The pathobiology of human coronary atheroma: contributions of interventional cardiology

The development of coronary angiography facilitated a complete new assessment of coronary circulation in humans, opening a new age in the study and treatment of coronary artery disease. A second revolution came from furrher developments of cardiac catheterisation that made possible the performance of percutaneous therapeutic procedures in the coronary arteries. During the last: 10 years balloon angioplasry has become not only a useful therapeutic tool for clinicians, but also as a model of myocardial ischaemia and vessel wall damage for researchers. More recendy, the development of new percutaneous intracoronary devices has provided new opportunities in the study of the pathophysiology of coronary artery disease. The central topic of this thesis is the use of three of these new technologies for the investigation of different aspects of the pathobiology of coronary atheroma: directional coronary amerectomy, a recanalisation technique based on debulking the obstructing atheromatous plaque; coronary angioscopy. which can be used percutaneously and allows direct visualizacion of luminal changes in the coronary- arteries; and intravascular ultrasound imaging, which provide information on the structure of vascular wall and atheromatous plaque.

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