Vessel, plaque, and lumen morphology after transluminal balloon angioplasty. Quantitative study in distended human arteries

Abstract

We performed transluminal balloon angioplasty in 24 cadaver and nine amputated limb superficial femoral arteries under controlled experimental conditions. The cadaver arteries were excised, restored to in situ length, redistended, and maintained at 100 mm Hg intraluminal pressure at 37 degrees C throughout the angiographic and dilation procedure and during fixation. The amputated limb arteries were dilated and pressure perfusion-fixed after dilation. Quantitative analysis of cadaver vessels revealed that arteries with prominent atherosclerotic lesions had the same internal elastic lamina (IEL) circumference (15.6 +/- 1.0 mm) as those with little or no stenosis (16.8 +/- 0.5 mm) but lumen area (8.8 +/- 1.7 mm2) was markedly reduced compared to nonstenotic sites (20.0 +/- 1.9 mm2, p less than 0.01). Lesions occupied 49 +/- 6% of the area circumscribed by the IEL in cadaver arteries with prominent plaques. After dilatation, lumen areas at stenotic sites were enlarged 43% on histologic sections (12.6 +/- 1.8 mm2 vs 8.8 +/- 1.7 mm2, p less than 0.01) and 31% as determined by angiography (p less than 0.05) when compared to immediately adjacent nondilated regions. The increased lumen area was associated with splitting of the intima near the edges of the plaque, separation of the edges of the plaque from the media, and stretching of the media and adventitia, often with accompanying rupture of the media. There was no evidence of plaque compression, fragmentation, deformation, modeling, or herniation into the media. The detached wedge-shaped edges of the lesions formed flaps projecting into the lumen, resulting in a marked increase in lumen irregularity on cross-section.(ABSTRACT TRUNCATED AT 250 WORDS)