Restenosis and the proportional neointimal response to coronary artery injury: results in a porcine model

Division of Cardiovascular Diseases, Mayo Graduate School of Medicine, Mayo Clinic and Foundation, Rochester, Minnesota 55905.

Restenosis is a reparative response to arterial injury occurring with percutaneous coronary revascularization. However, the quantitative characteristics of the relation between vessel injury and the magnitude of restenotic response remain unknown. This study was thus performed to determine the relation between severity of vessel wall injury and the thickness of resulting neointimal proliferation in a porcine model of coronary restenosis. Twenty-six porcine coronary artery segments in 24 pigs were subjected to deep arterial injury with use of overexpanded, percutaneously delivered tantalum wire coils. The vessels were studied microscopically 4 weeks after coil implantation to measure the relation between the extent of injury and the resulting neointimal thickness. For each wire site, a histopathologic score proportional to injury depth and the neointimal thicknesses at that site were determined. Mean injury scores were compared with both mean neointimal thickness and planimetry-derived area percent lumen stenosis. The severity of vessel injury strongly correlated with neointimal thickness and percent diameter stenosis (p less than 0.001). Neointimal proliferation resulting from a given wire was related to injury severity in adjacent wires, suggesting an interaction among effects at injured sites. If the results in this model apply to human coronary arteries, restenosis may depend on the degree of vessel injury sustained during angioplasty.

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				H. De Leon, J. D. Ollerenshaw, K. K. Griendling, and J. N. Wilcox Adventitial Cells Do Not Contribute to Neointimal Mass After Balloon Angioplasty of the Rat Common Carotid Artery Circulation, October 2, 2001; 104(14): 1591 - 1593. [Abstract] [Full Text] [PDF]

				L. M. Work, A. R. McPhaden, N. J. Pyne, S. Pyne, R. M. Wadsworth, and C. L. Wainwright Short-Term Local Delivery of an Inhibitor of Ras Farnesyltransferase Prevents Neointima Formation In Vivo After Porcine Coronary Balloon Angioplasty Circulation, September 25, 2001; 104(13): 1538 - 1543. [Abstract] [Full Text] [PDF]

				H. Mudra, C. di Mario, P. de Jaegere, H. R. Figulla, C. Macaya, R. Zahn, B. Wennerblom, W. Rutsch, V. Voudris, E. Regar, et al. Randomized Comparison of Coronary Stent Implantation Under Ultrasound or Angiographic Guidance to Reduce Stent Restenosis (OPTICUS Study) Circulation, September 18, 2001; 104(12): 1343 - 1349. [Abstract] [Full Text] [PDF]

				S. Windecker, I. Mayer, G. De Pasquale, W. Maier, O. Dirsch, P. De Groot, Y.-P. Wu, G. Noll, B. Leskosek, B. Meier, et al. Stent Coating With Titanium-Nitride-Oxide for Reduction of Neointimal Hyperplasia Circulation, August 21, 2001; 104(8): 928 - 933. [Abstract] [Full Text] [PDF]

				G. Tepe, L. M. Dinkelborg, U. Brehme, P. Muschick, B. Noll, T. Dietrich, A. Greschniok, A. Baumbach, C. D. Claussen, and S. H. Duda Prophylaxis of Restenosis With 186Re-Labeled Stents in a Rabbit Model Circulation, August 6, 2001; 104(4): 480 - 485. [Abstract] [Full Text] [PDF]

				G. Sianos, I. P. Kay, M. A. Costa, E. Regar, K. Kozuma, P. J. de Feyter, E. Boersma, C. Disco, and P. W. Serruys Geographical miss during catheter-based intracoronary beta-radiation: incidence and implications in the BRIE study J. Am. Coll. Cardiol., August 1, 2001; 38(2): 415 - 420. [Abstract] [Full Text] [PDF]

				A. Bayes-Genis, A. R. Camrud, M. Jorgenson, J. Donovan, K. L. Shogren, D. R. Holmes Jr, and R. S. Schwartz Pressure rinsing of coronary stents immediately before implantation reduces inflammation and neointimal hyperplasia J. Am. Coll. Cardiol., August 1, 2001; 38(2): 562 - 568. [Abstract] [Full Text] [PDF]

				M Albertal, G Van Langenhove, E Regar, I P Kay, D Foley, G Sianos, K Kozuma, T Beijsterveldt, S G Carlier, J A Belardi, et al. Uncomplicated moderate coronary artery dissections after balloon angioplasty: good outcome without stenting Heart, August 1, 2001; 86(2): 193 - 198. [Abstract] [Full Text] [PDF]

				A. Farb, P. F. Heller, S. Shroff, L. Cheng, F. D. Kolodgie, A. J. Carter, D. S. Scott, J. Froehlich, and R. Virmani Pathological Analysis of Local Delivery of Paclitaxel Via a Polymer-Coated Stent Circulation, July 24, 2001; 104(4): 473 - 479. [Abstract] [Full Text] [PDF]

				A. W. Heldman, L. Cheng, G. M. Jenkins, P. F. Heller, D.-W. Kim, M. Ware Jr, C. Nater, R. H. Hruban, B. Rezai, B. S. Abella, et al. Paclitaxel Stent Coating Inhibits Neointimal Hyperplasia at 4 Weeks in a Porcine Model of Coronary Restenosis Circulation, May 8, 2001; 103(18): 2289 - 2295. [Abstract] [Full Text] [PDF]

				W. R. Huckle, M. D. Drag, W. R. Acker, M. Powers, R. C. McFall, D. J. Holder, T. F. Walsh, R. S. Schwartz, W. J. Greenlee, and R. G. Johnson Jr Effects of L-749,329, an ETA/ETB Endothelin Receptor Antagonist, in a Porcine Coronary Artery Injury Model of Vascular Restenosis Circulation, April 10, 2001; 103(14): 1899 - 1905. [Abstract] [Full Text] [PDF]

				M.A Costa, L.E.A de Wit, V de Valk, P Serrano, A.J Wardeh, P.W Serruys, and W Sluiter Indirect evidence for a role of a subpopulation of activated neutrophils in the remodelling process after percutaneous coronary intervention Eur. Heart J., April 1, 2001; 22(7): 580 - 586. [Abstract] [PDF]

				Y. Kobayashi, Y. Honda, L. G. Christie, P. S. Teirstein, S. R. Bailey, C. L. Brown III, R. V. Matthews, A. C. De Franco, R. S. Schwartz, S. Goldberg, et al. Long-term vessel response to a self-expanding coronary stent: a serial volumetric intravascular ultrasound analysis from the ASSURE trial J. Am. Coll. Cardiol., April 1, 2001; 37(5): 1329 - 1334. [Abstract] [Full Text] [PDF]

				A. Bayes-Genis, R. S. Schwartz, D. A. Lewis, M. T. Overgaard, M. Christiansen, C. Oxvig, K. Ashai, D. R. Holmes Jr, and C. A. Conover Insulin-Like Growth Factor Binding Protein-4 Protease Produced by Smooth Muscle Cells Increases in the Coronary Artery After Angioplasty Arterioscler Thromb Vasc Biol, March 1, 2001; 21(3): 335 - 341. [Abstract] [Full Text] [PDF]

				C. Napoli, G. Cirino, P. Del Soldato, R. Sorrentino, V. Sica, M. Condorelli, A. Pinto, and L. J. Ignarro Effects of nitric oxide-releasing aspirin versus aspirin on restenosis in hypercholesterolemic mice PNAS, February 27, 2001; 98(5): 2860 - 2864. [Abstract] [Full Text] [PDF]

				M. Fenton, S. Barker, D. J. Kurz, and J. D. Erusalimsky Cellular Senescence After Single and Repeated Balloon Catheter Denudations of Rabbit Carotid Arteries Arterioscler Thromb Vasc Biol, February 1, 2001; 21(2): 220 - 226. [Abstract] [Full Text] [PDF]

				E. R. Edelman, P. Seifert, A. Groothuis, A. Morss, D. Bornstein, and C. Rogers Gold-Coated NIR Stents in Porcine Coronary Arteries Circulation, January 23, 2001; 103(3): 429 - 434. [Abstract] [Full Text] [PDF]

				C Hehrlein, A Kovacs, G.K Wolf, N Yue, and R Nath A novel balloon angioplasty catheter impregnated with beta-particle emitting radioisotopes for vascular brachytherapy to prevent restenosis. First in vivo results Eur. Heart J., December 2, 2000; 21(24): 2056 - 2062. [Abstract] [PDF]

				M. Roque, E. D. Reis, V. Fuster, A. Padurean, J. T. Fallon, M. B. Taubman, J. H. Chesebro, and J. J. Badimon Inhibition of tissue factor reduces thrombus formation and intimal hyperplasia after porcine coronary angioplasty J. Am. Coll. Cardiol., December 1, 2000; 36(7): 2303 - 2310. [Abstract] [Full Text] [PDF]

				D. E. Drachman, E. R. Edelman, P. Seifert, A. R. Groothuis, D. A. Bornstein, K. R. Kamath, M. Palasis, D. Yang, S. H. Nott, and C. Rogers Neointimal thickening after stent delivery of paclitaxel: change in composition and arrest of growth over six months J. Am. Coll. Cardiol., December 1, 2000; 36(7): 2325 - 2332. [Abstract] [Full Text] [PDF]