Elsevier

American Heart Journal

Volume 134, Issue 6, December 1997, Pages 1099-1106
American Heart Journal

Influence of coronary atherosclerotic remodeling on the mechanism of balloon angioplasty,☆☆,

Presented in part at the Annual Sessions of the American Heart Association, New Orleans, La., Nov. 10-13, 1996.
https://doi.org/10.1016/S0002-8703(97)70031-0Get rights and content

Abstract

Objectives Intracoronary ultrasonography was used to assess coronary arteries before and after balloon percutaneous transluminal coronary angioplasty (PTCA) to determine whether the mode of coronary atherosclerotic remodeling affects the mechanism of balloon dilation. Background Coronary arteries may enlarge or shrink in response to atherosclerotic plaque development. The effect of coronary remodeling on the mechanism of balloon PTCA has not yet been studied. Methods Forty-one patients with 47 native de novo coronary artery lesions were studied with a 30 MHz intracoronary ultrasound catheter before and after balloon PTCA. Images were analyzed at the lesion site and the adjacent reference segments. At each site the lumen, vessel, and plaque area and the percent area stenosis were measured. Lesions were separated into two groups based on relative vessel area (lesion vessel area/reference vessel area). A relative vessel area >1.0 defines adaptive enlargement (group 1, n = 25), whereas a relative vessel area ≤1.0 reflects coronary shrinkage (group 2, n = 22). Regression analysis examined whether elastic recoil and the PTCA balloon/vessel area ratio correlated. Results After balloon PTCA was performed, both the enlargement and shrinkage groups had similar gains in luminal area (2.3 ± 1.8 mm2 [mean ± SD] vs 2.8 ± 1.7 mm2, p = 0.32), reduction in percent stenosis (−19.2% ± 11.5% vs −14.4 ± 12.7, p = 0.18), and final lumen area (4.9 ± 1.7 mm2 vs 4.7 ± 1.9 mm2, p = 0.73). However, the mechanism of luminal enlargement was different in each group. Reduction in plaque area was significantly greater in the enlargement group (group 1, −2.0 ± 1.7 mm2 vs group 2, 0.04 ± 2.2 mm2 ; p = 0.001), whereas increased vessel area was more important in the shrinkage group (group 1, 0.8 ± 1.5 mm2 vs group 2, 2.4 ± 2.3 mm2; p = 0.009). Positive correlation was seen between elastic recoil and the balloon/vessel area ratio in lesions with vessel enlargement (r = 0.80, p < 0.0001). No such correlation was observed in shrinkage vessels (r = 0.28, p = 0.21). Conclusions The acute luminal gain after balloon PTCA is similar regardless of the type of coronary remodeling. However, the mode of remodeling affects the mechanism of balloon dilation such that enlargement vessels exhibit plaque compression, whereas shrinkage arteries demonstrate vessel stretch. The post-PTCA elastic recoil correlates linearly to the balloon/vessel area ratio in arteries that have undergone adaptive enlargement. (Am Heart J 1997;134:1099-106.)

Section snippets

Study group

Prospective data were collected on 41 consecutive patients with 47 de novo native coronary artery lesions. Each lesion was examined with intracoronary ultrasonography immediately before and after balloon percutaneous transluminal coronary angioplasty (PTCA). Fourteen lesions were studied in the left anterior descending artery, 19 in the circumflex artery, and 14 in the right coronary artery. The indication for angioplasty was angina associated with a coronary artery stenosis of at least 75%.

Baseline findings

At baseline 25 lesions demonstrated compensatory enlargement (group 1), whereas 22 exhibited vessel shrinkage (group 2) (Table I). Before balloon angioplasty was performed, the mean cross-sectional lumen area at the lesion site was similar in each group (group 1, 2.1 ± 1.4 mm2 vs group 2, 2.4 ± 1.3 mm2, p = 0.41). The lumen percent area stenosis determined by intracoronary ultrasonography was also similar in both groups (group 1, 82.4% ± 11.4% vs group 2, 75.2% ± 12.9%, p = 0.05). The vessel

Mechanism of angioplasty

This study is the first to describe that the mode of coronary artery remodeling affects the mechanism of response to balloon angioplasty. Coronary arteries with compensatory enlargement experienced an improvement in the lumen area primarily through a reduction in plaque size, whereas vessel area was minimally affected. Lesions demonstrating vessel shrinkage, on the other hand, achieved their gain by arterial stretch, as shown by an increase in vessel area. Plaque area, however, did not

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    From Northwestern University Medical School, Chicago, Ill., and St. Vincent Medical Center, Indianapolis, Ind.

    ☆☆

    Reprint requests: Charles J. Davidson, MD, Northwestern Memorial Hospital, 710 North Fairbanks Ct., Olson 4220, Chicago, IL 60611.

    4/1/86119

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