Abstract
Restenosis after angioplasty occurs with an incidence of 20–50% and remains a major draw-back. Certain randomized studies suggest that a bigger post-angioplasty lumen predicts a better long-term outcome. Conversely other studies showed a better outcome with limited injury. The present study aimed to investigate the depth of the lesion and relate this to cellular alterations after graded vascular injury.
Method
Vessel segments of 30 pigs underwent injury using a directional atherectomy catheter. Vessels were assigned according to the extent of injury to Group 1 (intima lesion) or Group 2 (media injury). 2 hours to 7 days after injury, 68 arteries showing 41 intimal and 27 media lacerations were excised and processed for histology and transmission electron microscopy.
Results
Immediately after injury, thrombus formation was found at the site of the altered segment. A marked, transient infiltration of polymorphonuclear leukocytes (PMN) occurred only if the media was lacerated, starting within the first hours and increasing up until the 12 hours time point. The cellular infiltration was followed by a transformation of contractile myocytes to a synthetic subtype. The ratio of myofilaments to organelles decreased. A pronounced myoproliferative response was found in Group 2 after 7 days (p<0.01), whereas only moderate tissue hyperplasia was seen in Group 1.
Conclusion
The data presented provide evidence that the cellular alteration of injured vessels begins immediately. Subsequent to an initial temporary PMN infiltration, an activation of local myocytes occurs at a very early stage. In particular, a myoproliferative response was found only after deep injury with rupture of the internal elastic lamina.
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References
Adelman AG, Cohen EA, Kimball BP, Bonan R, Ricci D, Webb JG, Laramee L, Barbeau G, Traboulsi M, Corbett BN, Schwartz L, Logan AG (1993) A comparison of directional atherectomy with balloon angioplasty for lesions of the left anterior descending coronary artery. N Engl J Med 329: 228–233
Austin GE, Ratliff NB, Hollman J, Tabei S, Phillips DF (1985) Intimal proliferation of smooth muscle cells as an explanation for recurrent coronary artery stenosis after percutaneous transluminal coronary angioplasty. J Am Coll Cardiol 6: 369–375
Bessis M (1964) Hemopoietic Tissue and Blood. In: Kurtz StM (ed) Electron Microscopic Anatomy; Academic Press; New York
Bittl JA (1993) Directional coronary atherectomy versus balloon angioplasty. N Engl J Med 329: 273–274
Burke JM, Ross R (1979) Synthesis of connective tissue macromolecules by smooth muscle. In: International review of connective tissue research. New York: Academic press 8: 119–157
Cole CW, Makhoul RG, McCann RL, O'Malley MK, Hagen PO (1985) Vascular smooth muscle cells proliferate in vitro in response to human polymorphonuclear leukocytes and indomethacin. Clin Invest Med 8: 228
Fawcett DW (1973) Atlas zur Elektronenmikroskopie der Zelle. Urban & Schwarzenberg München Berlin Wien
Faxon DP, Sanborn TA, Haudenschild CC (1987) Mechanism of angioplasty and its relation to restenosis. Am J Cardiol 60: 5B-9B
Fingerle J, Au YPT, Clowes AW, Reidy MA (1990) Intimal lesion formation in rat carotid arteries after endothelial denudation in absence of medial injury. Arteriosclerosis 10: 1082–1087
Fishman R, Kuntz R, Carrozza J, Pomeranz R, Diver D, Safian R, Baim D (1991) Results of coronary atherectomy — Bigger is better. Circulation 84: 2068
French JE, Jennings MA, Florey HW (1965) Morphological studies on atherosclerosis in swine. Ann NY Acad Sci 127: 780–799
Friedman RJ, Stemerman MB, Wenz B, Moore S, Gauldie J, Gent M, Tiell ML, Spaet TH (1977) The effect of thrombocytopenia on experimental arteriosclerotic lesion formation in rabbits. J Clin Invest 60: 1191–1201
Gerrity RG, Naito HK, Richardson M, Schwartz CJ (1979) Dietary induced atherogenesis in swine. Am J Pathol 95: 775–792
Gonschior P, Gerheuser F, Gonschior GM, Mack B, Welsch U, Höfling B (1992) Vergleich zellulärer Veränderungen nach experimenteller Atherektomie versus Ballonangioplastie. Z Kardiol 81: 17
Gonschior P, Gerheuser F, Mack B, Welsch U, Nerlich A, Höfling B (1993) Vergleichende Untersuchung zellulärer Veränderungen nach experimenteller und klinischer Atherektomie. Z Kardiol 82: 49
Gonschior P, Mack B, Simpson L, Bauriedel G, Höfling B (1992) Directional peripheral atherectomy: Angiographic and clinical acute and long term results in 80 Patients. Angiology 6: 454–463
Grüntzig AR (1978) Transluminal dilatation of coronary-artery stenosis. The Lancet, February 4, 1978: 263
Hanke H, Strohschneider T, Oberhoff M, Betz E, Karsch KR (1990) Time course of smooth muscle cell proliferation in the intima and media of arteries following experimental angioplasty. Circ Res 67: 651–659
Hirosumi J, Nomoto A, Ohkubo Y, Sekiguchi C, Mutoh S, Yamaguchi I, Aoki H (1987) Inflammatory responses in cuff-induced atherosclerosis in rabbits. Atherosclerosis 64: 243–254
Holmes DR, Vlietstra RE, Smith HC, Vetrovec GW, kent KM, Cowley MJ, Faxon DP, Gruentzig AR, Kelsey SF, Detre KM, VanRaden MJ, Mock MB (1984) Restenosis after percutaneous transluminal coronary angioplasty (PTCA): A report from the PTCA Registry of the National heart, Lung and Blood Institute. Am J Cardiol 53: 77C-81C
Kaltenbach M, Kober G, Scherer D, Vallbracht C (1985) Recurrence rate after successful coronary angioplasty. European Heart Journal 6: 276–281
Kling D, Holzschuh T, Betz E (1987) Temporal sequence of morphological alterations in artery walls during experimental atherogenesis — Occurence of leukocytes. Res Exp Med 187: 237–250
Leimgruber P, Roubin S, Hollman J, Cotsonis G, Meier B, Douglas J, King S, Gruentzig A (1986) Restenosis after successful coronary angioplasty in patients with single vessel desease. Circulation 73: 710–717
Matthews JL, Martin JH (1971) Atlas of human histology and ultrastructure. Lea & Febiger, Philadelphia
Monsen CH, Adams PC, Badimon JH, Fuster V (1987) Platelet-vessel wall interactions in the developement of restenosis after coronary angioplasty. Z Kardiol 76: 23–28
Mosse PRL, Campbell GR, Wang ZL, Campbell J (1985) Smooth muscle phenotypic expression in human carotic arteries. Lab Invest 53: 556–562
Nobuyoshi M, Kimura T, Ohishi H, Horiuchi H, Nosaka H, hamsaki N, Yokoi H, Kim K (1987) Restenosis after percutaneous transluminal coronary angioplasty: Pathologic examinations in 20 patients. J Am Coll Cardiol 17: 616–22
Pond WG (1986) Nutrition and the cardiovascular system of swine. In: Stanton HC, Mersman HJ (eds) Swine in cardiovascular research, Vol II: 1–22; CRC press, Boca Raton, Florida, USA
Ross R (1993) The pathogenesis of atherosclerosis — a perspective for the 1990s. Nature 362: 801–9
Schinko I, Höfling B, v Pölnitz A, Bauriedel G, Welsch U (1990) Electron-microscopic evaluation of primary and restenotic lesions after percutaneous atherectomy. J Am Coll Cardiol 15: 254
Schwartz RS, Edwards WD, Bailey KR, Camrud AR, Jorgenson MA, Holmes DR (1994) Differential neointimal response to coronary artery injury in pigs and dogs. Implications for restenosis model. Arterioscler Thromb 14: 395–400
Schwartz RS, Murphy JG, Edwards WD, Camrud AR, Vlietstra RE, Holmes DR (1990) Restenosis after balloon angioplasty. A practical proliferative model in porcine coronary arteries. Circulation 82: 2190–2200
Serruys PW, Luijten HE, Beatt KJ, Geuskens R, De Feyter PJ, van den Brand M, Reiber JHC, ten Katen HJ, van Es GA, Hugenholtz PG (1988) Incidence of restenosis after successful coronary angioplasty: a time-related phenomenon. Circulation 77: 361–371
Sims FH (1989) A comparison of structural features of the walls of the coronary arteries from 10 different species. Pathology 21: 115–12
Statistisches Bundesamt (1991) Ausgewählte Zahlen aus dem Gesundheitswesen. Gruppe VII D-M; Statistisches Bundesamt Wiesbaden
Steele PM, Chesebro JH, Stanson AW, Holmes DR Jr, Dewanjee MK, Badimon L, Fuster V (1985) Balloon angioplasty. Natural history of the pathophysiological response to injury in a pig model. Circ Res 57: 105–112
Steg PG, Pasquier C, Pham T, Martin S, Gourgon R, Hakim J (1990) Evidence for neutrophil and complement activation early after PTCA. J Am Coll Cardiol 15: 64
Topol EJ, Leya F, Pinkerton CA, Whitlow PL, Höfling B, Simonton CA, Masden RR, Serruys PW, Leon MB, Williams DO, King SB, Mark DB, Isner JM, Holmes DR, Ellis SG, Lee KL, Keeler GP, Berdan LG, Hinohara T, Califf RM (1993) A comparison of directional atherectomy with coronary angioplasty in patients with coronary artery disease. N Engl J Med 329: 221–227
Thornton M, Gruentzig A, Hollman J, King S, Douglas J (1984) Coumadin and aspirin in the prevention of recurrence after transluminal coronary angioplasty: Arandomized study. Circulation 69: 721
Totani L, Piccoli A, Pellegrini G, Di Santo A, Lorenzet R (1994) Polymorphonuclear Leukozytes enhance release of growth factors by cultured endothelial cells. Arterioscler Thromb 14: 125–132
US Dep of Health and Human Services (1987) Advance report of final mortality statistics, 1985. Monthly Vital Statistics Report 36: 28
Van Vleet JF, Ferrans VJ (1986) Cardiovascular diseases of swine. In: Swine in cardiovascular research, I, 121–168; Stanton HC, Mersman HJ (eds) CRC press, Boca Raton, Florida
Wilentz JR, Sanborn TA, Haudenschild CC, Valeri CR, Ryan TJ, Faxon DPO (1987) Platelet accumulation in experimental angioplasty: time course and relation to vascular injury. Circulation 75: 636–642
Yakubov SJ, Dick RJ, Haudenschild CC (1991) Deep tissue retrieval with coronary atherectomy is paradoxically associated with less restenosis. Circulation 84: 2070
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Supported by Sanderstiftung grant No. 90.026.1/2, Friedrich Baur Stiftung grant No. 58-94, German Heart Foundation and Deutsche Forschungsgemeinschaft (1076/1–2)
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Gonschior, P., Gerheuser, F., Lehr, A. et al. Ultrastructural characteristics of cellular reaction after experimentally induced lesions in the arterial vessel. Basic Res Cardiol 90, 160–166 (1995). https://doi.org/10.1007/BF00789445
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DOI: https://doi.org/10.1007/BF00789445