Response of femoral arteries of cholesterol-fed rabbits to balloon angioplasty with or without laser: emphasis on the distribution of foam cells.

Very little is known about the structural composition of the restenotic plaque in evolution. The responses of atherosclerotic femoral arteries of rabbits to balloon angioplasty (BA), thallium/holmium/chromium: YAG infrared laser angioplasty (LA), combined LA and BA, or no angioplasty were compared by blinded quantitative histomorphometry and angiography. The endothelium was injured by nitrogen/air desiccation, and the animals were fed a 2% cholesterol diet for 1 month prior to the angioplasty procedure. Animals were sacrificed 2 hr or 28 days after angioplasty by pressure perfusion with 10% formaldehyde (100 mm Hg), and arterial segments (4-5 cm) were excised bilaterally. The frequency of thrombus was greatest in arteries with LA. Arteries with combined LA and BA had the greatest initial gain in luminal diameter by angiography, but they also had the greatest reduction in luminal diameter from 2 hr to 28 days and the greatest cross-sectional area narrowing by plaque at 28 days. The principal component of the intimal plaques in all groups was fibrous tissue (approximately 90%), with the remainder consisting primarily of "foam cells." By multiple regression analysis, the strongest predictors of cross-sectional area narrowing were contiguity of foam cells between the intima and media, depth of the tear, percentage of foam cells in the plaque, and the intervention of LA followed by BA. The principal predictors of foam cells in the plaque, irrespective of treatment, were also cross-sectional area narrowing, contiguity of foam cells between plaque and media, and the depth of tear. It is suggested that a large proportion of the foam cells of the intima may be derived from foam cells of the media and adventitia rather than from the lumen. These observations may be of particular importance regarding angioplasty in young people where foam cells occupy a significantly greater proportion of the atherosclerotic plaque.