Arterial responses to balloon coronary angioplasty: an intravascular ultrasound study

Department of Medicine, Washington Hospital Center, Washington, D.C. 20010.

OBJECTIVES: The purpose of this study was to examine the coronary artery response to percutaneous transluminal coronary angioplasty by using intravascular ultrasound. BACKGROUND. The immediate effects of coronary angioplasty on arterial wall geometry and surface appearance are understood poorly. Most of the available data are derived from small necropsy series, inferred from animal models or extrapolated from in vitro studies. High frequency intravascular ultrasound provides transmural images of coronary arteries in vivo. METHODS. We used intravascular ultrasound to study 29 patients before or after, or both, successful coronary angioplasty. RESULTS. The angiographic diameter narrowing was 72 +/- 13% before and improved to 19 +/- 11% after angioplasty. Calcium was visualized in 7 (24%) of the 29 angioplasty sites by fluoroscopy versus 15 (52%) of sites by intravascular ultrasound (p = 0.022). Arterial dissection after angioplasty was observed in 8 (27%) of cases by contrast angiography versus 24 (83%) by intravascular ultrasound (p less than 0.001). Intravascular ultrasound detected extensive dissection at the angioplasty site in 11 (73%) of the 15 calcified plaques and in only 3 (21%) of the 14 noncalcified plaques (p = 0.024). Arterial expansion (defined as the area within the external elastic membrane at the angioplasty site greater than that of the proximal reference segment) occurred in 29% of calcified plaques compared with 86% of noncalcified plaques (p = 0.007). CONCLUSIONS. Intravascular ultrasound is more sensitive than angiography for identifying arterial calcium and dissection at the site of angioplasty. At the site of angioplasty, arterial dissection occurred more frequently in calcified plaques whereas arterial expansion occurred more frequently in noncalcified plaques. Successful angioplasty causes a continuum of arterial responses that vary importantly with plaque composition.

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