In vivo evaluation of neointimal healing after stenting with optical coherence tomography
In vivo beoordeling van neointimale heling na stentplaatsing met Optische Coherentie Tomografie
Ischemic heart disease is still today the first cause of mortality in the world, especially in the developed countries. The vast majority of cases are due to atherosclerosis, a complex systemic degenerative process resulting in cholesterol accumulation in the extra-cellular space of the arterial intima, with inflammation, foam-cells formation, and necrosis. The clinical manifestations of coronary atherosclerosis comprise from stable angina, due to flow-limiting stenosis of the artery, to acute myocardial infarction or sudden death, when the atheroma gets complicated by thrombotic phenomena. The first revolution in the treatment of this disease came in 1977, when Andreas Grüntzig performed the first coronary balloon angioplasty. The inflation of a balloon in a narrowed coronary vessel resulted in smash of the atheroma plaque and enlargement of the lumen, thus solving the flow limitation imposed by the stenosis. The success of this therapy was however mitigated by the risk of acute coronary occlusion due to extensive dissection requiring emergency bypass surgery and also by high restenosis rates at follow-up (about 30-50% after 1 year). The mechanism of restenosis had at least two differentiated components: constrictive remodelling of the vessel, defined as reduction in the area of the elastic external lamina (accounting for 73% of the lumen reduction) and neointimal hyperplasia (accounting for 27% of the lumen reduction).
|Keywords||stenting, cardiology, myocardial infarct, ischemic heart disease, coronary atherosclerosis|
|Promotor||P.W.J.C. Serruys (Patrick)|
|Publisher||Erasmus University Rotterdam|
|Sponsor||Financial support: Financial support by the Erasmus University Rotterdam, Cardialysis BV and Saint Jude Medical for the publication of this thesis is gratefully acknowledged.|
Gutiérrez-Chico, J.L. (2014, February 12). In vivo evaluation of neointimal healing after stenting with optical coherence tomography. Erasmus University Rotterdam. Retrieved from http://hdl.handle.net/1765/50522