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Published on: December 2, 2014
Histopathology of postpercutaneous transluminal coronary angioplasty remodeling in human coronary arteries
G Sangiorgi1, A J Taylor, A Farb
1Department of Internal Medicine, Mayo Clinic and Mayo Foundation. Rochester, MN, USA.
Insights
Long-term success in coronary balloon angioplasty (PTCA) hinges on arterial expansion, not neointimal growth. Constrictive remodeling, rather than plaque buildup, dictates PTCA outcomes.
Area of Science:
- Cardiovascular research
- Interventional cardiology
- Histopathology
Background:
- Understanding long-term outcomes of percutaneous transluminal coronary angioplasty (PTCA) is crucial.
- Restenosis after PTCA may involve failed arterial enlargement or constriction.
- The histopathology of long-term PTCA success in humans is not well-defined.
Purpose of the Study:
- To investigate the histomorphometric factors associated with successful long-term coronary balloon angioplasty (PTCA).
- To differentiate between compensatory arterial enlargement and constrictive remodeling in PTCA outcomes.
Main Methods:
- Studied 42 coronary segments from 41 patients deceased 60 ± 58 weeks post-PTCA.
- Compared histomorphometric findings at the PTCA site with a proximal reference site.
Main Results:
- Histologic success (PTCA site lumen ≥50% of reference lumen) was observed in 43% of arteries.
- Successful PTCA arteries showed larger acute lumens, smaller plaque, thinner adventitia, and external elastic lamina expansion.
- Histologic failures were characterized by reduced external elastic lamina area, indicating constrictive remodeling.
Conclusions:
- Constrictive remodeling, not neointimal formation, is the primary determinant of long-term PTCA success.
- Histomorphometric data confirm the role of remodeling in PTCA outcomes.
Background:
We studied the histomorphometric correlates of long-term successful coronary balloon angioplasty (percutaneous transluminal coronary angioplasty [PTCA]). Restenosis after PTCA may occur secondary to the failure of compensatory arterial enlargement or post-PTCA arterial constriction. The histopathology of this process in human subjects remains poorly defined.
Methods:
Forty-two coronary segments from 41 patients treated with PTCA 60 +/- 58 weeks before death were studied. The histomorphometric findings at the PTCA site were compared with those obtained at a proximal reference site.
Results:
Histologic long-term success was seen in 18 (43%) of 42 arteries. Histologically successful PTCA arteries (PTCA site lumen of >/=50% of the reference lumen) demonstrated a larger acute lumen, smaller plaque size (normalized to the internal elastic lamina area), and thinner adventitia compared with histologic failures. Relative to the reference sites, histologically successful PTCA showed expansion of the external elastic lamina. In contrast, histologic failures showed a reduced external elastic lamina area, suggesting constrictive remodeling. Neointimal area correlated with the extent of internal elastic lamina disruption, but neither variable was related to histologic PTCA success or failure.
Conclusions:
These data provide histomorphometric confirmation of the hypothesis that constrictive remodeling, not neointimal formation, determines the long-term outcome of PTCA.
