Prolonged application of pressure in transluminal coronary angioplasty

Kaltenbach, M.; Beyer, J; Walter, Stefanie; Klepzig, H; Schmidts, Ludwig

doi:10.1002/ccd.1810100305

Cited by 102 publications

(14 citation statements)

References 8 publications

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“…23 The tests suggested two important characteristics of the mechanical behavior of atherosclerotic plaque: 1) they exhibit compositiondependent mechanical behavior, and 2) they exhibit time-dependent behavior when subjected to a constant mechanical compressive load (e.g., creep).…”

Section: Introductionmentioning

confidence: 99%

Composition- and history-dependent radial compressive behavior of human atherosclerotic plaque

Topoleski

Salunke

Humphrey

et al. 1997

J. Biomed. Mater. Res.

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Invasive procedures to revascularize occluded blood vessels rely on the mechanical response of the diseased tissue. Failure rates associated with such procedures show the need for improvement. to understand the associated mechanics, the material properties of atherosclerotic plaque should be known; yet data are scant. The purpose of this study was to investigate the different mechanical responses exhibited by plaques with different compositions, focusing specifically on radial compressive behavior. A custom-built experimental system was developed that was fully computer controlled with a broad range of loading capabilities. A temperature-controlled, physiologic specimen bath allowed testing at 37 degrees C. Monotonically loaded specimens showed that plaque behavior was nonlinear under finite deformations. A multiple cycle protocol, executed in two phases, distinguished three types of mechanical response of different plaques. The differences in behavior were associated with histologic differences in plaque composition, and mechanically characterized by different "repeatability" (the stabilization of the cyclic response) and "recoverability" (the second loading phase retracing the first loading phase behavior). Type 1 behavior was categorized by repeatability and recoverability. Type 2 behavior displayed repeatability but only partial recovery during the second loading phase. Recovery was absent in type 3 behavior. The histologic observations demonstrated that calcified tissue was present only in specimens displaying type 1 behavior. Fibrous tissue and part of a modified media (due to disease) were present in specimens displaying type 2 behavior. An atheroma, along with a relatively thin modified media, was present in specimens displaying type 3 behavior. The differences in the maximum stretches attained at the end of phase I loading, the stretch offset from the first to the 15th cycle of phase I loading, and the hysteresis in the first and 15th cycles of phase I loading distinguished the specimen behaviors with statistical significance. These compression data showed that plaques exhibit composition- and history-dependent nonlinear and inelastic responses under finite deformations.

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Section: Introductionmentioning

confidence: 99%

Composition- and history-dependent radial compressive behavior of human atherosclerotic plaque

Topoleski

Salunke

Humphrey

et al. 1997

J. Biomed. Mater. Res.

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“…Theoretical advantages of more prolonged inflation periods, for which there is some experimental and clinical support, include improved initial angiographic results and lower restenosis rates. [1][2][3] Autoperfusion balloon catheters, which allow continued passive myocardial perfusion during periods of balloon inflation, provide us with the means potentially to achieve this goal. Previous studies with similar catheters have demonstated adequate Supported by Grant HL-37608 from the National Institutes of Health.…”

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confidence: 99%

Myocardial protection during coronary angioplasty with an autoperfusion balloon catheter in humans.

et al. 1988

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An autoperfusion balloon catheter was developed to allow passive myocardial perfusion during inflation through a central lumen and multiple side holes in the shaft proximal and distal to the balloon. We report its safety and efficacy in 11 patients undergoing elective angioplasty to a single coronary lesion. Each lesion was dilated three times with the autoperfusion inflation bracketed between two inflations by standard angioplasty catheters. Chest pain score, 12-lead electrocardiogram, heart rate, and mean aortic pressure were recorded before each inflation and at 1-minute intervals after inflation. Inflation duration during autoperfusion angioplasty (513+± 303 seconds) was longer than for the pre-(107+±-55 seconds, p=0.0004) and post-(139+± 71 seconds, p=0.0006) standard dilatations. The maximum ST-segment elevation and depression in any lead during autoperfusion angioplasty (0.3 0.5 and 0.6 0.8 mm) was significantly less than for the pre-(2.4± 1.7 mm, p=0.002 and 2.2± 1.3 mm, p=0.0004) or post-(1.9 + 1.3 mm, p = 0.002 and 1.6±+1.3 mm, p= 0.018) standard dilatations at the same point in time. Maximal chest pain score during autoperfusion (3.2-+ 3.5) was lower than for the pre-(6.1 2. 1, p=0.003) but not the post-(5.2 3.1, p=0.07) standard angioplasty. All 11 patients underwent successful, uncomplicated procedures. We conclude that this autoperfusion catheter significantly reduces ischemic symptoms and signs during coronary angioplasty, allowing prolonged periods of balloon inflation. (Circulation 1988;78:1128-1134 M a aximum duration of balloon inflation during conventional percutaneous transluminal coronary angioplasty is usually short (30-60 seconds) because it is limited by the development of symptoms and signs of myocardial ischemia. Theoretical advantages of more prolonged inflation periods, for which there is some experimental and clinical support, include improved initial angiographic results and lower restenosis rates.1-3 Autoperfusion balloon catheters, which allow continued passive myocardial perfusion during periods of balloon inflation, provide us with the means potentially to achieve this goal. Previous studies with similar catheters have demonstated adequate From the Interventional Cardiac Catheterization Program,

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“…In a preliminary report in human postmortem coronary arteries, the duration of balloon inflation was found to be an important factor in vessel diameter enlargement. 13 Other factors, such as the pressure or volume of balloon inflation as well as the elasticity of the vessel wall, obviously play a role. If the vesssel wall is compliant, lumen enlargement with stretching of the vessel wall and aneurysm formation result.…”

Section: Discussionmentioning

confidence: 99%

The mechanism of transluminal angioplasty: evidence for formation of aneurysms in experimental atherosclerosis.

Sanborn¹,

Faxon²,

Haudenschild³

et al. 1983

Circulation

173

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Quantitative histologic examination (morphometric analysis) of pressure-perfused rabbit atherosclerotic arteries was used to determine whether compression of atheromatous material occurs with transluminal angioplasty. Experimental atherosclerosis was developed in both iliac arteries, with transluminal angioplasty performed on the left iliac while the right iliac served as a nondilated control. Angiography showed equal degrees of luminal narrowing before angioplasty (p = NS). Angioplasty reduced the left iliac narrowing in all animals studied. Morphometric analysis of histologic sections of the left and right iliac arteries disclosed significant differences in luminal and total vessel areas (p < .05), whereas arterial wall (intima and media) areas were similar (p = NS). Dilated areas often demonstrated marked intimal splitting with dissection into the media. At higher magnification, loss of nuclear staining and dense layers of extracellular matrix consistent with stretching were frequently seen. It is concluded that the major mechanism of successful transluminal angioplasty is stretching of the vessel, resulting in localized aneurysm formation. Intimal splitting implies inelasticity of the neointima. No evidence of compression and remodeling of atheromatous material was disclosed in this study. Circulation 68, No. 5, 1136No. 5, -1140No. 5, , 1983 THE MECHANISM by which transluminal angioplasty dilates obstructive atherosclerotic lesions is not completely understood. Originally, it was proposed that the procedure remodeled the atheromatous material in the arterial wall by compressing it into a smaller volume,' with release of its fluid constituents.4 More recently, human postmortem57 and in vivo animal studies7'-0 investigating the histopathologic effects of transluminal angioplasty suggest an alternative mechanism of intimal splitting, dissection, and stretching rather than compression. In the present study, quantitative analysis of morphologic sections of pressureperfused dilated and control segments of rabbit iliac atherosclerotic lesions are compared to determine whether compression of the lesion or formation of aneurysm represents the mechanism of successful angioplasty.

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Prolonged application of pressure in transluminal coronary angioplasty

Cited by 102 publications

References 8 publications

Composition- and history-dependent radial compressive behavior of human atherosclerotic plaque

Composition- and history-dependent radial compressive behavior of human atherosclerotic plaque

Myocardial protection during coronary angioplasty with an autoperfusion balloon catheter in humans.

The mechanism of transluminal angioplasty: evidence for formation of aneurysms in experimental atherosclerosis.

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