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Vascular remodeling and the local delivery of cytochalasin B after coronary angioplasty in humans

Kenneth G. Lehmann, MD, FACC^{* b}, Jeffrey J. Popma, MD, FACC^{* b}, Jeffrey A. Werner, MD, FACC^{* b}, Alexandra J. Lansky, MD^{* b} and Robert L. Wilensky, MD, FACC^{* b}

^* Division of Cardiology, University of Washington School of Medicine, Veterans Affairs Puget Sound Health Care System and Providence Health Group, Seattle, Washington, USA
^b the Washington Hospital Center, Washington, DC, USA
University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA

View larger version (29K): [in a new window]   Figure 1 Delivery rate to angioplasty site during infusion of cytochalasin B/placebo, shown individually for each patient.

View larger version (12K): [in a new window]   Figure 2 Scatter plot demonstrating the relation between the drug delivery rate and the relative size of the infusion balloon, expressed as a ratio of its diameter to the MLD of the stenosis after balloon angioplasty. Solid circles represent the observed delivery rates; the line represents the results of multiple linear regression; and the open circles represent the predicted rates based on the multivariate model. Note the low correlation coefficient (r = 0.068) and the poor correspondence between observed and predicted values.

View larger version (19K): [in a new window]   Figure 3 The frequency and severity of angiographic dissections observed immediately after balloon angioplasty and immediately after local drug delivery. The letters A through F denote progressive grades of severity, with the corresponding boxes representing the number of patients with dissections in each grade. The width of each interconnecting line is proportional to the number of patients involved. One patient was excluded from this blinded analysis because his cineangiographic film was not available.

View larger version (131K): [in a new window]   Figure 4 Example of an asymptomatic angiographic "aneurysm" observed on the four- to six-week follow-up (f/u) study that was not present either before balloon angioplasty (pre) or immediately after local drug/placebo delivery (post). The thin arrows denote the site of the stenosis; the thick arrow indicates the aneurysm.