Lumen narrowing after percutaneous transluminal coronary balloon angioplasty follows a near gaussian distribution: a quantitative angiographic study in 1,445 successfully dilated lesions

Thoraxcenter, Erasmus University, Rotterdam, The Netherlands.

To determine whether significant angiographic narrowing and restenosis after successful coronary balloon angioplasty is a specific disease entity occurring in a subset of dilated lesions or whether it is the tail end of a gaussian distributed phenomenon, 1,445 successfully dilated lesions were studied before and after coronary angioplasty and at 6-month follow-up study. The original cohort consisted of 1,353 patients of whom 1,232 underwent repeat angiography with quantitative analysis (follow-up rate 91.2%). Quantitative angiography was carried out off-line in a central core laboratory with an automated edge detection technique. Analyses were performed by analysts not involved with patient care. Distributions of minimal lumen diameter before angioplasty (1.03 +/- 0.37 mm), after angioplasty (1.78 +/- 0.36 mm) and at 6-month follow-up study (1.50 +/- 0.57 mm) as well as the percent diameter stenosis at 6-month follow-up study (44 +/- 19%) were assessed. The change in minimal lumen diameter from the post-angioplasty angiogram to the follow-up angiogram was also determined (-0.28 +/- 0.52 mm). Seventy lesions progressed toward total occlusion at follow-up. All observed distributions approximately followed a normal or gaussian distribution. Therefore, restenosis can be viewed as the tail end of an approximately gaussian distributed phenomenon, with some lesions crossing a more or less arbitrary cutoff point, rather than as a separate disease entity occurring in some lesions but not in others.

This article has been cited by other articles:

				R A Byrne, S Eberle, A Kastrati, A Dibra, G Ndrepepa, R Iijima, J Mehilli, and A Schomig Distribution of angiographic measures of restenosis after drug-eluting stent implantation Heart, October 1, 2009; 95(19): 1572 - 1578. [Abstract] [Full Text] [PDF]

				M. Amato, P. Montorsi, A. Ravani, E. Oldani, S. Galli, P. M. Ravagnani, E. Tremoli, and D. Baldassarre Carotid intima-media thickness by B-mode ultrasound as surrogate of coronary atherosclerosis: correlation with quantitative coronary angiography and coronary intravascular ultrasound findings Eur. Heart J., September 1, 2007; 28(17): 2094 - 2101. [Abstract] [Full Text] [PDF]

				D. J. Kereiakes, R. E. Kuntz, L. Mauri, and M. W. Krucoff Surrogates, substudies, and real clinical end points in trials of drug-eluting stents J. Am. Coll. Cardiol., April 19, 2005; 45(8): 1206 - 1212. [Full Text] [PDF]

				L. Mauri, E. J. Orav, A. J. O'Malley, J. W. Moses, M. B. Leon, D. R. Holmes Jr, P. S. Teirstein, J. Schofer, G. Breithardt, D. E. Cutlip, et al. Relationship of Late Loss in Lumen Diameter to Coronary Restenosis in Sirolimus-Eluting Stents Circulation, January 25, 2005; 111(3): 321 - 327. [Abstract] [Full Text] [PDF]

				S. V. Dee and H. Samady Evolving Strategies for the Prevention and Treatment of Coronary Restenosis Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2003; 7(3): 281 - 293. [Abstract] [PDF]

				Y Otsuka, S Miyazaki, H Okumura, S Yasuda, S Daikoku, I Morii, Y Sutani, Y Goto, and H Nonogi Abnormal glucose tolerance, not small vessel diameter, is a determinant of long-term prognosis in patients treated with balloon coronary angioplasty Eur. Heart J., November 1, 2000; 21(21): 1790 - 1796. [Abstract] [PDF]

				M. Sabate, M. A. Costa, K. Kozuma, I. P. Kay, C. J. van der Wiel, V. Verin, W. Wijns, P. W. Serruys, and on behalf of the Dose Finding Study Group Methodological and clinical implications of the relocation of the minimal luminal diameter after intracoronary radiation therapy J. Am. Coll. Cardiol., November 1, 2000; 36(5): 1536 - 1541. [Abstract] [Full Text] [PDF]

				B. Jorgensen, S. Simonsen, K. Endresen, K. Forfang, K. Vatne, J. Hansen, J. Webb, C. Buller, G. Goulet, J. Erikssen, et al. Restenosis and clinical outcome in patients treated with amlodipine after angioplasty: results from the coronary AngioPlasty Amlodipine REStenosis Study (CAPARES) J. Am. Coll. Cardiol., March 1, 2000; 35(3): 592 - 599. [Abstract] [Full Text] [PDF]

				A. Betriu, M. Masotti, A. Serra, J. Alonso, F. Fernandez-Aviles, F. Gimeno, T. Colman, J. Zueco, J. L. Delcan, E. Garcia, et al. Randomized comparison of coronary stent implantation and balloon angioplasty in the treatment of de novo coronary artery lesions (START): A four-year follow-up J. Am. Coll. Cardiol., November 1, 1999; 34(5): 1498 - 1506. [Abstract] [Full Text] [PDF]

				B Jorgensen, S Simonsen, K Endresen, K Forfang, T Egeland, A.T Hostmark, and E Thaulow Luminal loss and restenosis after coronary angioplasty. The role of lipoproteins and lipids Eur. Heart J., October 1, 1999; 20(19): 1407 - 1414. [Abstract] [PDF]

				E. Van Belle, K. Abolmaali, C. Bauters, E. P. McFadden, J.-M. Lablanche, and M. E. Bertrand Restenosis, late vessel occlusion and left ventricular function six months after balloon angioplasty in diabetic patients J. Am. Coll. Cardiol., August 1, 1999; 34(2): 476 - 485. [Abstract] [Full Text] [PDF]

				A. Schomig, A. Kastrati, S. Elezi, H. Schuhlen, J. Dirschinger, F. Dannegger, M. Wilhelm, and K. Ulm Bimodal Distribution of Angiographic Measures of Restenosis Six Months After Coronary Stent Placement Circulation, December 2, 1997; 96(11): 3880 - 3887. [Abstract] [Full Text]

				J. P. Carrozza Jr and D. S. Baim Keeping the Open Artery Open : Is Stenting the Answer? Circulation, November 4, 1997; 96(9): 2762 - 2764. [Full Text]

				C. Bauters, J.-M. Lablanche, E. Van Belle, R. Niculescu, T. Meurice, E. P. Mc Fadden, and M. E. Bertrand Effects of Coronary Stenting on Restenosis and Occlusion After Angioplasty of the Culprit Vessel in Patients With Recent Myocardial Infarction Circulation, November 4, 1997; 96(9): 2854 - 2858. [Abstract] [Full Text]

				L. I. Heller, C. Cates, J. Popma, L. I. Deckelbaum, J. D. Joye, S. T. Dahlberg, B. J. Villegas, A. Arnold, R. Kipperman, W. C. Grinstead, et al. Intracoronary Doppler Assessment of Moderate Coronary Artery Disease : Comparison With 201Tl Imaging and Coronary Angiography Circulation, July 15, 1997; 96(2): 484 - 490. [Abstract] [Full Text]

				G. W. Stone, J. M. Hodgson, F. G. St Goar, A. Frey, H. Mudra, H. Sheehan, and T. J. Linnemeier Improved Procedural Results of Coronary Angioplasty With Intravascular Ultrasound–Guided Balloon Sizing : The CLOUT Pilot Trial Circulation, April 15, 1997; 95(8): 2044 - 2052. [Abstract] [Full Text]

				J.-M. Lablanche, G. Grollier, J.-R. Lusson, J.-P. Bassand, G. Drobinski, B. Bertrand, S. Battaglia, B. Desveaux, Y. Juilliere, J.-M. Juliard, et al. Effect of the Direct Nitric Oxide Donors Linsidomine and Molsidomine on Angiographic Restenosis After Coronary Balloon Angioplasty: The ACCORD Study Circulation, January 7, 1997; 95(1): 83 - 89. [Abstract] [Full Text]

				K. G. Lehmann, R. Melkert, and P. W. Serruys Contributions of Frequency Distribution Analysis to the Understanding of Coronary Restenosis : A Reappraisal of the Gaussian Curve Circulation, March 15, 1996; 93(6): 1123 - 1132. [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]

				M. Hamon, C. Bauters, C. Amant, E. P. McFadden, N. Helbecque, J.-M. Lablanche, M. E. Bertrand, and P. Amouyel Relation Between the Deletion Polymorphism of the Angiotensin-Converting Enzyme Gene and Late Luminal Narrowing After Coronary Angioplasty Circulation, August 1, 1995; 92(3): 296 - 299. [Abstract] [Full Text]

				B. De Bruyne, J. Bartunek, S. U. Sys, and G. R. Heyndrickx Relation Between Myocardial Fractional Flow Reserve Calculated From Coronary Pressure Measurements and Exercise-Induced Myocardial Ischemia Circulation, July 1, 1995; 92(1): 39 - 46. [Abstract] [Full Text]

				D. Keane, J. Haase, C. J. Slager, E. M. van Swijndregt, K. G. Lehmann, Y. Ozaki, C. di Mario, R. Kirkeeide, and P. W. Serruys Comparative Validation of Quantitative Coronary Angiography Systems : Results and Implications From a Multicenter Study Using a Standardized Approach Circulation, April 15, 1995; 91(8): 2174 - 2183. [Abstract] [Full Text]

				C. Bauters, P. Khanoyan, E. P. Mc Fadden, P. Quandalle, J.-M. Lablanche, and M. E. Bertrand Restenosis After Delayed Coronary Angioplasty of the Culprit Vessel in Patients With a Recent Myocardial Infarction Treated by Thrombolysis Circulation, March 1, 1995; 91(5): 1410 - 1418. [Abstract] [Full Text]

				R. D. Safian, R. M. Abel, E. J. Topol, S. G. Ellis, R. M. Califf, E. A. Cohen, and J. A. Bittl Coronary Atherectomy versus Angioplasty N. Engl. J. Med., December 16, 1993; 329(25): 1891 - 1893. [Full Text]

				E. J. Topol, F. Leya, C. A. Pinkerton, P. L. Whitlow, B. Hofling, C. A. Simonton, R. R. Masden, P. W. Serruys, M. B. Leon, D. O. Williams, et al. A Comparison of Directional Atherectomy with Coronary Angioplasty in Patients with Coronary Artery Disease N. Engl. J. Med., July 22, 1993; 329(4): 221 - 227. [Abstract] [Full Text]

				A. G. Adelman, E. A. Cohen, B. P. Kimball, R. Bonan, D. R. Ricci, J. G. Webb, L. Laramee, G. Barbeau, M. Traboulsi, B. N. Corbett, et al. A Comparison of Directional Atherectomy with Balloon Angioplasty for Lesions of the Left Anterior Descending Coronary Artery N. Engl. J. Med., July 22, 1993; 329(4): 228 - 233. [Abstract] [Full Text]