Circulation, Vol 82, 1790-1801, Copyright © 1990 by American Heart Association
PJ La Veau, IJ Sarembock, SL Sigal, TL Yang and MD Ezekowitz
Alterations in vessel wall reactivity (VR) at or adjacent to the dilation
site after balloon angioplasty (BA) may vary according to the inflation
protocol and the time after angioplasty and may influence outcome. In 64
atherosclerotic rabbit femoral arteries, we evaluated VR after BA with
intravenous ergonovine (ERGO) (40 micrograms/min for 5 minutes) and
intra-arterial nitroglycerin (NTG) (2,500 micrograms single bolus) 24-72
hours and 28 days after BA. Comparisons were made with atherosclerotic,
nonangioplastied, age-matched controls. BA was standardized to three
1-minute inflations, each 1 minute apart. For each balloon size, 2.5-
(appropriate size) or 3.0-mm (oversized) vessels were allocated to either 5
or 10 atm inflation pressure. For the analysis, four groups were compared:
Group 1, 3.0/5; group 2, 3.0/10; group 3, 2.5/5, and group 4, 2.5 mm/10
atm. Angiographic diameters were measured at, proximal, and distal to the
lesion at baseline, 10 minutes after ERGO, and 5 minutes after NTG.
Angiograms were measured with electronic calipers by two blinded observers.
All segments of control vessels vasoconstricted to ERGO and vasodilated to
NTG (p less than 0.05 versus baseline), indicating a normal response. At
24-72 hours after dilatation, the angioplasty sites for all inflation
pressure/balloon size combinations were not responsive to either ERGO or
NTG. All segments distal to the dilatation sites vasoconstricted to ERGO
and dilated to NTG (p less than 0.05 versus baseline), indicating a normal
response. Proximal segments of vessels dilated with a 2.5-mm balloon
(appropriate size) responded positively to both stimuli (p less than 0.05).
Those vessels dilated with a large balloon (3.0 mm) were nonreactive in the
segment proximal to the angioplasty site. Twenty-eight days later
angioplasty sites dilated with a 2.5-mm balloon (appropriately sized)
regained reactivity; however, segments dilated with a large balloon (3.0
mm) remained unresponsive. All proximal segments, including those from
vessels dilated with a large balloon, reacted positively. All distal
segments reacted appropriately. Restenosis rates were not different between
the over- and appropriately sized balloon groups. These data demonstrate
that immediately after angioplasty, vessels lose reactivity at the
dilatation site. Those vessels dilated with the smaller-size balloon (2.5
mm) regained reactivity. For large balloons, reactivity is not regained at
28 days. For segments proximal to the site of dilatation, transient loss of
reactivity is seen only when a large balloon is used. Thus, acute closure
originating at the site of dilatation is not a result of spasm.(ABSTRACT
TRUNCATED AT 400 WORDS)
ARTICLES
Vascular reactivity after balloon angioplasty in an atherosclerotic rabbit
Department of Medicine, Yale University School of Medicine, New Haven, Conn. 06510.
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