Abstract
Substantial damage is inflicted on the arterial wall by conventional balloon angioplasty as well as by newer interventional devices. Restenosis seems to be due to an exaggerated, albeit normal healing response of the arterial wall to interventional injury. Since the relationship between arterial wall damage and restenosis is not entirely clear, experimental studies were performed in the normal rabbit to assess the effects of the nature and the extent of injury on the subsequent myointimal proliferation. The results suggest that the myointimal proliferation is an aspecific repair response to wall injury. The results further suggest an on-off character of myointimal proliferation after injury, which would imply that alternative, less damaging interventional methods may not reduce the problem of restenosis.
Similar content being viewed by others
References
Virchow R. Der atheromatöse Prozess der Arteries.Wien Med Wochenschr 1856,6:825–9
Ross R, Glomset JA. Atherosclerosis and the arterial smooth muscle cell.Science 1973,180:1332–9
Ross R. The pathogenesis of atherosclerosis—an up-date.N Engl J Med 1986,314:488–500
Dotter CT, Judkins MP. Transluminal treatment of atherosclerotic obstruction.Circulation 1964,30:654–70
Lee G, Ikeda RM, Joye JA et al. Evaluation of translumial angioplasty of chronic coronary artery stenosis. Value and limitations assessed in fresh human cadaver hearts.Circulation 1980,61:77–83
Castaneda-Zuniga WR, Formanek A, Tadavarthy M et al. The mechanism of balloon angioplasty.Radiology 1980,135:565–71
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
Block PC, Myler RK, Stertzer S, Fallon JT. Morphology after transluminal angioplasty in human beings.N Engl J Med 1981,305:382–5
Mizuno K, Kurita A, Imazeki N. Pathological findings after percutaneous transluminal coronary angioplasty.Br Heart J 1984,52:588–90
Kohchi K, Takebayashi S, Block PC et al. Arterial changes after percutaneous transluminal coronary angioplasty: results at autopsy.J Am Coll Cardiol 1987,10:592–9
Holmes DR, Holubkov R, Vlietstra RE et al. Comparison of complications during percutaneous transluminal coronary angioplasty from 1977 to 1981 and from 1985 to 1986: the National Heart, Lung, and Blood Institute percutaneous transluminal coronary angioplasty registry.J Am Coll Cardiol 1988,12:1149–55
Detre KM, Holmes DR, Holubkov R et al. Incidence and consequences of periprocedural occlusion. The 1985–1986 National Heart, Lung, and Blood Institute percutaneous transluminal coronary angioplasty registry.Circulation 1990,82:739–50
Shiu MF, Silverton NP, Oakley D, Cumberland D. Acute coronary occlusion during percutaneous transluminal coronary angioplasty.Br Heart J 1985,54:129–33
Ellis SG, Roubin GS, King SB III et al. In-hospital cardiac mortality after acute closure after coronary angioplasty: analysis of risk factors from 8,207 procedures.J Am Coll Cardiol 1988,11:211–16
Topol EJ. Emerging strategies for failed percutaneous transluminal coronary angioplasty.Am J Cardiol 1989,63:249–50
Serruys PW, Luijten HE, Beatt KJ et al. Incidence of restenosis after successful coronary angioplasty: a time-related phenomenon. A quantitative angiographic study in 342 consecutive patients at 1,2, 3, and 4 months.Circulation 1988,77:361–71
Nobuyoshi M, Kimura T, Nosaka H et al. Restenosis after successful percutaneous transluminal coronary angioplasty: serial angiographic follow-up of 229 patients.J Am Coll Cardiol 1988,12:616–23
Nichols AB, Smith R, Berke AD et al. Importance of balloon size in coronary angioplasty.J Am Coll Cardiol 1989,13:1094–100
Roubin GS, Douglas JS, Jr., King SB III et al. Influence of balloon size on initial success, acute complications, and restenosis after percutaneous transluminal coronary angioplasty. A prospective randomized study.Circulation 1988,78:557–65
Leimgruber PP, Roubin GS, Hollman J et al. Restenosis after successful coronary angioplasty in patients with single-vessel disease.Circulation 1986,73:710–7
Leimgruber PP, Roubin GS, Anderson HV et al. Influence of intimal dissection on restenosis after successful coronary angioplasty.Circulation 1985,72:530–5
Sarembock IJ, La Veau PJ, Sigal SL et al. Influence of inflation pressure and balloon size on the development of intimai hyperplasia after balloon angioplasty. A study in the atherosclerotic rabbit.Circulation 1989,80:1029–40
Schatz RA. A view of vascular stents.Circulation 1989,79:445–57
Spears JR. Percutaneous laser treatment of atherosclerosis: an overview of emerging techniques.Cardiouasc Intervent Radiol 1986,9:303–12
Jenkins RD, Spears JR. Laser balloon angioplasty. A new approach to abrupt coronary occlusion and chronic restenosis.Circulation 1990,81:101–8
Lawrence JB, Prevosti LG, Kramer WS et al. Platelet adherence and thrombus formation with flowing human blood on atherosclerotic plaque: reduced thrombogenicity of Watanabe-heritable hyperlipidemic rabbit aortic subendothelium.Thromb Res 1989,54:99–114
Borst C, Bos AN, Zwaginga JJ et al. Loss of blood platelet adhesion after heating native and cultured human subendothelium to 100° Celsius.Cardiovasc Res 1990,24:665–8
Schwarten DE, Katzen BT, Simpson JB, Cutcliff WB. Simpson catheter for percutaneous transluminal removal of atheroma.AJR 1988,150:799–801
Hinohara T, Selmon R, Robertson GC et al. Directional atherectomy. New approaches for treatment of obstructive coronary and peripheral vascular disease.Circulation 1990,81(IV):79–91
Johnson DE, Braden L, Simpson JB. Mechanism of directed transluminal atherectomy.Am J Cardiol 1990,65:389–91
Safian RD, Gelbfish S, Erny RE et al. Coronary atherectomy: clinical, angiographic, and histological findings and observations regarding potential mechanism.Circulation 1990,82:69–79
Sanborn TA, Haudenschild CC, Garber GR et al. Angiographic and histologic consequences of laser thermal angioplasty: comparison with balloon angioplasty.Circulation 1987,75:1281–86
Verdaasdonk RM, Borst C, Boulanger LHMA, van Gemert MJC. Laser angioplasty with a metal laser probe (‘hot tip’): probe temperature in blood.Lasers Med Sci 1987,2:153–8
Sanborn TA, Alexopoulos D, Marmur JD et al. Coronary excimer laser angioplasty: reduced complications and indium-111 platelet accumulation compared with thermal laser angioplasty.J Am Coll Cardiol 1990,16:502–6
Grundfest WS, Litvack F, Forrester JS et al. Laser ablation of human atherosclerotic plaque without adjacent tissue injury.J Am Coll Cardiol 1985,5:929–33
Isner JM, Fortin Donaldson R, Deckelbaum LI et al. The excimer laser: light microscopic and ultrastructural analysis of potential advantages for use in laser therapy of cardiovascular disease.J Am Coll Cardiol 1985,6:1102–9
Isner JM, Gal D, Steg PG et al. Percutaneous, in vivo excimer laser angioplasty: results in two experimental animal models.Lasers Surg Med 1988,8:223–32
Karsch KR, Haase KK, Voelker W et al. Percutaneous coronary excimer laser angioplasty in patients with stable and unstable angina pectoris. Acute results and incidence of restenosis during 6-month follow-up.Circulation 1990,81:1849–59
Katzen BT, Kaplan JO, Schwarten DM, van-Breda A. Complications of ‘hot tip’ laser assisted angioplasty.Circulation 1988,78(II):417 (Abstract)
Tobis J, Smolin M, Mallery J et al. Laser-assisted thermal angioplasty in human peripheral artery occlusions: mechanism of recanalization.J Am Coll Cardiol 1989,13:1547–54
Fourrier JL, Bertrand ME, Auth DC et al. Percutaneous coronary rotational angioplasty in humans: preliminary report.J Am Coll Cardiol 1989,14:1278–82
Rosenthal E, Montarello JK, Palmer T, Curry PV. Coronary artery thermal damage during percutaneous ‘hot tip’ laser-assisted angioplasty.Am J Cardiol 1989,64:116–20
Isner JM, Rosenfield K, Losordo DW et al. Percutaneous intravascular US as adjunct to catheter-based interventions: preliminary experience in patients with peripheral vascular disease.Radiology 1990,175:61–70
van Leeuwen TG, van der Veen, MJ, Verdaasdonk RM, Borst C. Non-contact tissue ablation by Holmium-YSGG laser pulses in blood.Lasers Surg Med 1991,11:26–34
Haudenschild C. Pathogenesis of restenosis.Z Kardiol 1989,78:28–34
Groves HM, Kinlough-Rathbone RL, Richardson M et al. Platelet interaction with damaged rabbit aorta.Lab Invest 1979,40:194–200
Steele PM, Chesebro JH, Stanson AW et al. Balloon angioplasty. Natural history of the pathophysiological response to injury in a pig model.Circ Res 1985,57:105–12
Friedman RJ, Stemerman MB, Wenz B et al. The effect of thrombocytopenia on experimental atherosclerotic lesion formation in rabbits.J Clin Invest 1977,60:1191–201
Adams PC, Lam JY, Badimon L et al. Interactions of platelets and vessel wall in the development of restenosis after coronary angioplasty.Ann N Y Acad Sci 1987,516:605–20
Fischell TA, Derby G, Tse TM, Stadius ML. Coronary artery vasoconstriction routinely occurs after percutaneous transluminal coronary angioplasty. A quantitative arteriographic analysis.Circulation 1988,78:1323–34
Lindner V, Reidy MA, Fingerle J. Regrowth of arterial endothelium. Denudation with minimal trauma leads to complete endothelial cell regrowth.Lab Invest 1989,61:556–63
Schwartz SM, Campbell GR, Campbell JH. Replication of smooth muscle cells in vascular disease.Circ Res 1986,58:427–44
Campbell GR, Campbell JH, Manderson JA et al. Arterial smooth muscle. A multifunctional mesenchymal cell.Arch Pathol Lab Med 1988,112:977–86
Clowes AW, Reidy MA, Clowes MM. Mechanisms of stenosis after arterial injury.Lab Invest 1983,49:208–15
Clowes AW, Reidy MA, Clowes MM. Kinetics of cellular proliferation after arterial injury. I. Smooth muscle growth in the absence of endothelium.Lab Invest 1983,49:327–33
Clowes AW, Clowes MM, Fingerle J, Reidy MA. Regulation of smooth muscle cell growth in injured artery.J Cardiovasc Pharmacol 1989,14(Suppl 6):S12–5
Essed CE, van-den Brand M, Becker AE. Transluminal coronary angioplasty and early restenosis. Fibrocellular occlusion after wall laceration.Br Heart J 1983,49:393–96
Austin GE, Ratliff NB, Hollman J et al. Intimai proliferation of smooth muscle cells as an explanation for recurrent coronary artery stenosis after percutaneous transluminal coronary angioplasty.J Am Coll Cardiol 1985,6:369–75
Giraldo AA, Esposo OM, Meis JM. Intimal hyperplasia as a cause of restenosis after percutaneous transluminal coronary angioplasty.Arch Pathol Lab Med 1985,109:173–5
Liu MW, Roubin GS, King SB III. Restenosis after coronary angioplasty. Potential determinants and role of intimai hyperplasia.Circulation 1989,79:1374–87
Spears JR. Percutaneous transluminal coronary angioplasty restenosis: potential prevention with laser balloon angioplasty.Am J Cardiol 1987,60:61B-4B
Oomen A, van Erven L, Vandenbroucke WVA et al. Early and late arterial healing response to catheterinduced laser, thermal and mechanical wall damage in the rabbit.Lasers Surg Med 1990,10:363–74
van Erven L, Velema E, Post MJ, Borst C. Intimai hyperplasia is unrelated to extent of medial smooth muscle cell necrosis after balloon dilation in the rabbit.Circulation 1990,82(III):339 (abstract)
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Van Erven, L., Post, M.J. & Borst, C. Arterial wall injury, arterial wall healing and restenosis. Laser Med Sci 6, 271–279 (1991). https://doi.org/10.1007/BF02030880
Issue Date:
DOI: https://doi.org/10.1007/BF02030880