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(Circulation. 1996;94:35-43.)
© 1996 American Heart Association, Inc.
Articles |
Arterial Remodeling After Coronary Angioplasty
A Serial Intravascular Ultrasound Study
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).
Lumen CSA correlated more strongly with EEM CSA
(r=.751, P<.0001) than with P+M CSA
(r=.284, P<.0001). 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 (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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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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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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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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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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 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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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. [Full Text] [PDF]
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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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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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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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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. [Full Text] [PDF]
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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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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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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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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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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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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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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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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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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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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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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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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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 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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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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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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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]
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