Arterial changes after percutaneous transluminal coronary angioplasty: Results at autopsy

Abstract

Light and electron microscopic examinations were performed on 20 coronary artery sites from nine patients who had undergone percutaneous transluminal coronary angioplasty. Twelve successfully dilated sites without prior thrombosis showed evidence of a tear in the luminal surface (with or without fracture of an atheroma) even at 140 days after angioplasty. The tear split through a relatively undistensible intima in 9 (75%) of the 12 sites. Two successfully dilated sites with prior thrombosis showed an intraintimal tear with a widely lacerated fibrous cap and thin mural thrombus. After dilation, the occluded prior nonthrombosed site showed marked protrusion of a separated plaque. An occluded prior thrombosed site after dilation revealed intraintimal canal-like hematoma. Four sites that occluded after balloon passage revealed a dissecting hematoma in three and plaque disruption in the other.

Association of cholesterol levels and occurrence of angiographically detectable endothelial disruption during coronary angioplasty

“…The suboptimal accuracy of angiography is, in fact, well known since it shows an incidence of plaque fracture/endothelial dissection ranging from 9 to 45%, compared with 50 to 80% observed in autoptic and intravascular imaging studies. [14][15][16][17][18] Underestimation of the real incidence of plaque fracture/endothelial dissection, which was angiographically detectable in 35% of our population (and therefore comparable with previous studies), 14,15 could possibly weaken our conclusions. However, in routine clinical practice, angiography represents the reference technique for balloon angioplasty, and thus our findings maintain relevance.…”

Determinants of smooth muscle injury during balloon angioplasty.

“…5 The possibility that this arterial paralysis was the result of balloon oversizing or enhanced susceptibility to medial injury in these animal models was suggested by discrepancies between the severe medial injury observed histopathologically in the animal arteries4-7,25 compared with the milder injury observed in several human postmortem studies. [13][14][15][16][17][18] purpose of this study was to elaborate the determinants of smooth muscle injury caused by balloon angioplasty in perfused whole vessels under near-physiological conditions. Specifically, we addressed the following questions.…”

Expression of platelet derived growth factor B chain and beta receptor in human coronary arteries after percutaneous transluminal coronary angioplasty: an immunohistochemical study.

“…In some plaques the fibrous cap is dominated by smooth muscle cells, in others by macrophages, while the majority show intermediate varieties.I' Furthermore, the type of laceration induced by the angioplasty procedure may also vary markedly. [12][13][14][15] In view of the potential cellular heterogeneity present at the site of angioplasty injury, it is important to obtain information about the types of cell expressing PDGF. To do this, we have conducted a study using immunocytochemical techniques to identify cells expressing the PDGF-B protein and the PDGF-J receptor protein.…”