Arterial remodeling after experimental percutaneous injury is highly dependent on adventitial injury and histopathology

Staab, Michael E.; Srivatsa, Sanjay S.; Lerman, Amir; Sangiorgi, Giuseppe; Jeong, Myung Ho; Edwards, William D.; Holmes, David R.; Schwartz, Robert S.

doi:10.1016/s0167-5273(96)02844-6

Cited by 54 publications

(37 citation statements)

References 29 publications

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“…This needs to be explored, considering, however, the potential increase in vessel wall trauma leading to more subsequent tissue formation counteracting the acute angiographic results and clinical outcome. 23,24,25 The use of intracoronary ultrasound in this study was associated with the use of more balloon catheters, higher volume of contrast medium, extended x-ray exposition, and prolonged procedure time, which not only will increase costs but also could be potentially harmful. However, some of these drawbacks might be attenuated in the future by use of smaller and combined devices.…”

Section: Discussionmentioning

confidence: 98%

Randomized Comparison of Coronary Stent Implantation Under Ultrasound or Angiographic Guidance to Reduce Stent Restenosis (OPTICUS Study)

et al. 2001

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for the OPTICUS (OPTimization with ICUS to reduce stent restenosis) Study InvestigatorsBackground-Observational studies in selected patients have shown remarkably low restenosis rates after ultrasoundguided stent implantation. However, it is unknown whether this implantation strategy improves long-term angiographic and clinical outcome in routine clinical practice. Methods and Results-A total of 550 patients with a symptomatic coronary lesion or silent ischemia were randomly assigned to either ultrasound-guided or angiography-guided implantation of Յ2 tubular stents. The primary end points were angiographic dichotomous restenosis rate, minimal lumen diameter, and percent diameter stenosis after 6 months as determined by quantitative coronary angiography. Secondary end points were the occurrence rates of major adverse cardiac events (death, myocardial infarction, coronary bypass surgery, and repeat percutaneous intervention) after 6 and 12 months of follow-up. At 6 months, repeat angiography revealed no significant differences between the groups with ultrasound-or angiography-guided stent implantation with respect to dichotomous restenosis rate (24.

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Section: Discussionmentioning

confidence: 98%

Randomized Comparison of Coronary Stent Implantation Under Ultrasound or Angiographic Guidance to Reduce Stent Restenosis (OPTICUS Study)

et al. 2001

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“…23 A study using a thermal balloon injury in pigs suggested that fibrotic scar forming in the adventitia "may prevent remodeling by producing a thick, densely collagenous adventitial collar around the vessel that physically limits vessel expansion." 18 This mechanism may be similar to that impeding medial remodeling in Plg Ϫ /Fib ϩ mice. Specifically, the intense fibrin accumulation that persists in the adventitia of arteries of Plg Ϫ /Fib ϩ mice after cuff placement may be an impediment to arterial remodeling by forming a physical barrier to expansion/remodeling.…”

Section: Drew Et Al Vascular Remodeling In Plasminogen-deficient Micementioning

confidence: 91%

Plasminogen Is a Critical Determinant of Vascular Remodeling in Mice

Drew

Tucker

Kombrinck

et al. 2000

Circulation Research

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Abstract-Extracellular proteolysis is likely to be a feature of vascular remodeling associated with atherosclerotic and restenotic arteries. To investigate the role of plasminogen-mediated proteolysis in remodeling, polyethylene cuffs were placed around the femoral arteries of mice with single and combined deficiencies in plasminogen and fibrinogen. Neointimal development occurred in all mice and was unaffected by genotype. Significant compensatory medial remodeling occurred in the cuffed arteries of control mice but not in plasminogen-deficient mice. Furthermore, focal areas of medial atrophy were frequently observed in plasminogen-deficient mice but not in control animals. A simultaneous deficit of fibrinogen restored the potential of the arteries of plasminogen-deficient mice to enlarge in association with neointimal development but did not eliminate the focal medial atrophy. An intense inflammatory infiltrate occurred in the adventitia of cuffed arteries, which was associated with enhanced matrix deposition. Adventitial collagen deposition was apparent after 28 days in control and fibrinogen-deficient arteries but not in plasminogendeficient arteries, which contained persistent fibrin. These studies demonstrate that plasmin(ogen) contributes to favorable arterial remodeling and adventitial collagen deposition via a mechanism that is related to fibrinogen, presumably fibrinolysis. In addition, these studies reveal a fibrin-independent role of plasminogen in preventing medial atrophy in challenged vessels. A rterial procedures such as coronary angioplasty result in an early or "acute" gain in arterial lumen diameter. Late loss of lumen diameter erodes this acute gain and is the single factor limiting the long-term clinical success of percutaneous interventional procedures, necessitating target vessel revascularization in up to 40% of patients. This loss of lumen diameter, or restenosis, was once thought to be solely a function of the development of a proliferative, smooth muscle cell-rich neointima, and much attention has been focused on efforts to prevent or reduce neointima formation. However, an increasing number of reports indicate that vascular remodeling (ie, alteration of the dimensions of the arterial wall) may play a greater role in determining arterial luminal diameter than neointimal size. 1-4 Studies on rodents, rabbits, and primates suggest that desirable postangioplasty lumen sizes occur when arterial diameter increases (favorable remodeling), whereas a decreased arterial diameter is associated with decreased lumen size (unfavorable remodeling), independent of neointimal size. 5-8 Increased hemodynamic pressure during either development or atherosclerotic neointima formation may promote favorable remodeling to maintain the relationship between blood flow and lumen size (compensatory remodeling). 9 Glagov et al 2 demonstrated that human coronary arteries enlarge in response to plaque formation until plaque area occupies Ϸ40% of the luminal area. These findings were later confirmed by angiographic ...

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“…More aggressive measures that have been tried involved the use of thermal injury and copper stent implantation. 48,49 The vascular response to injury differs between these 2 methods, with neither perfectly replicating the human CTO; copper stents result in a dense inflammatory response with neointimal proliferation, whereas thermal injury induces adventitial remodeling with a decrease in vessel size and limited neointimal proliferation.…”

Section: Preclinical Models Of Ctosmentioning

confidence: 99%

Percutaneous Recanalization of Chronically Occluded Coronary Arteries

et al. 2005

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R emarkable progress in the percutaneous management of coronary artery disease has been achieved over the last decade. The scaffolding properties of coronary stents have resulted in percutaneous coronary intervention (PCI) becoming a predictable procedure, with reduced rates of acute closure and late restenosis compared with balloon angioplasty alone. 1,2 More recently, the site-specific delivery of antiproliferative agents from drug-eluting stents has been demonstrated to markedly attenuate vascular responses leading to neointimal hyperplasia, further reducing the occurrence of clinical and angiographic restenosis to Ͻ10% in most patients. 3,4 PCI in patients with acute coronary syndromes and acute myocardial infarction (AMI) has also been proven to save lives, reduce rates of myocardial infarction (MI), and enhance quality of life compared with alternative treatment modalities. [5][6][7] With these advances in perspective, it is often stated that successful recanalization of chronic total occlusions (CTOs) of native coronary arteries represents the "last frontier" of PCI. This statement is made in deference to the fact that CTOs represent the most technically challenging lesion subset that interventional cardiologists face, with procedural success rates considerably lower than those achieved in nonoccluded coronary vessels or acutely occluded arteries. Moreover, no consensus exists with regard to the definition of CTO, the factors related to procedural failure and/or complications, and the optimal technical approach. Indeed, until recently, the clinical benefits of PCI in CTOs had not been demonstrated.An international panel of 47 physicians from 9 countries was therefore convened in New York City for 2 days in January 2004, the purpose of which was to reach consensus on the current state of the art of CTO angioplasty (see Appendix in the online-only Data Supplement for a complete participant list). This goal was approached through a series of didactic lectures, roundtable discussions, breakout focus groups, and the performance of 14 live case demonstrations of CTO angioplasty by many of the world's most skilled operators in this subspecialty. The present report represents a synthesis of the findings from this meeting and also incorporates a literature review from the field of CTO intervention. Topics covered in Part I of this review include definitions, prevalence, and clinical presentation of CTOs; the anatomy and histopathology of coronary occlusions; experimental CTO models; and the clinical relevance and rationale for CTO revascularization. Part II will review the technical approach to and clinical outcomes after percutaneous intervention of CTOs and describe the novel devices and drugs approved and undergoing investigation for CTO recanalization.

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Arterial remodeling after experimental percutaneous injury is highly dependent on adventitial injury and histopathology

Cited by 54 publications

References 29 publications

Randomized Comparison of Coronary Stent Implantation Under Ultrasound or Angiographic Guidance to Reduce Stent Restenosis (OPTICUS Study)

Randomized Comparison of Coronary Stent Implantation Under Ultrasound or Angiographic Guidance to Reduce Stent Restenosis (OPTICUS Study)

Plasminogen Is a Critical Determinant of Vascular Remodeling in Mice

Percutaneous Recanalization of Chronically Occluded Coronary Arteries

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