From the Department of Cardiology, Koshigaya Hospital, Dokkyo University
School of Medicine, Saitama, Japan.
Correspondence to Teruo Inoue, MD, Department of Cardiology, Koshigaya Hospital, Dokkyo University School of Medicine, 2–1-50 Minamikoshigaya, Koshigaya City, Saitama 343–8555, Japan.
Background—The Cutting Balloon is a
novel dilatation catheter for coronary angioplasty
(InterVentional Technologies Inc). It produces longitudinal,
microsurgical incisions in the vessel wall before the actual
dilatation. It is assumed that these controlled surgical incisions
relieve hoop stress and reduce vessel wall injury and eventually
restenosis. However, no clinical indicator to support the
theory of reduced injury has been described. Certain clusters of
differentiation (eg, CD11, CD18 on the leukocytes) are implicated in
leukocyte adhesion, increased permeability, and opsonization.
Therefore, they might serve as clinical indicators of the injury level
of the vessels after angioplasty.
Methods and Results—We randomly selected 64 patients with
isolated left anterior descending coronary artery disease for
either Cutting Balloon angioplasty or conventional balloon angioplasty.
The expression of CD18 and CD11b on the surface of neutrophils was
determined by flow cytometric analysis. Serum levels of soluble
intercellular adhesion molecule-1 (sICAM-1) were also measured. The
expression of both the CD18 and CD11b in the coronary sinus
blood gradually increased and reached its maximum at 48 hours after
angioplasty. The sICAM-1 levels in the coronary sinus serum
also increased after angioplasty. Percentage increases of CD18 and
CD11b expression and the increase of the sICAM-1 levels at 48 hours
after angioplasty (as ratios to baseline values before angioplasty)
were less in the Cutting Balloon angioplasty group than in the
conventional balloon angioplasty group (CD18, 1.10±0.05 versus
1.31±0.05, P<0.05; CD11b, 1.23±0.06 versus
1.72±0.10, P<0.001; sICAM-1, 1.12±0.05 versus
1.25±0.02, P<0.05). In all patients, the late lumen
loss at follow-up angiogram positively correlated with the increased
levels of CD11b (R=0.59, P<0.001) and
sICAM-1 (R=0.38, P<0.05) at 48 hours
after angioplasty.
Conclusions—Balloon angioplasty upregulated Mac-1 (CD11b/CD18) on
the surface of the neutrophils and increased sICAM-1 levels in
association with late loss increase. These changes were significantly
smaller in the Cutting Balloon angioplasty group than in the
conventional balloon angioplasty group. This suggests that Cutting
Balloon angioplasty may produce less vessel wall injury and,
consequently, less neutrophil activation, which may account for the
lower rate of restenosis.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Lower Expression of Neutrophil Adhesion Molecule Indicates Less Vessel Wall Injury and Might Explain Lower Restenosis Rate After Cutting Balloon Angioplasty
Key Words: angioplasty • vasculature • cell adhesion molecules • restenosis
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