Vascular repair mechanisms after directional atherectomy or percutaneous transluminal coronary angioplasty in atherosclerotic rabbit iliac arteries

R. L. Wilensky, I. Gradus-Pizlo, G. Sandusky, K. L. March

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Although directional atherectomy (DA) reduces the plaque burden, successful revascularization is not associated with a reduced restenosis rate when compared with percutaneous transluminal coronary angioplasty (PTCA). The purpose of this study was to compare and contrast the vascular response to DA-induced and PTCA-induced injury. Six to 8 weeks after induction of atherosclerosis, PTCA (n = 34) was performed in one iliac artery and DA in the other (n = 30). Arteries were obtained at 6 time points: 1, 3, 5, 7, 14, and 28 days. Eleven arteries that did not undergo an intervention acted as controls. Radiograms obtained before and after intervention and at euthanization were compared. Morphometric, histologic, and immunohistochemical analyses were performed. Both PTCA and DA resulted in an immediate increase in luminal diameter that subsequently decreased over the ensuing month. PTCA caused deep dissection (7 of 8 arteries), often extending to the adventitia, whereas stand-alone DA resulted in deep cleft formation (4 of 5). Of the 30 arteries that underwent DA, 4 exhibited an increase in luminal diameter in the absence of tissue retrieval. Thrombus was observed in both the dissection planes and the clefts within the first 7 days, and cellular ingrowth was appreciated at 5 to 7 days. By 7 days the artery was repaired, and the histologic appearance of the arteries that had undergone PTCA could not be differentiated from the arteries that had undergone DA. Increased intimal and medial collagen and elastin was noted at 14 and 28 days. An increase in the area bordered by the external elastic lamina was observed in both groups. Although successful DA results in tissue removal and the production of a deep tissue cleft and PTCA causes a dissection, both produce a condition in which the arterial injury exposes the arterial media to blood, causing thrombus formation and inflammation with subsequent cellular accumulation into the thrombotic framework.

Original languageEnglish (US)
Pages (from-to)13-22
Number of pages10
JournalAmerican Heart Journal
Volume132
Issue number1 I
DOIs
StatePublished - Jan 1 1996

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Atherectomy
Coronary Balloon Angioplasty
Iliac Artery
Blood Vessels
Rabbits
Arteries
Dissection
Thrombosis
Tunica Intima
Tunica Media
Adventitia
Elastin
Wounds and Injuries
Atherosclerosis
Collagen
Inflammation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Vascular repair mechanisms after directional atherectomy or percutaneous transluminal coronary angioplasty in atherosclerotic rabbit iliac arteries. / Wilensky, R. L.; Gradus-Pizlo, I.; Sandusky, G.; March, K. L.

In: American Heart Journal, Vol. 132, No. 1 I, 01.01.1996, p. 13-22.

Research output: Contribution to journalArticle

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