Comparison of pathologic and angiographic findings in a porcine preparation of coronary atherosclerosis.

Weiner, Bonnie H.; Jarmolych, J.; Fritz, Katherine; Daoud, A.S.

doi:10.1161/01.cir.72.5.1081

Cited by 40 publications

(15 citation statements)

References 25 publications

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“…There is general agreement that coronary angiography in humans underestimates coronary artery disease compared with postmortem specimens. 64 The most credible evaluation of coronary angiography reported to date was a study by Weiner et al 65 in 200-lb pigs in which it was reported that lesion size was underestimated.…”

Section: Future Directions Improved Computerized Image Processingmentioning

confidence: 99%

George Lyman Duff Memorial Lecture. Arterial imaging and atherosclerosis reversal.

Blankenhorn

Hodis

1994

Arterioscler Thromb

202

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This review explores evidence for the reversibility of atherosclerosis and augmentation of angiography with noninvasive arterial wall imaging. Meta-analysis from coronary angiographic trials demonstrates that regression and stabilization are 1.5 to 2 times more common in treated than placebo subjects, and progression is reduced by half in treated subjects. Odds ratios for clinical coronary events are significantly reduced with treatment. Lesion improvement occurs more readily in women than men and more so in women receiving concomitant estrogen replacement therapy. Lesions with >50% diameter stenosis (%S) at baseline respond more readily to lipid lowering than those <50%S, whereas reduction in coronary events is related to stabilization of lesions <50%S. Lipoproteins have a differential effect on lesion progression according to lesion size, and triglyceride-rich lipoproteins play an important role in the progression of coronary artery lesions <50%S. Improved therapeutic regimens to alter progression of atherosclerosis may require adjunctive therapy, such as with antioxidants or hormone replacement therapy, in concert with low-density lipoprotein cholesterol reduction to prevent new lesion formation or early lesion progression. Sequential coronary angiographic determination of progression evaluated by both quantitative coronary angiography and global change score, a visual assessment of overall lesion change, predicts clinical coronary events. Only inferences about the state of the arterial wall can be made from angiography, because it delineates only the lumen. Therapy testing and study of atherosclerosis progression can be improved with noninvasive B-mode ultrasonographic imaging of the distal common carotid artery far-wall intima-media thickness (IMT), a reliable measure of early preintrusive atherosclerosis. Measurement of common carotid IMT is useful for the study of coronary artery risk factors and can augment studies of coronary artery intrusive lesions, because it is associated with coronary artery disease. B-mode measurement of common carotid IMT has the potential of serving as a noninvasive surrogate end point for clinical coronary events. Screening for peripheral vessel changes indicative of high risk for coronary artery disease is possible and cost-effective with the noninvasive procedures now available. (Arterioscler Thromb. 1994;14:177-192.) Key Words • atherosclerosis • angiography • ultrasound • regression • clinical trials • intima-media thickness • quantitative computerized angiography • common carotid artery • coronary arteries • meta-analysis E vidence that progression of atherosclerosis can be retarded and atherosclerotic lesions can regress derives from several sources. These sources include studies of arterial lesions obtained at autopsy from starved human populations, animal experimentation, and clinical trials using serial angiography. In the first half of this article, we review serial angiographic evidence for atherosclerotic lesion improvement induced by diverse modes of int...

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Section: Future Directions Improved Computerized Image Processingmentioning

confidence: 99%

George Lyman Duff Memorial Lecture. Arterial imaging and atherosclerosis reversal.

Blankenhorn

Hodis

1994

Arterioscler Thromb

202

View full text Add to dashboard Cite

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“…Coronary arteries were fixed with pressure perfusion and reangiogramed, and paraffin-sectioned histological specimens were projected, traced, and measured with digital image analysis. Weiner et al 7 found excellent correlation between histological specimens and in vivo images at sites of focal narrowing but also found larger lumens where vessels were normal. This latter finding was attributed to shrinkage during histology processing, despite perfusion fixation at physiological pressures.…”

Section: Calibration Study In Coronary Atherosclerosismentioning

confidence: 94%

“…Selective arteriography has been calibrated against peripheral arterial specimens in intact cadavers under conditions that realistically simulate clinical radiography, 18 but such studies cannot reproduce cardiac motion to test coronary angiography. Except for the study of Weiner et al 7 (discussed in the next section), quantitative coronary angiographic procedures have been calibrated by procedures employing either radiographic test objects, 19 measurements of coronary flow past single constrictions, 20 measurements in excised hearts 21 or arteries, 22 or measurements of total myocardial flow. Win, reader's score used as consensus score; loss, other reader's score used as consensus score; compromise, neither reader's score used as consensus score; win ratio, wins/(losses + compromises).…”

Section: Limitations Of Coronary Imaging Technologymentioning

confidence: 99%

“…Coronary lesions have been evaluated for clinical research in three general ways: 1) human readers viewing angiographic films alone 1 " 3 or as panel members 4 -6 ; 2) human readers measuring films with calipers 7 or tracing vessel edges by hand for later computer analysis 8 ; and 3) computerized edge-finding after human designation of the search areas. 8 " 10 The reliability of film evaluation by humans for changes in coronary status is influenced by 1) technical features, such as film quality, the conditions for film reading, the number of films a reader has recently evaluated, and order of film presentation and 2) coronary pathological and anatomic characteristics, such as of coronary status (including bypass grafts).…”

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confidence: 99%

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Evaluation of human panelists in assessing coronary atherosclerosis.

Azen

Cashin-Hemphill

Pogoda

et al. 1991

Arterioscler Thromb

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The Cholesterol Lowering Atherosclerosis Study, a randomized, angiographic clinical trial, has demonstrated the beneficial effect of niacin/colestipol therapy on coronary and femoral atherosclerosis. The primary outcome was a panel-determined consensus score evaluating global coronary changes determined angiographically at 2 years. This article presents an evaluation of interreader agreement in independently assessing the status of native coronary arteries and overall coronary condition. Parameters include 1) identification of the presence of lesions and lesion changes; 2) estimation of lesion severity (percent stenosis) and amount of change in lesion severity, and 3) global assessment of change in coronary status. Readers independently agreed on 1) presence of lesions (82%) and change in lesions (51%); 2) percent stenosis±10% (76%) and change in stenosis±10% (81%); and 3) global assessment of change in coronary status within one step (96%). Results of these analyses may be useful in effectively designing angiographic trials that use a panel of human evaluators as well as computerized methods for angiographic interpretation. {Arteriosclerosis and Thrombosis 1991;ll:385-394) V alid and reliable information about the status of coronary lesions is needed for evaluation of interventional therapy in controlled angiographic trials. When patients are randomized to test or control, the required information should lead to analysis on a per-patient basis to determine trial outcome. For patients with multiple lesions, results for each lesion must be integrated into a single score for that patient.Coronary lesions have been evaluated for clinical research in three general ways: 1) human readers viewing angiographic films alone 1 " 3 or as panel members 4 -6 ; 2) human readers measuring films with calipers 7 or tracing vessel edges by hand for later computer analysis 8 ; and 3) computerized edge-finding after human designation of the search areas.8 " 10 The reliability of film evaluation by humans for changes in coronary status is influenced by 1) technical features, such as film quality, the conditions for film reading, the number of films a reader has recently evaluated, and order of film presentation and 2) coronary pathological and anatomic characteristics, such as lesion size, degree and direction of change in lesions, degree and direction of change in per-patient disease status, degree to which branches overlap, and frequency of lesion formation at branch junctions. " 13The Cholesterol Lowering Atherosclerosis Study (CLAS) was a randomized, placebo-controlled clinical trial testing the effects of colestipol plus niacin therapy. 4 Coronary, carotid, and femoral angiograms, selected to sample treatment effects as widely as possible, were obtained at baseline and at 2 years. CLAS was monitored by an external advisory committee, which mandated an analysis of coronary vessels at 2 years as a requirement for a proposed trial extension (CLAS-II), in which each patient would remain on his assigned treatment for 4 years and the...

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“…1995. In an effort to provide solutions to these problems, several stent et al 1982, Weiner et al 1985, Schwartz &. Holmes 1994.…”

mentioning

confidence: 99%

Experimental intracoronary stenting: comprehensive experience in a porcine model

et al. 1998

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Appropriate animal models for intracoronary stenting are most important for improving understanding of the pathophysiology of acute occlusion and long-term re-stenosis, which currently limits the safety and efficacy of percutaneous transluminal coronary angioplasty in humans. Since the anatomy and physiology of swine coronary arteries closely resemble those of humans, the procine model should be ideal for testing of stents. This is a comprehensive report on an experimental set-up in pigs, communicating in detail the necessary techniques as well as some modifications facilitating safe intra coronary stent placement and successful follow-up studies for weeks or months. Stent procedure is performed in mechanically ventilated and haemodynamically monitored animals under balanced anaesthesia. Intracoronary application of flow wires allows the assessment of local flow conditions, flow properties and coronary flow reserve. Real-time intravascular ultrasonography (IVUS) provides detailed information on coronary morphology and enables the appropriate sizing of the coronary lumen. From our own experience, we like to propose that the use of the porcine model has the potential to gain new insights into the pathophysiology of intracoronary stent placement-associated complications and allows for the study of modifications in techniques and materials, and the development of novel pharmacological therapeutic strategies.

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Comparison of pathologic and angiographic findings in a porcine preparation of coronary atherosclerosis.

Abstract: Coronary atherosclerosis was induced in Yorkshire swine by diet-induced hyperlipidemia and balloon intimal abrasion of a coronary artery. Severe stenoses pathologically similar to the lesions of human atherosclerosis were seen after 8 months of the atherogenic regimen.

Cited by 40 publications

References 25 publications

George Lyman Duff Memorial Lecture. Arterial imaging and atherosclerosis reversal.

George Lyman Duff Memorial Lecture. Arterial imaging and atherosclerosis reversal.

Evaluation of human panelists in assessing coronary atherosclerosis.

Experimental intracoronary stenting: comprehensive experience in a porcine model

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