Morphometric and Histologic Assessment of Remodeling Associated with Restenosis after Percutaneous Transluminal Coronary Angioplasty

Abstract

The role of remodeling in restenosis of coronary arteries on which percutaneous transluminal coronary angioplasty (PTCA) had been performed was investigated. At autopsy, presence (n = 6) or absence of restenosis (n = 5) based on the cross-sectional area of stenosis was determined in 11 coronary lesions. Remodeling was defined as a ratio of the artery area at the PTCA site to that at the reference site of <1.0. According to this definition, remodeling had occurred in all of the lesions in the restenosis group, and in only 1 lesion in the group with no restenosis which had the least residual plaque (p < 0.05). Dense caps of collagen fibers in the adventitia in the vicinity of the disrupted internal elastic laminae were present in all of the remodeling lesions. We suggest that remodeling, which results in adventitial scarring, is one of the major causative factors of restenosis.

Hemodialysis Vascular Access Dysfunction: From Pathophysiology to Novel Therapies

“…There has recently been a great deal of interest in adventitial remodeling, whereby it is postulated that the final amount of luminal stenosis is dependent both on the magnitude of neointimal hyperplasia and the pattern of adventitial or vascular remodeling [49][50][51]. Thus, in the presence of equivalent amounts of neointimal hyperplasia, vascular constriction will result in a smaller luminal area, while vascular dilatation will result in a larger luminal area [52].…”

<b>Poststenting Axial Redistribution of Atherosclerotic Plaque Into the Reference Segments and Lumen Reduction at the Stent Edge</b>

“…The plausible stimulus of late lumen reduction at the stent edge could be vessel trauma during coronary intervention. Vessel injury has been established as an important factor of late lumen loss after coronary intervention in animal [13][14][15] and in human 16) studies. Vessel response to balloon injury may resemble a wound healing process.…”

Novel Therapies for Hemodialysis Vascular Access Dysfunction: Fact or Fiction!

“…It is now believed that the fi nal degree of luminal stenosis is dependent not only on the amount of neointimal hyperplasia, but also on the extent of adverse or benefi cial vascular remodeling (vascular dilatation or constriction) [11][12][13] . Specifi cally, in the setting of experimental coronary angioplasty models, it is currently believed that vascular remodeling is responsible for approximately 50% of fi nal luminal stenosis [12] .…”