Farb A, Virmani R, Atkinson J B, Anderson P G
Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, Washington, D.C. 20306-6000.
J Am Coll Cardiol. 1994 Nov 1;24(5):1229-35. doi: 10.1016/0735-1097(94)90103-1.
This study assessed the relation between histologic acute and long-term lumen size after coronary angioplasty.
Angiographic studies suggest that the creation of a larger acute lumen is associated with a reduced incidence of restenosis. Histologic evaluation of the influence of the acute lumen on late outcome has not been previously reported.
Detailed histologic examination and planimetry were performed in 28 postmortem coronary arteries subjected to angioplasty at an average of 71 weeks antemortem. The lumen area on each histologic segment was defined as the final lumen area. The lumen area immediately after angioplasty, the acute lumen area, was defined by the sum of the neointimal area plus final lumen. A final lumen area > or = 25% of the arterial area was considered a long-term success; a final lumen area < 25% was considered a long-term failure.
Arterial size and neointimal area were similar in long-term successes and failures. In successes, the mean (+/- SD) acute lumen area was greater than in failures (4.1 +/- 1.9 vs. 2.7 +/- 1.4 mm2, respectively, p < 0.001). The acute lumen area as a percent of arterial area was 46 +/- 10% in successes versus 27 +/- 11% in failures (p < 0.0001). The corresponding estimated mean acute lumen diameter stenosis was 24 +/- 8% in successes versus 42 +/- 12% in failures (p < 0.0001). Plaque area was greater in failures (7.1 +/- 3.2 mm2) than in successes (4.8 +/- 2.4 mm2, p < 0.002).
Neointimal proliferation after angioplasty occurs in all dilated coronary arteries, and the amount of neointimal growth is independent of vessel size. The creation of a larger lumen and a larger lumen as a percent of vessel size were associated with an improved long-term histologic patency.
本研究评估冠状动脉血管成形术后组织学急性改变与长期管腔大小之间的关系。
血管造影研究表明，形成更大的急性管腔与再狭窄发生率降低相关。此前尚未有关于急性管腔对晚期结局影响的组织学评估报告。
对28例冠状动脉血管成形术后平均71周死亡的尸体冠状动脉进行详细的组织学检查和面积测量。每个组织学节段的管腔面积定义为最终管腔面积。血管成形术后即刻的管腔面积，即急性管腔面积，定义为新生内膜面积与最终管腔面积之和。最终管腔面积≥动脉面积的25%被视为长期成功；最终管腔面积＜25%被视为长期失败。
长期成功组和失败组的动脉大小和新生内膜面积相似。成功组的平均（±标准差）急性管腔面积大于失败组（分别为4.1±1.9 vs. 2.7±1.4 mm²，p＜0.001）。成功组急性管腔面积占动脉面积的百分比为46±10%，失败组为27±11%（p＜0.0001）。成功组相应的估计平均急性管腔直径狭窄率为24±8%，失败组为42±12%（p＜0.0001）。失败组的斑块面积（7.1±3.2 mm²）大于成功组（4.8±2.4 mm²，p＜0.002）。
血管成形术后新生内膜增生在所有扩张的冠状动脉中均会发生，新生内膜生长量与血管大小无关。形成更大的管腔以及更大的管腔面积占血管大小的百分比与改善的长期组织学通畅性相关。
