Intimal proliferation of smooth muscle cells as an explanation for recurrent coronary artery stenosis after percutaneous transluminal coronary angioplasty

The pathologic changes in the coronary arteries of three patients who died 5, 17 and 62 days, respectively, after percutaneous transluminal coronary angioplasty were studied. Changes in the vessel wall seen early after angioplasty included focal denudation of the endothelium, splits in the intima extending to and along the inner aspect of the media, focal intimal necrosis and adventitial hemorrhage. Extensive medial dissections were seen in the coronary arteries of the two patients who died 5 and 17 days after coronary angioplasty. Fibrin was deposited on the surface of the intima, within intimal cracks and in areas of intimal and medial necrosis. Focal proliferation of smooth muscle cells was prominent on neointimal surfaces of the coronary artery from the patient who died 17 days after angioplasty. The previously dilated coronary segment from the patient who died 62 days after angioplasty was stenosed by an extensive recent proliferation of smooth muscle cells that were distributed over the entire circumference of the intimal surface as well as within gaps in the old atherosclerotic plaques. This type of intimal proliferation would appear to be responsible for the recurrent coronary artery stenosis that develops in some patients after coronary angioplasty.

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				D. Panda, G. C. Kundu, B. I. Lee, A. Peri, D. Fohl, I. Chackalaparampil, B. B. Mukherjee, X. D. Li, D. C. Mukherjee, S. Seides, et al. Potential roles of osteopontin and alpha Vbeta 3 integrin in the development of coronary artery restenosis after angioplasty PNAS, August 19, 1997; 94(17): 9308 - 9313. [Abstract] [Full Text] [PDF]

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				M. Aikawa, Y. Sakomura, M. Ueda, K. Kimura, I. Manabe, S. Ishiwata, N. Komiyama, H. Yamaguchi, Y. Yazaki, and R. Nagai Redifferentiation of Smooth Muscle Cells After Coronary Angioplasty Determined via Myosin Heavy Chain Expression Circulation, July 1, 1997; 96(1): 82 - 90. [Abstract] [Full Text]

				E. Camenzind, W. H. Bakker, A. Reijs, I. M. van Geijlswijk, E. Boersma, M. J. B. Kutryk, E. P. Krenning, J. R. T. C. Roelandt, P. W. Serruys, and P. W. Serruys Site-Specific Intracoronary Heparin Delivery in Humans After Balloon Angioplasty : A Radioisotopic Assessment of Regional Pharmacokinetics Circulation, July 1, 1997; 96(1): 154 - 165. [Abstract] [Full Text]

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				N. Klauber, F. Browne, B. Anand-Apte, and R. J. D'Amato New Activity of Spironolactone: Inhibition of Angiogenesis In Vitro and In Vivo Circulation, November 15, 1996; 94(10): 2566 - 2571. [Abstract] [Full Text]

				Y. Shi, J. E. O'Brien, A. Fard, J. D. Mannion, D. Wang, and A. Zalewski Adventitial Myofibroblasts Contribute to Neointimal Formation in Injured Porcine Coronary Arteries Circulation, October 1, 1996; 94(7): 1655 - 1664. [Abstract] [Full Text]

				E. R. Edelman and C. Rogers Hoop Dreams: Stents Without Restenosis Circulation, September 15, 1996; 94(6): 1199 - 1202. [Full Text]

				D. F. Lazarous, M. Shou, M. Scheinowitz, E. Hodge, V. Thirumurti, A. N. Kitsiou, J. A. Stiber, A. D. Lobo, S. Hunsberger, E. Guetta, et al. Comparative Effects of Basic Fibroblast Growth Factor and Vascular Endothelial Growth Factor on Coronary Collateral Development and the Arterial Response to Injury Circulation, September 1, 1996; 94(5): 1074 - 1082. [Abstract] [Full Text]

				G. S. Mintz, J. J. Popma, A. D. Pichard, K. M. Kent, L. F. Satler, S. Chiu Wong, M. K. Hong, J. A. Kovach, and M. B. Leon Arterial Remodeling After Coronary Angioplasty : A Serial Intravascular Ultrasound Study Circulation, July 1, 1996; 94(1): 35 - 43. [Abstract] [Full Text]

				Y.-Q. Chen, D. M. Gilliam, B. Rydzewski, and A. J. Naftilan Multiple Enhancer Elements Mediate Induction of c-fos in Vascular Smooth Muscle Cells Hypertension, June 1, 1996; 27(6): 1224 - 1233. [Abstract] [Full Text]

				S.-i. Ozeki, A. Ohtsuru, S. Seto, S. Takeshita, H. Yano, T. Nakayama, M. Ito, T. Yokota, M. Nobuyoshi, G. V. Segre, et al. Evidence That Implicates the Parathyroid Hormone–Related Peptide in Vascular Stenosis : Increased Gene Expression in the Intima of Injured Rat Carotid Arteries and Human Restenotic Coronary Lesions Arterioscler Thromb Vasc Biol, April 1, 1996; 16(4): 565 - 575. [Abstract] [Full Text]

				E. R. O'Brien, K. L. Bennett, M. R. Garvin, T. W. Zderic, T. Hinohara, J. B. Simpson, T. Kimura, M. Nobuyoshi, H. Mizgala, A. Purchio, et al. ßig-h3, a Transforming Growth Factor–ß–Inducible Gene, Is Overexpressed in Atherosclerotic and Restenotic Human Vascular Lesions Arterioscler Thromb Vasc Biol, April 1, 1996; 16(4): 576 - 584. [Abstract] [Full Text]

				M. Ragosta, W. L. Barry, L. W. Gimple, S. D. Gertz, K. W. McCoy, G. A. Stouffer, C. A. McNamara, E. R. Powers, G. K. Owens, and I. J. Sarembock Effect of Thrombin Inhibition With Desulfatohirudin on Early Kinetics of Cellular Proliferation After Balloon Angioplasty in Atherosclerotic Rabbits Circulation, March 15, 1996; 93(6): 1194 - 1200. [Abstract] [Full Text]

				L. A. Guzman, M. J. Mick, A. M. Arnold, F. Forudi, and P. L. Whitlow Role of Intimal Hyperplasia and Arterial Remodeling After Balloon Angioplasty : An Experimental Study in the Atherosclerotic Rabbit Model Arterioscler Thromb Vasc Biol, March 1, 1996; 16(3): 479 - 487. [Abstract] [Full Text]

				J. S. Lee, C. Adrie, H. J. Jacob, J. D. Roberts Jr, W. M. Zapol, and K. D. Bloch Chronic Inhalation of Nitric Oxide Inhibits Neointimal Formation After Balloon-Induced Arterial Injury Circ. Res., February 1, 1996; 78(2): 337 - 342. [Abstract] [Full Text]

				J. R. Laird, A. J. Carter, W. M. Kufs, T. G. Hoopes, A. Farb, S. H. Nott, R. E. Fischell, D. R. Fischell, R. Virmani, and T. A. Fischell Inhibition of Neointimal Proliferation With Low-Dose Irradiation From a ß-Particle–Emitting Stent Circulation, February 1, 1996; 93(3): 529 - 536. [Abstract] [Full Text]

				Y. Shi, M. Pieniek, A. Fard, J. O'Brien, J. D. Mannion, and A. Zalewski Adventitial Remodeling After Coronary Arterial Injury Circulation, January 15, 1996; 93(2): 340 - 348. [Abstract] [Full Text]

				R. Waksman, K. A. Robinson, I. R. Crocker, C. Wang, M. B. Gravanis, G. D. Cipolla, R. A. Hillstead, and S. B. King III Intracoronary Low-Dose ß-Irradiation Inhibits Neointima Formation After Coronary Artery Balloon Injury in the Swine Restenosis Model Circulation, November 15, 1995; 92(10): 3025 - 3031. [Abstract] [Full Text]

				E. Camenzind, P.-P. Kint, C. Di Mario, J. Ligthart, W. van der Giessen, E. Boersma, and P. W. Serruys Intracoronary Heparin Delivery in Humans : Acute Feasibility and Long-term Results Circulation, November 1, 1995; 92(9): 2463 - 2472. [Abstract] [Full Text]

				A. Lafont, L. A. Guzman, P. L. Whitlow, M. Goormastic, J. F. Cornhill, and G. M. Chisolm Restenosis After Experimental Angioplasty : Intimal, Medial, and Adventitial Changes Associated With Constrictive Remodeling Circ. Res., June 1, 1995; 76(6): 996 - 1002. [Abstract] [Full Text]

				J. M. Isner, M. Kearney, S. Bortman, and J. Passeri Apoptosis in Human Atherosclerosis and Restenosis Circulation, June 1, 1995; 91(11): 2703 - 2711. [Abstract] [Full Text]

				A. E. Villa, L. A. Guzman, E. J. Poptic, V. Labhasetwar, S. D'Souza, C. L. Farrell, E. F. Plow, R. J. Levy, P. E. DiCorleto, and E. J. Topol Effects of Antisense c-myb Oligonucleotides on Vascular Smooth Muscle Cell Proliferation and Response to Vessel Wall Injury Circ. Res., April 1, 1995; 76(4): 505 - 513. [Abstract] [Full Text]

				L. Weir, D. Chen, C. Pastore, J. M. Isner, and K. Walsh Expression of gax, a Growth Arrest Homeobox Gene, Is Rapidly Down-regulated in the Rat Carotid Artery during the Proliferative Response to Balloon Injury J. Biol. Chem., March 10, 1995; 270(10): 5457 - 5461. [Abstract] [Full Text] [PDF]

				M. R. Soma, E. Donetti, C. Parolini, C. R. Sirtori, R. Fumagalli, and G. Franceschini Recombinant Apolipoprotein A-IMilano Dimer Inhibits Carotid Intimal Thickening Induced by Perivascular Manipulation in Rabbits Circ. Res., March 1, 1995; 76(3): 405 - 411. [Abstract] [Full Text]

				S. O. Marx, T. Jayaraman, L. O. Go, and A. R. Marks Rapamycin-FKBP Inhibits Cell Cycle Regulators of Proliferation in Vascular Smooth Muscle Cells Circ. Res., March 1, 1995; 76(3): 412 - 417. [Abstract] [Full Text]

				I. Nyamekye, S. Anglin, J. McEwan, A. MacRobert, S. Bown, and C. Bishop Photodynamic Therapy of Normal and Balloon-Injured Rat Carotid Arteries Using 5-Amino-Levulinic Acid Circulation, January 15, 1995; 91(2): 417 - 425. [Abstract] [Full Text]

				M. Simons, G. Leclerc, R. D. Safian, J. M. Isner, L. Weir, and D. S. Baim Relation between Activated Smooth-Muscle Cells in Coronary-Artery Lesions and Restenosis after Atherectomy N. Engl. J. Med., March 4, 1993; 328(9): 608 - 613. [Abstract] [Full Text]

				S. R. Johansson, L. Ekstrom, and H. Emanuelsson Higher Recurrence Rate After Coronary Angioplasty in Unstable Angina Pectoris Angiology, April 1, 1991; 42(4): 273 - 280. [Abstract] [PDF]