Arterial disruption and remodeling following balloon dilatation

We studied immediate and long-term alterations in human atherosclerotic arteries subjected to balloon dilatation. Pathologic material included vessels obtained at amputation or autopsy that had been previously dilated in vivo and cadaver vessels dilated under physiologic pressure and temperature. All vessels were pressure-perfusion fixed, and morphologic observations were correlated with sequential angiograms obtained in 36 patients. Balloon dilatation resulted in disruption of both the plaque and the artery wall, with separation of the plaque from the tunica media, rupture of the tunica media, and stretching of the tunica adventitia to increase lumen cross-sectional area. The intimal plaque protruded into the lumen, accounting for the angiographic appearance of local flaps and dissection channels. Remodeling occurred by readherence of the intimal flaps with little change in plaque volume. Achievement of a sufficient radius of curvature may be necessary to achieve long-term patency. Restenosis may occur because of insufficient dilatation but may also result from extention of dissection channels into nondilated segments of the artery.