Catheter‐induced intimal injury during routine coronary catheterization in dogs

Abstract

The location and progression of changes in arterial permeability and structure were studied in nine dogs over a 13-week period following left coronary catheterization with standard coronary catheters. Changes in arterial permeability were analyzed by quantitating Evans blue dye (EBD) uptake over the aortic luminal surface (blue areas). Structural changes were assessed by light and electron microscopy. In the catheterized animals, compared to uncatheterized controls, we observed a significant increase in aortic luminal EBD uptake that was maximal 4 hours after the procedure but still present up to 13 weeks later. Microscopic analysis of "blue areas" shortly after the procedure revealed widespread endothelial denudation, platelet and leukocyte adherence, with occasional intimal avulsions, disruption of the internal elastica, and thrombi. The EBD uptake patterns in association with the electron microscopic findings in these animals suggested that 67-89% of the aortic endothelium was removed by the catheter during the procedure. The proliferative response that occurred following this catheter-induced injury produced fibrocellular intimal thickening in the aortas and left main coronary arteries of animals studied 10 to 92 days after the procedure. In the aortic root, such thickening was associated with incomplete re-endothelialization, thrombogenicity, and grossly abnormal permeability patterns. We conclude that significant catheter-induced intimal injury can occur during coronary angiography. In the canine model, such injury is associated with widespread fibrocellular intimal thickening and abnormal permeability that persists for at least 13 weeks after the procedure.

Endothelial Cell Recoverage and Intimal Hyperplasia after Endothelium Removal with or without Smooth Muscle Cell Necrosis in the Rabbit Carotid Artery

“…A possible explanation has recently been given by Lindner and Reidy [21] who showed an enhanced expression of platelet-derived growth factor B by endothelium of the leading edge up to 6 weeks after balloon injury of rat arteries. At the same time, more intimal hyperplasia was found underneath regenerating endothelium compared to the adjacent de nuded regions which could be explained by the disposi tion of platelet-derived growth factor B in the intimal layers since it is known to promote intimal lesion forma tion [22], During routine arterial cathctherization, large areas are denuded because of catheter manipulations [23], From the present study we infer that careful manipulation of a catheter may result in endothelial cell removal with out media necrosis, hence fast reendothelialization and relatively little intimal hyperplasia.…”

Selective Increase of Cardiac Neuronal Sympathetic Tone

“…Because transvascular nerve stimulation does not increase local wall temperature (18), lesions are probably due to catheter pressure against the wall. Similar lesions have been described for coronary angiography catheters (19). Thus, it seems reasonable to expect that the lesions may resolve, which needs to be proven during chronic experiments.…”

Long‐term follow‐up of catheter‐induced intimal injury from routine coronary angiography in moderately hypercholesterolemic minipigs

“…On the other hand, the association between experimental endothelial denudation and atherosclerosis may have clinical relevance if the intimal surface suffers damage during clinical catheterization procedures that is comparable to that produced by balloon catheters. A previous study in dogs suggested that extensive endothelial denudation that involves over 70% of the aorta and proximal coronary luminal surfaces does occur as a consequence of catheter trauma during coronary angiography [ 5 ] . A similar degree of endothelial disruption was observed in the present study in the minipig whose size and arterial anatomy is comparable to that of man.…”

“…Recently, a study in normal dogs has suggested that significant catheter-induced intimal injury, comparable to that associated with balloon injury noted above, can occur during routine coronary angiography [5]. In this study, we examined the impact of such clinical catheter injury on the progression of atherosclerosis over a 1 year period following routine coronary angiography in moderately hypercholesterolemic minipigs, which, unlike the dog, have been shown to develop humanoid atherosclerotic lesions.…”