Arterial remodeling after balloon angioplasty of the coronary artery: An intravascular ultrasound study (original) (raw)
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American Heart Journal
Objective Before balloon dilation, failure of compensatory enlargement and even arterial shrinkage are frequently observed at the lesion site in response to plaque accumulation. Balloon angioplasty may be regarded as artificial remodeling to enlarge the artery. The prevalence of the different types of arterial wall remodeling after applied stretch by balloon angioplasty is unknown.Methods and Results In 181 patients an intravascular ultrasound study was performed after coronary balloon angioplasty ( n = 200 lesions). The vessel area was measured at a proximal and distal reference site and at the lesion site. Subsequently, the relative vessel area [(Vessel area lesion site)/Vessel area reference site) × 100] was calculated. Lesions were classified in three groups on the basis of their relative vessel areas: ≥105%, 95%, and ≤95%. A relative vessel area ≥105%, indicating enlargement compared with the reference site, was observed in 84 (44%) lesions. A relative vessel area 95% was observed in 43 (22%) lesions. A relative vessel area ≤95%, indicating “shrinkage” compared with the reference site, was observed in 66 (34%) lesions.Conclusions After balloon angioplasty, the vessel area was found to be smaller compared with the reference site in 34% of the lesions. This small vessel area at the lesion site compared with a reference site may be a reflection of insufficient stretch by balloon angioplasty. (Am Heart J 1997;134:680-4.)
International journal of cardiac imaging, 1998
After autopsy 12 human coronary arteries were investigated by intracoronary ultrasound in order to measure the vessel wall dimensions and to detect damage on the vessel wall architecture after balloon angioplasty. Histology revealed artherosclerosis in 11/12 arteries. A total of 41 representative coronary segments were selected for further off-line ultrasound and histological analysis. Intracoronary ultrasound and histological measurements of the vessel wall thickness after balloon dilatation demonstrated a good correlation between the maximum thickness of the intima (histology 0.62 mm vs. intracoronary ultrasound 0.65 mm, r = 0.87) and the intima-media complex (0.80 mm vs. 0.83 mm, r = 0.87), in contrast to a weak one between the minimum thickness (r = 0.46 and r = 0.37). A total of 21 cases of damage occurred during angioplasty; intracoronary ultrasound detected 17. Further analysis showed that it imaged 10 of 11 cases of damage involving more than 30 degrees of the vessel circumf...
Arterial responses to balloon coronary angioplasty: An intravascular ultrasound study
Journal of the American College of Cardiology, 1992
The purpose of this study was to examine the cwonary artery repo"w to prcutanmws trmIslumtnal mmnrry angiopiasry by using intravascular ultrawuwJ. Eackzmmd. The immediate e&cts of comnw aneioplestv on belore and imp&d 1; I!? t 11% alter angiop&y. Calclum was visualized in 7 (24%) of the 29 aogioplasty sib by Euomscopy verse 15 (52%) of sites by intravawular ultraswad (p = 0.022). Arterial diwction aftpr angiopbasty wzs observed in 8 (27%) of c&se by contrast sngiograpky venus 24 (83%, by intrava,wu,s~ abrasound (p < 0.001). ,i,:-avascular ultrasaud detected exteo. slvedtswtion st tbeangloplarty site in II (73%) oftbe 15 c&lAPd plaques and in ollry 3 (21%) nf tke 14 nmwakified plsques (p = 0.024). Arterial expmwiom (d&ad 8s the area within Ike external elastic membrane at tke angknplrty site greater lban that of Ike pmximal reference q-t) occurred in 29% OrcsLibIed plaques compared wltb 86% ofnoocakttted plaque (p = 0.007). Conclusianr. Intravawulnr ultrawund is more sensitive tbnn angiograpby for idrntirying nrfprip, calcium and disarettm, at the site oi angioplasty. At the site of .angioplasIy, srtorial diw&n wurred ntore frequently in c&b&d plaque wbetw arterial axpPn.Qioo occurred nun rreqwnuy In nonca,clRcd pkaques. 8uccESful angioplssty CalwS a cont,n~"m or *ria, resprmses that vary inpwkmtiy with plaque wnpwitton.
Heart (British Cardiac Society), 2001
To assess the mechanism of restenosis after balloon angioplasty. Prospective study. 13 patients treated with balloon angioplasty. 111 coronary subsegments (2 mm each) were analysed after balloon angioplasty and at a six month follow up using three dimensional intravascular ultrasound (IVUS). Qualitative and quantitative IVUS analysis. Total vessel (external elastic membrane), plaque, and lumen volume were measured in each 2 mm subsegment. Delta values were calculated (follow up - postprocedure). Remodelling was defined as any (positive or negative) change in total vessel volume. Positive remodelling was observed in 52 subsegments while negative remodelling occurred in 44. Remodelling, plaque type, and dissection were heterogeneously distributed along the coronary segments. Plaque composition was not associated with changes in IVUS indices, whereas dissected subsegments had a greater increase in total vessel volume than those without dissection (1.7 mm(3) v -0.33 mm(3), p = 0.04). Ch...
American Heart Journal, 1997
We evaluated the long-term angiographic outcome of balloon angioplasty by comparing original and follow-up target coronary narrowing. Rather than using restenosis to determine outcome, as in most angioplasty studies, we took an unusual approach and analyzed outcome in terms that are commonly Used in progression and regression studies after medical interventions. Quantitative angiographic measurements were undertaken in 315 narrowings with an initial diameter stenosis <90% before and after angioplasty and at follow-up. Angiographic deterioration (>10% increase in follow-up diameter stenosis) was identified in 44 (14%) narrowings. Angiographic deterioration was not influenced by age, sex, risk factors, lipid profile, or the indication for angioplasty. Deterioration was also not predicted by the severity, length, or the location of the narrowing. The deteriorating narrowings had a higher recoil after dilatation compared with narrowings with angiographic improvement (21% ± 31% vs 12% ± 17%, p= 0.006); the residual stenosis after angioplasty was therefore higher. The late loss was also significantly increased compared with narrowings with angiographic improvement (65% ± 26% vs 8 % ± 24%, p< 0.001). We conclude that the incidence of angiographic deterioration of coronary disease as a result of restenosis is uncommon but not negligible. Interventional cardiologists should resist the temptation to dilate mild, silent coronary narrowings because the procedure might have an unfavorable angiographic (and probably clinical) effect. (Am Heart J 1997;133:575-9.) The late outcome of successful balloon angioplasty is judged by the rate of restenosis. 1-s Other interventions to treat coronary artery disease, such as anti-From the
Importance of balloon size in coronary angioplasty
Journal of the American College of Cardiology, 1989
The effect of balloon size on the success of coronary angioplasty was studied to develop quantitative criteria for optimal selection of balloon size. Coronary dimensions of 165 stenotic lesions were measured by computer-assisted cinevideodensitometry in 120 patients who had undergone angioplasty with a balloon selected by visual estimates. Cross-sectional areas and diameters of normal and stenotic arterial segments were measured before and after angioplasty by a previously validated cinevideodensitometric technique. The diameter of the inflated balloon compared with that of the normal arterial segment was expressed as a ratio for sizing balloons. Oversized balloons with a ratio b1.3 (n = 35) caused a high (37%) incidence of dissection, with three severely compromised arterial lumens. Undersized balloons with a ratio <0.9 (n = 29) often resulted in significant (>50% diameter stenosis) residual stenotic lesions (21%) and a
The American Journal of Cardiology, 1996
limited information is provided by angiogra h on plaque morpholog r and composition before a loon I3 an ioplasty. ldenti ication of plaques associated with re 1 uced lumen gain or a high complication rate may provide the rationale for using alternative revascularization devices. We studied 60 patients with quantitative angiography and intracoronary ultrasound (ICUS) before and after balloon dilation. Angiography was used to measure transient wall stretch and elastic recoil. ICUS was used to investigate the mechanisms of lumen enlargement among different in the presence of a laque compositions and disease-ree wall (minimal thick-f ness 10.6 mm). Corn r red with ultrasound, an phy underestimated e presence of vessel calci ication 9 iogra-(13% vs 78%), lumen eccentricity (35% vs 62%), and wall dissection (32% vs 57%). ICUS measurements showed that balloon angioplasty increased lumen area from 1.82 + 0.5 1 to 4.8 1 f 1.43 mm2. lumen enlargement was the result of the combined effect of an increase in the total cross-sectional area of the vessel (wall stretching, 43%) and of a reduction in the area occupied by the plaque (plaque compression or redistribution, 57%). Vessels with a disease-free wall had smaller lumen gain than other types of vessels (2.13 f