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CORONARY ARTERY DISEASE

Increased intimal apoptosis in coronary atherosclerotic vessel segments lacking compensatory enlargement

^a Department of Cardiology, University of Vienna, Vienna, Austria
^b Department of Pathology, University of Vienna, Vienna, Austria

Manuscript received December 20, 1999; revised manuscript received May 15, 2001, accepted July 11, 2001.

^* Reprint requests and correspondence: Dr. Irene M. Lang, Division of Cardiology, Allgemeines Krankenhaus, University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
irene.lang{at}univie.ac.at

OBJECTIVES

In a histopathologic study, we assessed the balance of cell proliferation and apoptosis by counting the number of apoptotic and proliferating cell nuclear antigen-positive cells in freshly harvested atherectomy specimens from 34 patients.

BACKGROUND

Remodeling of human coronary arteries is an adaptive process that alters vascular lumen size.

METHODS

Intravascular ultrasound was performed prior to atherectomy. Total vessel area (area within the external elastic lamina [EEL]), lumen area and plaque area were measured at the region of interest (ROI), and at a proximal and distal reference segment, utilizing the formula . Positive arterial remodeling (R+) resulting in luminal expansion was defined as EEL >10%. Absence of remodeling (0 < EEL <10%) and constrictive arterial remodeling (EEL <0) were considered as neutral remodeling (R0) and negative remodeling (R–), respectively.

RESULTS

In R– lesions, apoptotic indices (APO) were significantly elevated (17.17 ± 2.19%) compared with R+ lesions (4.89 ± 1.7%; p = 0.0007). In a rabbit iliac percutaneous transluminal coronary angioplasty model intimal apoptosis was increased four weeks after balloon angioplasty injury (APO 8.8 ± 0.03%) compared with contralateral untreated segments (APO 3.0 ± 0.04%, n = 6). Lesions with an EEL/intimal area <3.0 showed significantly more intimal apoptosis than untreated lesions (p = 0.02).

CONCLUSIONS

The data indicate that constrictive remodeling of atherosclerotic coronary lesions is associated with increased apoptosis of intimal cells. We speculate that increased apoptosis is due to extensive plaque healing after episodes of symptomatic or asymptomatic plaque rupture.

Abbreviations and Acronyms   APO = apoptotic indices   DCA = directional coronary atherectomy   EEL = external elastic lamina   IVUS = intravascular ultrasound   LA = lumen area   m = mean   QCA = quantitative coronary angiography   ROI = region of interest   PA = plaque area   PBS = phosphate-buffered saline   PCNA = proliferating cell nuclear antigen   px = proximal reference segment   TUNEL = TdT-mediated dUTP biotin nick end labeling

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