Skip to main content
SpringerLink
Log in

Predictors of restenosis after angioplasty: Morphologic and quantitative evaluation by intravascular ultrasound

  • Chapter
Imaging and Intervention in Cardiology

Part of the book series: Developments in Cardiovascular Medicine ((DICM,volume 173))

  • 60 Accesses

Abstract

Restenosis remains the major limitation of angioplasty and restenosis rates vary from 30 to 60% [1, 2] The pathophysiologic mechanism of restenosis has been enigmatic so far, but accumulated evidence strongly suggests that intimai hyperplasia is a major mechanism [3]. The process of restenosis must be viewed as the vascular reaction to angioplasty-created injury and represents of form of wound healing. Vessel damage caused by the balloon is commonly observed in autopsy studies in patients dying early after angiographically successful angioplasty and intimai damage is often extensive and extends into the media in almost all specimens [4]. In addition to intimai hyperplasia, acute overstretching of the arterial wall and subsequent elastic recoil or fibrotic contraction is another important mechanism responsible restenosis formation [4, 5].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Leimgruber PD, Roubin GS, Hollman J et al. Restenosis after successful coronary angioplasty in patients with single vessel disease. Circulation 1986; 73: 710–7.

    Article  PubMed  CAS  Google Scholar 

  2. Topol EJ, Leya F, Pinkerton CA et al. A comparison of directional atherectomy with coronary angioplasty in patients with coronary artery disease. The CAVEAT Study Group. N Engl J Med 1993; 329: 221–227.

    Article  PubMed  CAS  Google Scholar 

  3. Liu MW, Roubin GS, King SB. Restenosis after coronary angioplasty. Potential biologic determinants and role of intimai hyperplasia. Circulation 1989; 79: 1374–1387.

    Article  PubMed  CAS  Google Scholar 

  4. Potkin BN, Roberts WC. Effects of percutaneous transluminal coronary angioplasty on atherosclerotic plaques and relation of plaque composition and arterial size to outcome. Am J Cardiol 1988; 62: 41–50.

    Article  PubMed  CAS  Google Scholar 

  5. Rensing BJ, Hermans WR, Beatt KJ et al. Quantitative angiographic assessment of elastic recoil after percutaneous transluminal coronary angioplasty. Am J Cardiol 1990; 66: 1039–44.

    Article  PubMed  CAS  Google Scholar 

  6. de Marchena EJ, Mallon SM, Knopf WD et al. Effectiveness of holmium laser-assisted coronary angioplasty. The Holmium Laser Coronary Registry. Am J Cardiol 1994; 73: 117–121.

    Article  PubMed  Google Scholar 

  7. Safian RD, Niazi KA, Strzelecki M et al. Detailed angiographic analysis of high-speed mechanical rotational atherectomy in human coronary arteries. Circulation 1993; 88: 961–8.

    PubMed  CAS  Google Scholar 

  8. Hermans WR, Rensing BJ, Strauss BH, Serruys PW. Prevention of restenosis after percutaneous transluminal coronary angioplasty: The search for a “magic bullet”. Am Heart J 1991; 122: 171–87.

    Article  PubMed  CAS  Google Scholar 

  9. Califf RM, Fortin DF, Frid DJ et al. Restenosis after coronary angioplasty: An overview. J Am Coll Cardiol 1991; 17 (Suppl B): 2B–13B.

    Article  PubMed  CAS  Google Scholar 

  10. Carrozza JJ, Kuntz RE, Fishman RF, Bairn DS. Restenosis after arterial injury caused by coronary stenting in patients with diabetes mellitus. Ann Intern Med 1993; 118: 344–9.

    PubMed  Google Scholar 

  11. Weintraub WS, Kosinski AS, Brown CL, King SB. Can restenosis after coronary angioplasty be predicted from clinical variables? J Am Coll Cardiol 1993; 21: 6–14.

    Article  PubMed  CAS  Google Scholar 

  12. Mintz GS, Pichard AD, Kovach JA et al. Impact of preintervention intravascular ultrasound imaging on transcatheter treatment strategies in coronary artery disease. Am J Cardiol 1994; 73: 423–30.

    Article  PubMed  CAS  Google Scholar 

  13. Fitzgerald PJ, Yock PG. Mechanisms and outcomes of angioplasty and atherectomy assessed by intravascular ultrasound imaging. J Clin Ultrasound 1993; 21: 579–88.

    Article  PubMed  CAS  Google Scholar 

  14. Potkin BN, Keren G, Mintz GS et al. Arterial responses to balloon coronary angioplasty: an intravascular ultrasound study. J Am Coll Cardiol 1992; 20: 942–51.

    Article  PubMed  CAS  Google Scholar 

  15. Ellis SG, Roubin GS, King SB et al. Importance of stenosis morphology in the estimation of restenosis risk after elective percutaneous transluminal coronary angioplasty. Am J Cardiol 1989; 63: 30–4.

    Article  PubMed  CAS  Google Scholar 

  16. Arnett EN, Isner JM, Redwood DR et al. Coronary artery narrowing in coronary artery disease: comparison of cineangiographic and necropsy findings. Ann Intern Med 1979; 91: 350–6.

    PubMed  CAS  Google Scholar 

  17. Porter TR, Sears T, Xie F et al. Intravascular ultrasound study of angiographically mildly diseased coronary arteries. J Am Coll Cardiol 1993; 22: 1858–65.

    Article  PubMed  CAS  Google Scholar 

  18. Glagov S, Weisenberg E, Zarins CK et al. Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med 1987; 316: 1371–5.

    Article  PubMed  CAS  Google Scholar 

  19. St Goar FG, Pinto FJ, Alderman EL et al. Intravascular ultrasound imaging of angiographically normal coronary arteries: An in vivo comparison with quantitative angiography. J Am Coll Cardiol 1991; 18: 952–958

    Article  Google Scholar 

  20. Nissen SE, Gurley JC, Grines CL et al. Intravascular ultrasound assessment of lumen size and wall morphology in normal subjects and patients with coronary artery disease. Circulation 1991; 84: 1087–99.

    PubMed  CAS  Google Scholar 

  21. De Scheerder I, De Man F, Herregods MC et al. Intravascular ultrasound versus angiography for measurement of luminal diameters in normal and diseased coronary arteries. Am Heart J 1994; 127: 243–51.

    Article  PubMed  Google Scholar 

  22. Nishimura RA, Edwards WD, Warnes CA et al. Intravascular ultrasound imaging: in vitro validation and pathologic correlation. J Am Coll Cardiol 1990; 16: 145–54.

    Article  PubMed  CAS  Google Scholar 

  23. Dietz WA, Tobis JM, Isner JM. Failure of angiography to accurately depict the extent of coronary artery narrowing in three fatal cases of percutaneous transluminal coronary angioplasty. J Am Coll Cardiol 1992; 19: 1261–70.

    Article  PubMed  CAS  Google Scholar 

  24. Ehrlich S, Honye J, Mahon D et al. Unrecognized stenosis by angiography documented by intravascular ultrasound imaging. Cathet Cardiovasc Diagn 1991; 23: 198–201.

    Article  PubMed  CAS  Google Scholar 

  25. Mintz GS, Douek P, Pichard AD et al. Target lesion calcification in coronary artery disease: an intravascular ultrasound study. J Am Coll Cardiol 1992; 20: 1149–55.

    Article  PubMed  CAS  Google Scholar 

  26. Fitzgerald PJ, St Goar FG, Connolly AJ et al. Intravascular ultrasound imaging of coronary arteries. Is three layers the norm? Circulation 1992; 86: 154–158

    PubMed  CAS  Google Scholar 

  27. Gussenhoven EJ, Frietman PA, The SH et al. Assessment of medial thinning in atherosclerosis by intravascular ultrasound. Am J Cardiol 1991; 68: 1625–32.

    Article  PubMed  CAS  Google Scholar 

  28. Tobis JM, Mallery J, Mahon D et al. Intravascular ultrasound imaging of human coronary arteries in vivo: Analysis of tissue characterizations with comparison to in vitro histological specimens. Circulation 1991; 83: 913–26.

    PubMed  CAS  Google Scholar 

  29. Di Mario C, The SH, Madretsma S et al. Detection and characterization of vascular lesions by intravascular ultrasound: An in vitro study correlated with histology. J Am Soc Echocardiogr 1992; 5: 135–46.

    PubMed  Google Scholar 

  30. Gussenhoven EJ, Essed CE, Lancee CT et al. Arterial wall characteristics determined by intravascular ultrasound imaging: An in vitro study. J Am Coll Cardiol 1989; 14: 947–52.

    Article  PubMed  CAS  Google Scholar 

  31. Sechtem U, Arnold G, Keweloh T et al. In-vitro-Diagnose der koronaren Plaquemorpholo-gie mit intravaskularem Ultraschall: Vergleich mit histopathologischen Befunden. Z Kardiol 1993; 82: 618–27.

    PubMed  CAS  Google Scholar 

  32. Waller BF, Pinkerton CA, Orr CM et al. Morphological observations late (greater than 30 days) after clinically successful coronary balloon angioplasty: An analysis of 20 necropsy patients and literature review of 41 necropsy patients with coronary angioplasty restenosis. Circulation 1991; 83 (Suppl I): I-28–I-41

    CAS  Google Scholar 

  33. Potkin BN, Bartorelli AL, Gessert JM et al. Coronary artery imaging with intravascular high-frequency ultrasound. Circulation 1990; 81: 1575–85.

    Article  PubMed  CAS  Google Scholar 

  34. Finet G, Maurincomme E, Tabib A et al. Artifacts in intravascular ultrasound imaging: Analyses and implications. Ultrasound Med Biol 1993; 19: 533–47.

    Article  PubMed  CAS  Google Scholar 

  35. Braden GA, Herrington DM, Downes TR et al. Qualitative and quantitative contrasts in the mechanisms of lumen enlargement by coronary balloon angioplasty and directional coronary atherectomy. J Am Coll Cardiol 1994; 23: 40–8.

    Article  PubMed  CAS  Google Scholar 

  36. Füessl R, Burkhard-Meier C, Kaspers S et al. Dissektion nach Ballonangioplastie:Vorhersagemöglichkeit mit präinterventionellem intra-vaskulärem Ultraschall. Z Kardiol 1995; 84: 205–215

    Google Scholar 

  37. Losordo DW, Rosenfield K, Pieczek A et al. How does angioplasty work? Serial analys; of human iliac arteries using intravascular ultrasound. Circulation 1992; 86: 1845–58.

    PubMed  CAS  Google Scholar 

  38. Werner GS, Sold G, Buchwald A et al. Intravascular ultrasound imaging of human coronary arteries after percutaneous transluminal angioplasty: Morphologic and quantitative assessment. Am Heart J 1991; 122: 212–20.

    Article  PubMed  CAS  Google Scholar 

  39. Honye J, Mahon DJ, Jain A et al. Morphological effects of coronary balloon angioplasty in vivo assessed by intravascular ultrasound imaging. Circulation 1992; 85: 1012–1025.

    PubMed  CAS  Google Scholar 

  40. Tobis JM, Mallery J, Mahon D et al. Intravascular ultrasound imaging of human coronary arteries in vivo. Analysis of tissue characterizations with comparison to in vitro histological specimens. Circulation 1991; 83: 913–926.

    PubMed  CAS  Google Scholar 

  41. Gerber TC, Erbel R, Gorge G et al. Classification of morphologic effects of percutaneous transluminal coronary angioplasty assessed by intravascular ultrasound. Am J Cardiol 1992; 70: 1546–54.

    Article  PubMed  CAS  Google Scholar 

  42. Tenaglia AN, Buller CE, Kisslo KB et al. Mechanisms of balloon angioplasty and directional coronary atherectomy as assessed by intracoronary ultrasound. J Am Coll Cardiol 1992; 20: 685–91.

    Article  PubMed  CAS  Google Scholar 

  43. Tenaglia AN, Buller CE, Kisslo KB et al. Intracoronary ultrasound predictors of adverse outcomes after coronary artery interventions. J Am Coll Cardiol 1992; 20: 1385–90.

    Article  PubMed  CAS  Google Scholar 

  44. Hodgson JM, Reddy KG, Suneja R et al. Intracoronary ultrasound imaging: Correlation of plaque morphology with angiography, clinical syndrome and procedural results in patients undergoing coronary angioplasty. J Am Coll Cardiol 1993; 21: 35–44.

    Article  PubMed  CAS  Google Scholar 

  45. Block PC, Myler RK, Stertzer S, Fallon JT. Morphology after transluminal angioplasty in human beings. N Engl J Med 1981; 305: 382–6.

    Article  PubMed  CAS  Google Scholar 

  46. Tobis JM, Mallery JA, Gessert J et al. Intravascular ultrasound cross-sectional arterial imaging before and after balloon angioplasty in vitro. Circulation 1989; 80: 873–82.

    Article  PubMed  CAS  Google Scholar 

  47. Farb A, Virmani R, Atkinson JB, Kolodgie FD. Plaque morphology and pathologic changes in arteries from patients dying after coronary balloon angioplasty. J Am Coll Cardiol 1990; 16: 1421–9.

    Article  PubMed  CAS  Google Scholar 

  48. Block PC, Baughman KL, Pasternak RC, Fallon JT. Transluminal angioplasty: Correlation of morphologic and angiographic findings in an experimental model. Circulation 1980; 61: 778–85.

    PubMed  CAS  Google Scholar 

  49. Fitzgerald PJ, Ports TA, Yock PG. Contribution of localized calcium deposits to dissection after angioplasty. An observational study using intravascular ultrasound. Circulation 1992; 86: 64–70.

    PubMed  CAS  Google Scholar 

  50. Di Mario C, Madretsma S, Linker DL et al. The angle of incidence of the ultrasonic beam: a critical factor for the image quality in intravascular ultrasonography. Am Heart J 1993; 125: 442–8.

    Article  PubMed  Google Scholar 

  51. Lyon RT, Zarins CK, Lu CT et al. Vessel, plaque, and lumen morphology after transluminal balloon angioplasty: Quantitative study in distended human arteries. Atherosclerosis 1987; 7: 306–14.

    CAS  Google Scholar 

  52. Sechtem U, Hopp HW, Rudolph D et al. Recoil after percutaneous transluminal coronary angioplasty depends on stenosis morphology: Assessment by intravascular ultrasound (Abstr). Eur Heart J 1993; 14 (Suppl B): 128

    Google Scholar 

  53. Kuntz RE, Keaney KM, Senerchia C, Bairn DS. A predictive method for estimating the late angiographic results of coronary intervention despite incomplete ascertainment. Circulation 1993; 87: 815–30.

    PubMed  CAS  Google Scholar 

  54. Matthews BJ, Ewels CJ, Kent KM. Coronary dissection: A predictor of restenosis? Am Heart J 1988; 115: 547–54.

    Article  PubMed  CAS  Google Scholar 

  55. Bourassa MG, Lesperance J, Eastwood C et al. Clinical, physiologic, anatomic and procedural factors predictive of restenosis after percutaneous transluminal coronary angioplasty. J Am Coll Cardiol 1991; 18: 368–76.

    Article  PubMed  CAS  Google Scholar 

  56. Lambert M, Bonan R, Cote G et al. Multiple coronary angioplasty: A model to discriminate systemic and procedural factors related to restenosis. J Am Coll Cardiol 1988; 12: 310–4.

    Article  PubMed  CAS  Google Scholar 

  57. Schwartz JS, Jugo R et al. Restenosis after coronary angioplasty: A multivariate statistical model to relate lesion and procedure variables to restenosis. The M-HEART Investigators. J Am Coll Cardiol 1991; 18: 647–656

    Article  PubMed  Google Scholar 

  58. Gorge G, Erbel R, Gerber T et al. Morphologie im intravasalen Ultrasachall nach PTCA und klinischer Verlauf (Abstr). Z Kardiol 1993; 82 (Suppl 1): 567

    Google Scholar 

  59. Sechtem U, Rudolph D, Klass O et al. Restenosis after balloon angioplasty: Influence of post interventional vessel morphology as assessed by intracoronary ultrasound (Abstr). Eur Heart J 1994; 16 (Suppl).

    Google Scholar 

  60. Suarez de Lezo J, Romero M, Medina A et al. Intracoronary ultrasound assessment of directional coronary atherectomy: Immediate and follow-up findings. J Am Coll Cardiol 1993; 21: 298–307.

    Article  PubMed  CAS  Google Scholar 

  61. Kimura BJ, Fitzgerald PJ, Sudhir K et al. Guidance of directed coronary atherectomy by intracoronary ultrasound imaging. Am Heart J 1992; 124: 1365–9.

    Article  PubMed  CAS  Google Scholar 

  62. Keren G, Pichard AD, Kent KM et al. Failure or success of complex catheter-based interventional procedures assessed by intravascular ultrasound. Am Heart J 1992; 123: 200–8.

    Article  PubMed  CAS  Google Scholar 

  63. Suneja R, Nair RN, Reddy KG et al. Mechanisms of angiographically successful directional coronary atherectomy: Evaluation by intracoronary ultrasound and comparison with transluminal coronary angioplasty. Am Heart J 1993; 126: 507–14.

    Article  PubMed  CAS  Google Scholar 

  64. Mintz GS, Pichard AD, Ditrano CJ et al. Intravascular ultrasound predictors of angiographic restenosis (Abstr). Circulation 1993; 88 (Suppl): 1–598.

    Google Scholar 

  65. Nissen SE, Tuzcu EM, de Franco AC et al. Intravascular evidence of atherosclerosis at “normal”, reference sites predicts adverse clinical outcomes following percutaneous coronary interventions (Abstr). J Am Coll Cardiol 1994; 271A.

    Google Scholar 

  66. Mudra H, Blasini R, Klauss V et al. Verbesserung des Akut- und Langzeitresultats durch Ultraschall-gesteuerte Ballonangioplastie (Abstr). Z Kardiol 1994; 83 (Suppl 1): 12.

    Google Scholar 

  67. Mata LA, Bosch X, David PR et al. Clinical and angiographic assessment 6 months after double vessel percutaneous coronary angioplasty. J Am Coll Cardiol 1985; 6: 1239–44.

    Article  PubMed  CAS  Google Scholar 

  68. Vandormael MG, Deligonul U, Kern MJ et al. Multilesion coronary angioplasty: Clinical and angiographic follow-up. J Am Coll Cardiol 1987; 10: 246–52.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Innere Medizin, University of Cologne, Joseph-Stelzmannstrasse 9, D-50924, Cologne, Germany

    Prof. Dr Udo Sechtem

Authors
  1. Prof. Dr Udo Sechtem
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hans-Wilhelm Höpp
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dirk Rudolph
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Cardiology, University Hospital Eppendorf, Martinistrasse 52, D-20246, Hamburg, Germany

    Christoph A. Nienaber

  2. Klinik III für Innere Medizin, University of Cologne, Joseph-Stelzmannstrasse 9, D-50924, Cologne, Germany

    Udo Sechtem

Rights and permissions

Reprints and permissions

Copyright information

© 1996 Kluwer Academic Publishers

About this chapter

Cite this chapter

Sechtem, U., Höpp, HW., Rudolph, D. (1996). Predictors of restenosis after angioplasty: Morphologic and quantitative evaluation by intravascular ultrasound. In: Nienaber, C.A., Sechtem, U. (eds) Imaging and Intervention in Cardiology. Developments in Cardiovascular Medicine, vol 173. Springer, Dordrecht. https://doi.org/10.1007/978-94-009-0115-5_25

Download citation

  • DOI: https://doi.org/10.1007/978-94-009-0115-5_25

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-6538-2

  • Online ISBN: 978-94-009-0115-5

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation