Angiographic risk factors of luminal narrowing after coronary balloon angioplasty using balloon measurements to reflect stretch and elastic recoil at the dilatation site

Abstract

on behalf of the CARPORT Study Group Because many ongoing clinical restenosis prevention trials are using quantitative angiography to assess whether a drug is capable of reducing the amount of intimal hyperplasia, quantitative angiographic risk factors for angiographic luminal narrowing after balloon angioplasty were determined, including stretch and elastic recoil at the dilatation site. Quantitative analysis was performed on 666 lesions in 575 patients during angioplasty and at 6-month follow-up. Stretch was defined as balloon diameter minus minimal luminal diameter (MLD) before angioplasty/reference diameter, and recoil as balloon diameter minus MLD after angioplasty/reference diameter. Multivariate analysis was used to yield independent risk factors for luminal narrowing at follow-up. Predictors of absolute change in MLD were (1) relative gain at angioplasty (gain in millimeters normalized for reference diameter) and (2) lesion length. To allow risk stratification, logistic regression analysis was applied using the decrease in MLD as a binary outcome variable. A decrease in MLD at follow-up of 20.72 mm was considered significant. Variables retained in the model were: relative gain >0.3 mm (rate ratio 2.9), relative gain 0.2 to 0.3 (rate ratio 2.1), stenosis length 16.8 (rate ratio 1.7), and thrombus after angioplasty (rate ratio 2.6). Although stretch was significantly related to luminal narrowing at univariate analysis, it was not retained in the multivariate models.A large gain in lumen diameter at angioplasty, dilation of long lesions, and angiographically determined thrombus after angioplasty were found to be accompanied by more severe luminal narrowing at follow-up. (Am J Cardiol 1992;69:564-591)

Clinical and intravascular imaging outcomes at 1 and 2 years after implantation of absorb everolimus eluting bioresorbable vascular scaffolds in small vessels. Late lumen enlargement: does bioresorption matter with small vessel size? Insight from the ABSORB cohort B trial

“…In previous studies, a larger relative gain was observed to be an independent predictor of restenosis, with a direct relationship between relative gain and the subsequent relative loss at follow-up 11 16…”

HMGB1-Driven Inflammation and Intimal Hyperplasia After Arterial Injury Involves Cell-Specific Actions Mediated by TLR4

“…4,5 These interventional procedures result in endothelial denudation with intimal and medial damage, which induces substantial local inflammation. This inflammation is manifested by monocyte infiltration as well as inflammatory mediator and growth factor production.…”

Long‐term clinical outcome after implantation of medium Palmaz (biliary) stents in very large native coronary arteries

“…In a study of pooled data by Foley et al [11], increased coronary size was an independent predictor of a larger MLD and of reduced late luminal loss, thereby a lower restenosis rate. It has also been established that the overall net gain remains greater in vessels dilated with greater acute luminal gain, despite a greater absolute loss in follow‐up [16].…”

“…Several studies have determined angiographic or intravascular ultrasound (IVUS) predictors of in‐stent restenosis using the “bigger is better” hypothesis [12–15]. It has been well recognized that achieving greater acute luminal gain after coronary stenting allows greater net gain despite greater absolute loss [16]. During the study period, coronary stent for vessel diameter greater than 4 mm is not available except the hand‐crimped unmounted Palmaz biliary (PB) stents.…”