Elastic recoil, dissection and restenosis in patients treated by coronary balloon angioplasty

The topic of this thesis is early and late luminal narrowing after percutaneous transluminal coronary balloon angioplasty as assessed by quantitative angiography, and the role of two possible risk factors: elastic recoil and dissection. In Chapter 2, an review is given of the pharmacological agents that have been tested in the animal model and postangioplasty patients. In Chapter 3 and 4, the methodological problems in the assessment of elastic recoil, stretch and balloon-artery ratio and the role of elastic recoil as a cause of luminal narrowing using quantitative methods are discussed. The 453 patients described in Chapter 3, represents the patients that were enrolled in the Thoraxcenter, in one of three following pharmacological restenosis prevention trials: 1) CARPORT (Coronary Artery Restenosis Prevention On Repeated Thromboxane-antagonism), 2) MERCATOR (Multicenter European Research trial with Cilazapril after Angioplasty to prevent Transluminal coronary Obstruction and Restenosis) or 3) PARK (Post Angioplasty Restenosis prevention with Ketanserin)). In Chapter 4 angiographic risk factors, including stretch and elastic recoil, for long term luminal narrowing (6 months) after a successful angioplasty procedure were investigated. To obtain independent predictors of a significant Joss in minimal luminal diameter (MLD) - loss ::: 0.72 mm - a multivariate logistic regression analysis was applied to 595 lesions with balloon measurements. Patients described in this chapter were enrolled in the CARPORT trial. In Chapter 5 and 6 the role of an "unwanted'' and "therapeutic" type of dissection during and after percutaneous transluminal coronary balloon angioplasty are discussed. In Chapter 5, the role of qualitative and quantitative lesion morphology, in addition to clinical patient characteristics, in prediction of patients at high risk for major cardiac procedural or in-hospital cardiac events, was investigated. In this chapter, all 69 patients with a major procedural or in-hospital cardiac event • that were enrolled in CARPORT and MERCATOR trial -formed the study population. These patients were randomly matched to 267 patients (to the nearest week within the same hospital) wrthout any major procedural and cardiac events from the same 2 trials. In Chapter 6, the relationship between an angiographically visible coronary dissection immediately after successful coronary balloon angioplasty and subsequent restenosis and longterm clinical outcome was investigated. The study population comprised all 693 patients who participated in the MERCATOR trial. In Chapter 7, the angiographic morphology, as derived from quantitative coronary analysis, of the non-restenotic and restenotic lesion, was assessed in all 778 successfully dilated lesions with follow-up angiography, of 653 patients participating in the MERCATOR trial.

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