Vink Aryan, Schoneveld Arjan H, Borst Cornelius, Pasterkamp Gerard
Experimental Cardiology Laboratory, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
J Vasc Surg. 2002 Dec;36(6):1194-8. doi: 10.1067/mva.2002.128300.
Atherosclerotic luminal narrowing is caused by plaque growth and arterial remodeling. In peripheral arteries, a role for constrictive remodeling in luminal narrowing has been recognized, but the impact on lumen decrease has not yet been assessed. We studied to what extent arterial remodeling and plaque formation contribute to luminal narrowing in the superficial femoral artery.
Elderly subjects (n = 79) were studied. Post mortem, pressure-fixed femoral arteries (n = 125) were dissected and divided into 0.5-cm segments (n = 3266). In each cross section, we measured lumen area, plaque area, and the area encompassed by the internal elastic lamina (IEL area). For each artery, the cross section with the least amount of plaque was considered the reference segment. In cross sections with a decrease in lumen area compared with the reference, we determined the contributions of both plaque increase and IEL area change.
A decrease in lumen area was found in 2193 cross sections. In cross sections with >50% lumen stenosis, plaque increase (accompanied by IEL area increase) fully explained lumen decrease in 80 of 280 cross sections (29%). In the remaining 200 of 280 cross sections (71%), both plaque increase and IEL area decrease contributed to lumen stenosis. In 57 of 280 cross sections (20%), IEL area decrease was the major determinant of lumen decrease, dominating over plaque increase. In 143 of 280 cross sections (51%), plaque increase was the major determinant, dominating over IEL area decrease.
The results of this post mortem study suggest that in a substantial part (20%) of severely stenotic lesions in the femoral artery, constrictive remodeling, not plaque size, is the major determinant of lumen decrease. Further serial studies are needed to confirm these results.
动脉粥样硬化性管腔狭窄是由斑块生长和动脉重塑引起的。在外周动脉中，缩窄性重塑在管腔狭窄中的作用已得到认可，但对管腔减小的影响尚未评估。我们研究了动脉重塑和斑块形成在股浅动脉管腔狭窄中所起作用的程度。
对老年受试者（n = 79）进行研究。尸检时，解剖经压力固定的股动脉（n = 125），并将其分成0.5厘米的节段（n = 3266）。在每个横切面中，我们测量管腔面积、斑块面积以及内弹性膜所包含的面积（内弹性膜面积）。对于每条动脉，斑块最少的横切面被视为参考节段。在管腔面积相较于参考节段减小的横切面中，我们确定了斑块增大和内弹性膜面积变化两者的作用。
在2193个横切面中发现管腔面积减小。在管腔狭窄>50%的横切面中，斑块增大（伴有内弹性膜面积增大）在280个横切面中的80个（29%）中完全解释了管腔减小的原因。在280个横切面中的其余200个（71%）中，斑块增大和内弹性膜面积减小均导致管腔狭窄。在280个横切面中的57个（20%）中，内弹性膜面积减小是管腔减小的主要决定因素，其作用超过斑块增大。在280个横切面中的143个（51%）中，斑块增大是主要决定因素，其作用超过内弹性膜面积减小。
这项尸检研究结果表明，在股动脉严重狭窄病变的相当一部分（20%）中，缩窄性重塑而非斑块大小是管腔减小的主要决定因素。需要进一步的系列研究来证实这些结果。
