Evaluation of transluminal angioplasty of chronic coronary artery stenosis. Value and limitations assessed in fresh human cadaver hearts.

Abstract

The possibility of increasing reduced blood flow in atherosclerotic coronary obstruction by catheter balloon dilatation offers a nonsurgical approach to relieve clinical coronary stenosis. To assess the ability of effectively dilating such diseased vessels by transluminal angioplasty, we used the Grüntzig balloon-tipped catheter in 12 fresh human cadaver hearts in which the intervention was performed in 21 noncalcified stenotic areas, including each of the three major coronary arteries. Quantitative coronary arteriography documented decreased obstruction of each lesion; luminal diameter increased 58% (1.9 +/- 0.2 mm to 2.8 +/- 0.3; p less than 0.001) and luminal diameter relative to the most proximal normal coronary segment diminished 61% (46 +/- 4% to 18 +/- 3%; p less than 0.001). Angioplasty was most successfully applied in proximal, discrete, noncalcified lesions of the right and left anterior descending coronaries; calcified, tortuous, middle and distal lesions and the left circumflex coronary were entered with difficulty or unapproachable. Histologic examination revealed microanatomic changes, most often endothelial disruption and atheroma compression, but no serious vascular tears. Dilatation beyond normal coronary diameter caused vessel rupture. This study extends elucidation of the value and limitations of percutaneous transluminal angioplasty in the clinical use of this technique in selected patients for relieving coronary obstruction without surgery.