Plaque sealing by coronary angioplasty

Abstract

Falk E: Coronary thrombosis: pathogenesis and clinical manifestation. Am J Cardiol 68:28535B, 1991. Kragel AH, Gertz DS, Roberts WC: Morphologic comparison of frequency and types of acute lesions in the major epicardial coronary arteries in unstable angina pectoris, sudden coronary death and acute myocardial infarction. J Am Coll Cardiol 18:801-808, 1991. Falk E, Fernandez-Ortiz A: Role of thrombosis in atherosclerosis and its complications. Am J Cardiol 75:5B-I IB, 1995. Hackett D, Davies G , Maseri A: he-existing coronary stenoses in patients with first myocardial infarction are not necessarily severe. Eur Heart J 9:1317-1323, 1989. Nakazawa Y, Nagamatsu T: Serial changes of coronary arteries after percutaneous transluminal coronary angioplasty : histopathological and immuno-histochemical study. J Cardiol 24:279-29 1 , 1994. Virmani R , Farb A, Burke AP: Coronary angioplasty from the perspective of atherosclerotic plaque: morphologic predictors of immediate success and restenosis. Am Heart J 127:163-169, 1994.

On the Inappropriateness of Noninvasive Multidetector Computed Tomography Coronary Angiography to Trigger Coronary Revascularization

“…Because acute myocardial infarction and sudden death can proceed from plaque events at mildly obstructed sites, some physicians and patients fear to defer "treatment" of nonobstructive plaque, and preventive mechanical "plaque sealing" has been advocated. However, this hypothesis has not been properly investigated thus far (26,27). Instead, stented angioplasty of nonhemodynamically significant stenoses with an FFR Ͼ0.75 was shown not to improve the patient's prognosis or symptoms, while consuming resources unnecessarily (12,13).…”

The Current and Future State of Interventional Cardiology: A Critical Appraisal

“…Plaque sealing by balloon angioplasty of such lesions in strategically important areas (fig. 11) has been advocated, based on the fact that balloon angioplasty carries virtually no risk of late thrombosis of the dilated site, even in the case of restenosis (which may cause angina but not infarction [23]), that hemodynamically nonsignificant stenoses harbor a low but significant risk of causing an infarction, and that it is not possible to predict which stenoses will rupture and when this will occur (fig. 12) [24].…”

“…Prognosis, on the other hand, is determined by plaque rupture and thrombosis of a coronary artery producing a myocardial infarction. Thus, the heretofore ubiquitously accepted principle of restricting PCI to hemodynamically significant lesions has been challenged [17], but it has not been waived yet. Hemodynamically nonsignificant stenoses account for the majority (about 80%) of myocardial infarctions [18,19,20,21,22] although their individual potential to cause an infarction is smaller than that of a hemodynamically significant stenosis.…”

“…11 Region of coronary arteries where plaque sealing (preventive balloon angioplasty of not yet hemodynamically significant stenoses) has been advocated [23]. …”

Koronare Stents / Von der Idee zum High–Tech–Implantat

“…Sofern eine sichere Identifizierung einer instabilen Plaque möglich wäre, könnte durch eine gezielte Stentimplantation eine kontrollierte Plaqueheilung induziert werden. Die Stentimplantation würde die Ausbildung einer kollagenreichen Neointima bewirken, die zu einer Heilung der endoluminalen Gefäßverlet-zung führt[80]. Dieses Konzept der Plaqueversiegelung ("plaque sealing") wurde schon Mitte der 80er Jahre von B. Meier, Bern, Schweiz, aufgeworfen, war jedoch aufgrund der hohen periinterventionellen Komplikations-und Restenoserate nicht allgemein akzeptiert und bereits von Grüntzig abgelehnt worden.…”