Skip to main content
SpringerLink
Log in

Towards complete assessment of progression/regression of coronary atherosclerosis: Implications for intervention trials

  • Chapter
Progress in quantitative coronary arteriography

Part of the book series: Developments in Cardiovascular Medicine ((DICM,volume 155))

Summary

Visual assessment of serial angiograms has always been the standard method to study progression/regression of coronary atherosclerosis. Visual assessment is subjective and suffers from the large intra- and interobserver variability. This stimulated the development of quantitative coronary angiography, employing computer based edge-finding detection techniques, which are currently applied and now considered as the new’ standard’.

However, angiography has its inherent limitations to assess progression/-regression mainly because the technique is ‘indirect’ as it provides a shadowgram of the contrast-filled lumen only.

Coronary atherosclerosis causes alterations of the coronary artery wall. In the earlier phases of atherosclerosis vascular remodelling preserves the original vascular lumen; only in later phases of the disease encroachment on the lumen takes place.

Intracoronary ultrasound imaging (ICUS) holds great promise to study progression/regression of coronary atherosclerosis. It is a ‘direct’ imaging technique and allows assessment of the arterial wall, components of the plaque including lipid content, fibrous tissue or calcification, and it allows quantification of the extent of the plaque. Thus ICUS provides insights into the underlying pathologic processes, during all stages of the coronary atherosclerosis. It may predict which lesion has potential for progression/ regression, and it may be used to monitor the effects of an intervention.

The functional significance of a coronary lesion can be assessed by applying the concept of coronary flow reserve. Measurement of coronary blood flow velocity with intracoronary Doppler-techniques (Flo-map wire or Doppler catheter) at baseline and during maximal vasodilation is currently possible in clinical practise.

Complete assessment of progression/regression with the application of quantitative coronary angiography, intracoronary ultrasound and intracoronary Doppler, three complementary techniques, is now possible and soon will be implemented in clinical practise.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Davies MJ, Krikler DM, Katz D. Atherosclerosis: inhibition or regression as therapeutic possibilities. Br Heart J 1991; 65: 302–310.

    Article  PubMed  CAS  Google Scholar 

  2. Vos J, deFeyter PJ, Simoons ML, Tijssen JG, Deckers JW. Retardation and arrest of progression or regression of coronary artery disease: a review. Prog Cardiovasc Dis 1993; 35: 435–454.

    Article  PubMed  CAS  Google Scholar 

  3. Thompson GR. Progression and regression of coronary artery disease. Curr Opin Lipidol 1992; 3: 263–267.

    Article  Google Scholar 

  4. de Feyter PJ, Serruys PW, Davies MJ, Richardson P, Lubsen J, Oliver MF. Quantitative coronary angiography to measure progression or regression of coronary atherosclerosis. Value, limitations, and implications for clinical trials. Circulation 1991; 84: 412–423.

    Article  PubMed  Google Scholar 

  5. Vlodaver Z, Edwards JE. Pathology of coronary atherosclerosis. Prog Cardiovasc Dis 1971; 14: 256–274.

    Article  PubMed  CAS  Google Scholar 

  6. Marcus ML, Harrison DG, White CW, McPherson DD, Wilson RF, Kerber RE. Assessing the physiologic significance of coronary obstructions in patients: importance of diffuse undetected atherosclerosis. Prog Cardiovasc Dis 1988; 31: 39–56.

    Article  PubMed  CAS  Google Scholar 

  7. Waller BF. Topography of atherosclerotic coronary artery disease. Clin Cardiol 1990; 13: 435–442.

    Article  PubMed  CAS  Google Scholar 

  8. Marcus ML, Armstrong ML, Heistad DD, Eastham CL, Mark AL. Comparison of three methods of evaluating coronary obstructive lesions: postmortem arteriography, pathologic examination and measurement of regional myocardial perfusion during maximal vasodilation. Am J Cardiol 1982; 49: 1699–1706.

    Article  PubMed  CAS  Google Scholar 

  9. Schwartz JN, Kong Y, Hackel DB, Bartel AG. Comparison of angiographic and postmortem finds in patients with coronary artery disease. Am J Cardiol 1975; 36: 174–178.

    Article  PubMed  CAS  Google Scholar 

  10. Hutchins GM, Bulkley GH, Ridolfi RL, Griffith LS, Lohr FT, Piasio MA. Correlation of coronary arteriograms and left ventriculograms with postmortem studies. Circulation 1977; 56: 32–37.

    Article  PubMed  CAS  Google Scholar 

  11. Thomas AC, Davies MJ, Dilly S, Dilly N, Franc F. Potential errors in the estimation of coronary arterial stenosis from clinical arteriography with reference to the shape of the coronary arterial lumen. Br Heart J 1986; 55: 129–139.

    Article  PubMed  CAS  Google Scholar 

  12. Arnett EN, Isner JM, Redwood DR et al. Coronary artery narrowing in coronary heart disease: comparison of cineangiographic and necropsy findings. Ann Intern Med 1979; 91: 350–356.

    PubMed  CAS  Google Scholar 

  13. Kemp HG, Evans H, Elliott WC, Gorlin R. Diagnostic accuracy of selective coronary cinearteriography. Circulation 1967; 36: 526–533.

    Article  PubMed  CAS  Google Scholar 

  14. Vlodaver Z, Frech R, Van Tassel RA, Edwards JE. Correlation of the antemortem coronary arteriogram and the postmortem specimen. Circulation 1973; 47: 162–169.

    Article  PubMed  CAS  Google Scholar 

  15. Grondin CM, Dyrda I, Pasternac A, Campeau L, Bourassa MG, Lesperance J. Discrepancies between cineangiographic and postmortem findings in patients with coronary artery disease and recent myocardial revascularization. Circulation 1974; 49: 703–708.

    Article  PubMed  CAS  Google Scholar 

  16. Isner JM, Kishel J, Kent KM, Ronan JA Jr, Ross AM, Roberts WC. Accuracy of angiographic determination of left main coronary artery narrowing. Angiographic histologic correlative analysis in 28 patients. Circulation 1981; 63: 1056–1064.

    Article  PubMed  CAS  Google Scholar 

  17. Glagov S, Weisenberg E, Zarins CK, Stankunavicius R, Kolettis GJ. Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med 1987; 316: 1371–1375.

    Article  PubMed  CAS  Google Scholar 

  18. Zarins CK, Weisenberg E, Kolettis G, Stankunavicius R, Glagov S. Differential enlargement of artery segments in response to enlarging atherosclerotic plaques. J Vasc Surg 1988; 7: 386–394.

    PubMed  CAS  Google Scholar 

  19. Stiel GM, Stiel LS, Schofer J, Donath K, Mathey DG. Impact of compensatory enlargement of atherosclerotic coronary arteries on angiographic assessement of coronary artery disease. Circulation 1989; 80: 1603–1609.

    Article  PubMed  CAS  Google Scholar 

  20. McPherson DD, Sirna SJ, Hiratzka LF et al. Coronary arterial remodeling studied by high-frequency epicardial echocardiography: an early compensatory mechanism in patients with obstructive coronary atherosclerosis. J Am Coll Cardiol 1991; 17: 79–86.

    Article  PubMed  CAS  Google Scholar 

  21. Isner JM, Donaldson RF, Fortin AH, Tischler A, Clarke RH. Attenuation of the media of coronary arteries in advanced atherosclerosis. Am J Cardiol 1986; 58: 937–939.

    Article  PubMed  CAS  Google Scholar 

  22. Yock PG, Johnson EL, Linker DT. Intravascular ultrasound: development and clinical potential. Am J Card Imaging 1988; 2: 185–193.

    Google Scholar 

  23. Gussenhoven EJ, Essed CE, Lancee CT et al. Arterial wall characteristics determined by intravascular ultrasound imaging: an in vitro study. J Am Coll Cardiol 1989; 14: 947–952.

    Article  PubMed  CAS  Google Scholar 

  24. Mallery JA, Tobis JM, Griffith J et al. Assessment of normal and atherosclerotic arterial wall thickness with an intravascular ultrasound imaging catheter. Am Heart J 1990; 119: 1392–1400.

    Article  PubMed  CAS  Google Scholar 

  25. Coy KM, Maurer G, Siegel RJ. Intravascular ultrasound imaging: a current perspective. J Am Coll Cardiol 1991; 18: 1811–1823.

    Article  PubMed  CAS  Google Scholar 

  26. Nissen SE, Gurley JC, Grines CL et al. Intravascular ultrasound assessment of lumen size and wall morphology in normal subjects and patients with coronary artery disease. Circulation 1991; 84: 1087–1099.

    Article  PubMed  CAS  Google Scholar 

  27. Fitzgerald PJ, St. Goar FG, Connolly AJ et al. Intravascular ultrasound imaging of coronary arteries. Is three layers the norm? Circulation 1992; 86: 154–158.

    Article  PubMed  CAS  Google Scholar 

  28. Tobis JM, Mallery JA, Gessert J et al. Intravascular ultrasound cross-sectional arterial imaging before and after balloon angioplasty in vitro. Circulation 1989; 80: 873–882.

    Article  PubMed  CAS  Google Scholar 

  29. Nishimura RA, Edwards WD, Warnes CA et al. Intravascular ultrasound imaging: in vitro validation and pathologic correlation. J Am Coll Cardiol 1990; 16: 145–154.

    Article  PubMed  CAS  Google Scholar 

  30. Hodgson JM, Reddy KG, Suneja R, Nair RN, Lesnefsky EJ, Sheehan HM. Intracoronary ultrasound imaging: correlation of plaque morphology with angiography, clinical syndrome and procedural results in patients undergoing coronary angioplasty. J Am Coll Cardiol 1993; 21: 35–44.

    Article  PubMed  CAS  Google Scholar 

  31. DiMario C, The SH, Madretsma S et al. Detection and characterization of vascular lesions by intravascular ultrasound: an in vitro study correlated with histology. J Am Soc Echocardiogr 1992; 5: 135–146.

    PubMed  Google Scholar 

  32. Potkin BN, Bartorelli AL, Gessert JM et al. Coronary artery imaging with intravascular high-frequency ultrasound. Circulation 1990; 81: 1575–1585.

    Article  PubMed  CAS  Google Scholar 

  33. Yock PG, Fitzgerald PJ, Linker DT, Angelsen BAJ. Intravascular ultrasound guidance for catheter-based coronary interventions. J Am Coll Cardiol 1991; 17(Suppl B): 39B–45B.

    Article  PubMed  CAS  Google Scholar 

  34. Gussenhoven EJ, Frietman PAV, The SHK et al. Assessment of medial thinning in atherosclerosis by intravascular ultrasound. Am J Cardiol 1991; 68: 1625–1632.

    Article  PubMed  CAS  Google Scholar 

  35. Kitney RL, Moura L, Straughan K. 3-D visualization of arterial structures using ultrasound and Voxel modelling. Int J Card Imaging 1989; 4: 135–143.

    Article  PubMed  CAS  Google Scholar 

  36. Rosenfield K, Losordo DW, Ramaswamy K et al. Three-dimensional reconstruction of human coronary and peripheral arteries from images recorded during two-dimensional intravascular ultrasound examination. Circulation 1991; 84: 1938–1956.

    Article  PubMed  CAS  Google Scholar 

  37. Coy KM, Park JC, Fishbein MC et al. In vitro validation of three-dimensional intravascular ultrasound for the evaluation of arterial injury after balloon angioplasty. J Am Coll Cardiol 1992; 20: 692–700.

    Article  PubMed  CAS  Google Scholar 

  38. Klocke FJ. Measurements of coronary blood flow and degree of stenosis: current clinical implications and continuing uncertainties. J Am Coll Cardiol 1983; 1: 31–41.

    Article  PubMed  CAS  Google Scholar 

  39. Kirkeeide RL, Gould KL, Parsel L. Assessment of coronary stenoses by myocardial perfusion imaging during pharmacologic coronary vasodilation. VII. Validition of coronary flow reserve as a single integrated functional measure of stenosis severity reflecting all its geometric dimensions. J Am Coll Cardiol 1986; 7: 103–113.

    Article  PubMed  CAS  Google Scholar 

  40. Gould KL, Kirkeeide RL, Buchi M. Coronary flow reserve as a physiologic measure of stenosis severity. J Am Coll Cardiol 1990; 15: 459–474.

    Article  PubMed  CAS  Google Scholar 

  41. Klocke FJ. Measurements of coronary blood flow reserve: defining pathophysiology versus making decisions about patient care. Circulation 1987; 76: 1183–1189.

    Article  PubMed  CAS  Google Scholar 

  42. Hoffman JIE. A critical view of coronary reserve. Circulation 1987; 75(suppl I): 16–111.

    Google Scholar 

  43. Emanuelsson H, Dohnal M, Lamm C, Tenerz L. Initial experiences with a miniaturized pressure transducer during coronary angioplasty. Cathet Cardiovasc Diagn 1991; 24: 137–143.

    Article  PubMed  CAS  Google Scholar 

  44. Doucette JW, Corl PD, Payne HM et al. Validation of a Doppler guide wire for intravascular measurement of coronary artery flow velocity. Circulation 1992; 85: 1899–1911.

    Article  PubMed  CAS  Google Scholar 

  45. Ornish D, Brown SE, Scherwitz LW et al. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet 1990; 336: 129–133.

    Article  PubMed  CAS  Google Scholar 

  46. The Lipid Research Clinics Coronary Prevention Trial results. 1. Reduction in incidence of coronary heart disease. JAMA 1984; 251: 351–364.

    Article  Google Scholar 

Download references

Authors
  1. Pim J. De Feyter
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carlo Di Mario
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cees J. Slager
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Patrick W. Serruys
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jos R. T. C. Roelandt
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Laboratory for Clinical and Experimental Image Processing, Department of Diagnostic Radiology and Nuclear Medicine, University Hospital Leiden, The Netherlands

    Johan H. C. Reiber

  2. Catheterization Laboratory, Thorax Center, Erasmus University, Rotterdam, The Netherlands

    Patrick W. Serruys

Rights and permissions

Reprints and permissions

Copyright information

© 1994 Springer Science+Business Media Dordrecht

About this chapter

Cite this chapter

De Feyter, P.J., Di Mario, C., Slager, C.J., Serruys, P.W., Roelandt, J.R.T.C. (1994). Towards complete assessment of progression/regression of coronary atherosclerosis: Implications for intervention trials. In: Reiber, J.H.C., Serruys, P.W. (eds) Progress in quantitative coronary arteriography. Developments in Cardiovascular Medicine, vol 155. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-1172-0_18

Download citation

  • DOI: https://doi.org/10.1007/978-94-011-1172-0_18

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-4511-7

  • Online ISBN: 978-94-011-1172-0

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation