice selected for serial analysis had an axial location within the target lesion at the smallest follow-up lumen CSA. At follow-up, 73% of the decrease in lumen (from 6.6±2.5 to 4.0±3.7 mm2, P<.0001) was due to a decrease in EEM (from 20.1±6.4 to 18.2±6.4 mm2, P<.0001); 27% was due to an increase in P+M (from 13.5±5.5 to 14.2±5.4 mm2, P<.0001). {Delta}Lumen CSA correlated more strongly with {Delta}EEM CSA (r=.751, P<.0001) than with {Delta}P+M CSA (r=.284, P<.0001). {Delta}EEM was bidirectional; 47 lesions (22%) showed an increase in EEM. Despite a greater increase in P+M (1.5±2.5 versus 0.5±2.0 mm2, P=.0009), lesions exhibiting an increase in EEM had (1) no change in lumen (-0.1±3.3 versus 3.6±2.3 mm2, P<.0001), (2) a reduced restenosis rate (26% versus 62%, P<.0001), and (3) a 49% frequency of late lumen gain (versus 1%, P<.0001) compared with lesions with no increase in EEM.

Conclusions Restenosis appears to be determined primarily by the direction and magnitude of vessel wall remodeling ({Delta}EEM). An increase in EEM is adaptive, whereas a decrease in EEM contributes to restenosis.


Key Words: angioplasty • restenosis • ultrasonics • remodeling




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R. J. Pettersen, Z. A. Muna, K. K.J. Kuiper, E. Svendsen, F. Muller, P. Aukrust, R. K. Berge, and J. Erik Nordrehaug
Sustained retention of tetradecylthioacetic acid after local delivery reduces angioplasty-induced coronary stenosis in the minipig
Cardiovasc Res, November 1, 2001; 52(2): 306 - 313.
[Abstract] [Full Text] [PDF]


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CirculationHome page
E.-i. Okamoto, T. Couse, H. De Leon, J. Vinten-Johansen, R. B. Goodman, N. A. Scott, and J. N. Wilcox
Perivascular Inflammation After Balloon Angioplasty of Porcine Coronary Arteries
Circulation, October 30, 2001; 104(18): 2228 - 2235.
[Abstract] [Full Text] [PDF]


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CirculationHome page
P. S. Teirstein
Living the Dream of No Restenosis
Circulation, October 23, 2001; 104(17): 1996 - 1998.
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CirculationHome page
G. S. Mintz, N. J. Weissman, and P. J. Fitzgerald
Intravascular Ultrasound Assessment of the Mechanisms and Results of Brachytherapy
Circulation, September 11, 2001; 104(11): 1320 - 1325.
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Eur Heart JHome page
J.J Piek, E Boersma, M Voskuil, C di Mario, E Schroeder, C Vrints, P Probst, B de Bruyne, C Hanet, E Fleck, et al.
The immediate and long-term effect of optimal balloon angioplasty on the absolute coronary blood flow velocity reserve. A subanalysis of the DEBATE study
Eur. Heart J., September 2, 2001; 22(18): 1725 - 1732.
[Abstract] [PDF]


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J Am Coll CardiolHome page
N. Mercado, E. Boersma, W. Wijns, B. J. Gersh, C. A. Morillo, V. de Valk, G.-A. van Es, D. E. Grobbee, and P. W. Serruys
Clinical and quantitative coronary angiographic predictors of coronary restenosis: A comparative analysis from the balloon-to-stent era
J. Am. Coll. Cardiol., September 1, 2001; 38(3): 645 - 652.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
P. Schoenhagen, K. M. Ziada, D. G. Vince, S. E. Nissen, and E. M. Tuzcu
Arterial remodeling and coronary artery disease: the concept of "dilated" versus "obstructive" coronary atherosclerosis
J. Am. Coll. Cardiol., August 1, 2001; 38(2): 297 - 306.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
G. Sianos, I. P. Kay, M. A. Costa, E. Regar, K. Kozuma, P. J. de Feyter, E. Boersma, C. Disco, and P. W. Serruys
Geographical miss during catheter-based intracoronary beta-radiation: incidence and implications in the BRIE study
J. Am. Coll. Cardiol., August 1, 2001; 38(2): 415 - 420.
[Abstract] [Full Text] [PDF]


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CirculationHome page
M. R. Ward, P. Kanellakis, D. Ramsey, J. Funder, and A. Bobik
Eplerenone Suppresses Constrictive Remodeling and Collagen Accumulation After Angioplasty in Porcine Coronary Arteries
Circulation, July 24, 2001; 104(4): 467 - 472.
[Abstract] [Full Text] [PDF]


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J. Lipid Res.Home page
O. Zschenker, N. Jung, J. Rethmeier, S. Trautwein, S. Hertel, M. Zeigler, and D. Ameis
Characterization of lysosomal acid lipase mutations in the signal peptide and mature polypeptide region causing Wolman disease
J. Lipid Res., July 1, 2001; 42(7): 1033 - 1040.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
S. C. Smith Jr, J. T. Dove, A. K. Jacobs, J. Ward Kennedy, D. Kereiakes, M. J. Kern, R. E. Kuntz, J. J. Popma, H. V. Schaff, D. O. Williams, et al.
ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines): A report of the American College of Cardiology/ American Heart Association Task Force on practice guidelines (Committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty) endorsed by the Society for Cardiac Angiography and Interventions
J. Am. Coll. Cardiol., June 15, 2001; 37(8): 2239 - 2239.
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CirculationHome page
T. Kosokabe, K. Okumura, T. Sone, J. Kondo, H. Tsuboi, H. Mukawa, T. Tomida, T. Suzuki, H. Kamiya, H. Matsui, et al.
Relation of a Common Methylenetetrahydrofolate Reductase Mutation and Plasma Homocysteine With Intimal Hyperplasia After Coronary Stenting
Circulation, April 24, 2001; 103(16): 2048 - 2054.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
A.J Wardeh, A.H.M Knook, I.P Kay, M Sabate, V.L.M.A Coen, D.P Foley, J.N Hamburger, P.C Levendag, W.J van der Giessen, and P.W Serruys
Clinical and angiographical follow-up after implantation of a 6-12{micro}Ci radioactive stent in patients with coronary artery disease
Eur. Heart J., April 2, 2001; 22(8): 669 - 675.
[Abstract] [PDF]


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J Am Coll CardiolHome page
Y. Kobayashi, Y. Honda, L. G. Christie, P. S. Teirstein, S. R. Bailey, C. L. Brown III, R. V. Matthews, A. C. De Franco, R. S. Schwartz, S. Goldberg, et al.
Long-term vessel response to a self-expanding coronary stent: a serial volumetric intravascular ultrasound analysis from the ASSURE trial
J. Am. Coll. Cardiol., April 1, 2001; 37(5): 1329 - 1334.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
G. S. Mintz, S. E. Nissen, W. D. Anderson, S. R. Bailey, R. Erbel, P. J. Fitzgerald, F. J. Pinto, K. Rosenfield, R. J. Siegel, E. M. Tuzcu, et al.
American College of Cardiology clinical expert consensus document on standards for acquisition, measurement and reporting of intravascular ultrasound studies (ivus): A report of the american college of cardiology task force on clinical expert consensus documents developed in collaboration with the european society of cardiology endorsed by the society of cardiac angiography and interventions
J. Am. Coll. Cardiol., April 1, 2001; 37(5): 1478 - 1492.
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Circ. Res.Home page
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]


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J Am Coll CardiolHome page
H. Okura, Y. Morino, A. Oshima, M. Hayase, M. R. Ward, J. J. Popma, R. E. Kuntz, H. N. Bonneau, P. G. Yock, and P. J. Fitzgerald
Preintervention arterial remodeling affects clinical outcome following stenting: an intravascular ultrasound study
J. Am. Coll. Cardiol., March 15, 2001; 37(4): 1031 - 1035.
[Abstract] [Full Text] [PDF]


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HeartHome page
F Schiele, M K Batur, M F Seronde, N Meneveau, P Sewoke, A Bassignot, G Couetdic, F Caulfield, and J-P Bassand
Cytomegalovirus, Chlamydia pneumoniae, and Helicobacter pylori IgG antibodies and restenosis after stent implantation: an angiographic and intravascular ultrasound study
Heart, March 1, 2001; 85(3): 304 - 311.
[Abstract] [Full Text]


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CirculationHome page
J.-G. Bienvenu, J.-F. Tanguay, J.-F. Theoret, A. Kumar, R. G. Schaub, and Y. Merhi
Recombinant Soluble P-Selectin Glycoprotein Ligand-1-Ig Reduces Restenosis Through Inhibition of Platelet-Neutrophil Adhesion After Double Angioplasty in Swine
Circulation, February 27, 2001; 103(8): 1128 - 1134.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
M. R. Ward, P. S. Tsao, A. Agrotis, R. J. Dilley, G. L. Jennings, and A. Bobik
Low Blood Flow After Angioplasty Augments Mechanisms of Restenosis : Inward Vessel Remodeling, Cell Migration, and Activity of Genes Regulating Migration
Arterioscler Thromb Vasc Biol, February 1, 2001; 21(2): 208 - 213.
[Abstract] [Full Text] [PDF]


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CirculationHome page
S. E. Nissen and P. Yock
Intravascular Ultrasound : Novel Pathophysiological Insights and Current Clinical Applications
Circulation, January 30, 2001; 103(4): 604 - 616.
[Abstract] [Full Text] [PDF]


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CirculationHome page
M. J. Sierevogel, G. Pasterkamp, E. Velema, P. P. T. de Jaegere, B. J. G. L. de Smet, J. H. Verheijen, D. P. V. de Kleijn, and C. Borst
Oral Matrix Metalloproteinase Inhibition and Arterial Remodeling After Balloon Dilation : An Intravascular Ultrasound Study in the Pig
Circulation, January 16, 2001; 103(2): 302 - 307.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
A. Endo, H. Hirayama, O. Yoshida, T. Arakawa, T. Akima, T. Yamada, and M. Nanasato
Arterial remodeling influences the development of intimal hyperplasia after stent implantation
J. Am. Coll. Cardiol., January 1, 2001; 37(1): 70 - 75.
[Abstract] [Full Text] [PDF]


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HeartHome page
M A Costa, K Kozuma, A L Gaster, W J van der Giessen, M Sabaté, D P Foley, I P Kay, J M R Ligthart, P Thayssen, M J van den Brand, et al.
Three dimensional intravascular ultrasonic assessment of the local mechanism of restenosis after balloon angioplasty
Heart, January 1, 2001; 85(1): 73 - 79.
[Abstract] [Full Text]


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CirculationHome page
G. S. Mintz, N. J. Weissman, P. S. Teirstein, S. G. Ellis, R. Waksman, R. J. Russo, I. Moussa, P. Tripuraneni, S. Jani, Y. Kobayashi, et al.
Effect of Intracoronary {{gamma}}-Radiation Therapy on In-Stent Restenosis : An Intravascular Ultrasound Analysis from the Gamma-1 Study
Circulation, December 12, 2000; 102(24): 2915 - 2918.
[Abstract] [Full Text] [PDF]


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CirculationHome page
D. Godin, E. Ivan, C. Johnson, R. Magid, and Z. S. Galis
Remodeling of Carotid Artery Is Associated With Increased Expression of Matrix Metalloproteinases in Mouse Blood Flow Cessation Model
Circulation, December 5, 2000; 102(23): 2861 - 2866.
[Abstract] [Full Text] [PDF]


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Eur Heart JHome page
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]


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J. Pharmacol. Exp. Ther.Home page
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]


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RadiologyHome page
S. K. Parikh, D. Nori, A. Osian, and P. Tripuraneni
Practical Considerations in Setting Up an Intracoronary Brachytherapy Program: Results of a Multicenter Survey
Radiology, December 1, 2000; 217(3): 723 - 728.
[Abstract] [Full Text]


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SEMIN CARDIOTHORAC VASC ANESTHHome page
S. L. Meyerson, C. L. Skelly, M. A. Curi, and L. B. Schwartz
Gene Therapy for Cardiovascular Disease
Seminars in Cardiothoracic and Vascular Anesthesia, November 1, 2000; 4(4): 289 - 300.
[Abstract] [PDF]


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Eur Heart JHome page
R. Hoffmann and G.S. Mintz
Coronary in-stent restenosis--predictors, treatment and prevention
Eur. Heart J., November 1, 2000; 21(21): 1739 - 1749.
[PDF]