EFFECTS OF VASCULAR RUNOFF ON MYOINTIMAL HYPERPLASIA AFTER MECHANICAL BALLOON OR THERMAL LASER ARTERIAL INJURY IN DOGS
EFFECTS OF VASCULAR RUNOFF ON MYOINTIMAL HYPERPLASIA AFTER MECHANICAL BALLOON OR THERMAL LASER ARTERIAL INJURY IN DOGS
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DOI：
10.1161/01.cir.84.2.884
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发表时间：
1991-08-01
期刊：
影响因子：
37.8
通讯作者：
SVENSON, RH
中科院分区：
文献类型：
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作者：
HEHRLEIN, C;CHI, HC;SVENSON, RH
背景 临床证据表明，不良的血管流出会降低股动脉血管成形术的长期成功率。 本实验研究的目的是检查犬股动脉球囊剥脱后，热激光动脉损伤，或假手术在正常和减少血管径流conditions.Methods和结果的肌内膜增生。 在机械球囊损伤或经腔加热激光探针运动之前，通过结扎股动脉的三个远端侧支下方来减少犬的外周血管流出，将股动脉流速从114 +/- 9降至52 +/- 5 ml/min（平均值+/- SEM）。 球囊损伤后1小时，光学显微镜观察到内皮剥脱，主要是完整的弹性内膜和中膜的环形结构变化。 热激光损伤动脉后1小时，内膜和中膜局灶性完全坏死。 8周后，在正常径流犬中，球囊损伤（0.45 +/- 0.03 mm）和热激光损伤（0.54 +/-0.03 mm）后先前干预部位的新生内膜加中膜的最大厚度大于假手术后（0.40 +/- 0.01 mm; p < 0.001）。 在球囊损伤和热损伤的动脉中，减少的血管流出增加了肌内膜增生;壁厚分别从0.45 +/- 0.03增加到0.93 +/- 0.10 mm和从0.54 +/- 0.03增加到0.65 +/- 0.05 mm（p < 0.001）。 球囊损伤动脉的新生内膜和中壁面积占外弹性膜覆盖面积的48%，而血管流出减少时占81%（p < 0.01）。 在热损伤的动脉中，正常流出量的新生内膜和中壁面积为47%，而减少流出量的新生内膜和中壁面积为63%（p < 0.05）。 这项研究表明，血流动力学因素与不良的血管径流发挥了重要作用，在扩大肌内膜增生的方法和血管成形术中的动脉损伤的严重程度无关。
Background. Clinical evidence suggests that poor vascular runoff reduces the long-term success rate of femoral angioplasty procedures. The purpose of this experimental study was to examine myointimal hyperplasia of dog femoral arteries after balloon denudation, thermal laser arterial injury, or sham operation in normal and reduced vascular runoff conditions.Methods and Results. Before mechanical balloon injury or transluminal heated laser probe motion, the peripheral vascular runoff of dogs was reduced by ligating the femoral artery below its three distal side branches, decreasing the femoral flow rate from 114 +/- 9 to 52 +/- 5 ml/min (mean +/- SEM). Endothelial denudation with a predominantly intact elastic internal membrane and circumferential structural changes in the media were noted by light microscopy 1 hour after balloon injury. Focal completely necrotic lesions of intima and media were found 1 hour after thermal laser arterial injury. After 8 weeks, the maximal thickness of neointima plus media of the site of previous intervention was greater after balloon injury (0.45 +/- 0.03 mm) and thermal laser injury (0.54 +/- 0.03 mm) than after sham operation (0.40 +/- 0.01 mm; p < 0.001) in normal runoff dogs. Reduced vascular runoff augmented myointimal hyperplasia both in the balloon-injured and thermally damaged arteries; the wall thickness increased from 0.45 +/- 0.03 to 0.93 +/- 0.10 mm and from 0.54 +/- 0.03 to 0.65 +/- 0.05 mm, respectively (p < 0.001). The neointimal and medial wall area of the balloon-injured arteries contributed 48% to the area encompassed by the external elastic membrane compared with an 81% portion when vascular runoff was reduced (p < 0.01). A 47% neointimal and medial wall area was found in thermally injured arteries with normal runoff compared with 63% after runoff reduction (p < 0.05).Conclusion. This study suggests that hemodynamic factors associated with poor vascular runoff play an important role in extending myointimal hyperplasia independent of method and severity of the arterial injury during angioplasty.