"Crackers, breakers, stretchers, drillers, scrapers, shavers, burners, welders and melters"--the future treatment of atherosclerotic coronary artery disease? A clinical-morphologic assessment

Department of Pathology, University Hospital, Indianapolis, Indiana 46223.

Although various public health preventive efforts and prescribed pharmacologic treatment methods will have long-term benefits in the reduction of coronary artery atherosclerosis and subsequent cardiac events, the immediate and short-term future in the treatment of coronary artery disease will focus on several interventional devices designed to remodel or remove causes of acute and chronic coronary artery obstruction. Certain clinical-morphologic aspects of these interventional devices or techniques that result in remodeling of the coronary lumen shape (balloon angioplasty, thermal probes, intravascular stents) or removal of obstructing material (lasers, atherectomy devices) are reviewed. Two new areas in the pathology of atherosclerotic plaque (plaque fissures, eccentric plaque) and their clinical relevance in coronary heart disease are described.

This article has been cited by other articles:

				G. A. Mensah Fantastic voyage through cardiology: from 1969 to 2008. J. Am. Coll. Cardiol., June 9, 2009; 53(23): 2197 - 2197. [Full Text] [PDF]

				M. A. Julien, P. Wang, C. A. Haller, J. Wen, and E. L. Chaikof Mechanical strain regulates syndecan-4 expression and shedding in smooth muscle cells through differential activation of MAP kinase signaling pathways Am J Physiol Cell Physiol, January 1, 2007; 292(1): C517 - C525. [Abstract] [Full Text] [PDF]

				REFERENCES J. ICRU, December 1, 2004; 4(2): 165 - 175. [Full Text] [PDF]

				S. E. Nissen Pathobiology, not angiography, should guide managementin acute coronary syndrome/non-ST-segment elevation myocardial infarction: The non-interventionist's perspective J. Am. Coll. Cardiol., February 19, 2003; 41(4_Suppl_S): 103S - 112S. [Abstract] [Full Text] [PDF]

				A. DeFranco Understanding the pathophysiology of the arterial wall: which method should we choose? Intra-vascular ultrasound Eur. Heart J. Suppl., September 1, 2002; 4(suppl_F): F29 - F40. [Abstract] [PDF]

				E. Atalar, K. Aytemir, I. Haznedaroglu, S. Aksoyek, K. Ovunc,, S. Kirazli, and F. Ozmen Platelet and Leukocyte Deactivation After Intracoronary Stent Placement in Patients Receiving Combined Antiplatelet Therapy Clinical and Applied Thrombosis/Hemostasis, April 1, 2001; 7(2): 116 - 121. [Abstract] [PDF]

				S. E. Nissen and P. Yock Intravascular Ultrasound : Novel Pathophysiological Insights and Current Clinical Applications Circulation, January 30, 2001; 103(4): 604 - 616. [Abstract] [Full Text] [PDF]

				N. Al-Saadi, E. Nagel, M. Gross, B. Schnackenburg, I. Paetsch, C. Klein, and E. Fleck Improvement of myocardial perfusion reserve early after coronary intervention: assessment with cardiac magnetic resonance imaging J. Am. Coll. Cardiol., November 1, 2000; 36(5): 1557 - 1564. [Abstract] [Full Text] [PDF]

				M. Bulvas, R. Urbanová, R. Klézlová, and I. Vítková Markedly Eccentric Peripheral Vascular Stenoses: Percutaneous Atherectomy with an Endomyocardial Biopsy Device Radiology, November 1, 2000; 217(2): 587 - 592. [Abstract] [Full Text]

				J. Hug, E. Nagel, A. Bornstedt, B. Schnackenburg, H. Oswald, and E. Fleck Coronary Arterial Stents: Safety and Artifacts during MR Imaging Radiology, September 1, 2000; 216(3): 781 - 787. [Abstract] [Full Text]

				C. L. de Korte, G. Pasterkamp, A. F. W. van der Steen, H. A. Woutman, and N. Bom Characterization of Plaque Components With Intravascular Ultrasound Elastography in Human Femoral and Coronary Arteries In Vitro Circulation, August 8, 2000; 102(6): 617 - 623. [Abstract] [Full Text] [PDF]

				P. J. Scanlon, D. P. Faxon, A.-M. Audet, B. Carabello, G. J. Dehmer, K. A. Eagle, R. D. Legako, D. F. Leon, J. A. Murray, S. E. Nissen, et al. ACC/AHA guidelines for coronary angiography: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography) developed in collaboration with the Society for Cardiac Angiography and Interventions J. Am. Coll. Cardiol., May 1, 1999; 33(6): 1756 - 1824. [Full Text] [PDF]

				M. S. Gotsman and D. Admon Paradigm Shifts in Coronary Artery Disease: The Old New Initiatives Arch Intern Med, May 11, 1998; 158(9): 949 - 953. [Full Text] [PDF]

				W. F. Baker JR Thrombosis and Hemostasis in Cardiology: Review of Pathophysiology and Clinical Practice (Part I) Clinical and Applied Thrombosis/Hemostasis, January 1, 1998; 4(1): 51 - 75. [Abstract] [PDF]

				W. D. Coats, P. Whittaker, D. T. Cheung, J. W. Currier, B. Han, and D. P. Faxon Collagen Content Is Significantly Lower in Restenotic Versus Nonrestenotic Vessels After Balloon Angioplasty in the Atherosclerotic Rabbit Model Circulation, March 4, 1997; 95(5): 1293 - 1300. [Abstract] [Full Text]

				M. J. Vonesh, L. F. Mockros, C. J. Davidson, K. B. Chandran, and D. D. McPherson In Vitro Identification of Angioplasty-Induced Injury by Use of Vascular Acoustic Emissions Circulation, February 18, 1997; 95(4): 1022 - 1029. [Abstract] [Full Text]

				A. Aris One Hundred Years of Cardiac Surgery Ann. Thorac. Surg., September 1, 1996; 62(3): 636 - 637. [Full Text]

				S. Waxman, M. A. Sassower, M. A. Mittleman, S. Zarich, A. Miyamoto, K. S. Manzo, J. E. Muller, G. S. Abela, and R. W. Nesto Angioscopic Predictors of Early Adverse Outcome After Coronary Angioplasty in Patients With Unstable Angina and Non–Q-Wave Myocardial Infarction Circulation, June 15, 1996; 93(12): 2106 - 2113. [Abstract] [Full Text]

				G. S. Mintz, J. J. Popma, A. D. Pichard, K. M. Kent, L. F. Satler, Y. Chien Chuang, R. A. DeFalco, and M. B. Leon Limitations of Angiography in the Assessment of Plaque Distribution in Coronary Artery Disease : A Systematic Study of Target Lesion Eccentricity in 1446 Lesions Circulation, March 1, 1996; 93(5): 924 - 931. [Abstract] [Full Text]

				E. J. Topol and S. E. Nissen Our Preoccupation With Coronary Luminology : The Dissociation Between Clinical and Angiographic Findings in Ischemic Heart Disease Circulation, October 15, 1995; 92(8): 2333 - 2342. [Abstract] [Full Text]

				C. Indolfi, G. Esposito, E. Di Lorenzo, A. Rapacciuolo, A. Feliciello, A. Porcellini, V. E. Avvedimento, M. Condorelli, and M. Chiariello Smooth Muscle Cell Proliferation Is Proportional to the Degree of Balloon Injury in a Rat Model of Angioplasty Circulation, September 1, 1995; 92(5): 1230 - 1235. [Abstract] [Full Text]

				G. Wright, L. Michalis, and P. Rolfe Insularity and professional protectionism or matrixing and professional security in the provision of perfusion services Perfusion, March 1, 1995; 10(2): 89 - 92. [PDF]

				D. L. Fischman, M. B. Leon, D. S. Baim, R. A. Schatz, M. P. Savage, I. Penn, K. Detre, L. Veltri, D. Ricci, M. Nobuyoshi, et al. A Randomized Comparison of Coronary-Stent Placement and Balloon Angioplasty in the Treatment of Coronary Artery Disease N. Engl. J. Med., August 25, 1994; 331(8): 496 - 501. [Abstract] [Full Text]

				R. L. Dalman, L. M. Taylor Jr, and J. M. Porter Current Status of Extracoronary Endovascular Procedures Perspectives in Vascular Surgery and Endovascular Therapy, January 1, 1990; 3(1): 1 - 24. [PDF]