山梨医科大学雑誌　第12巻4号　131-142(1997)

Balloon Angioplasty for Re-stenosis of Coarcution of Aorta:
An Experimental Study in Rabbits

Samuel JK. ABRAHAM, Shinpei YOSHII, Shoji SUZUKI, Junya KATOH, Ryoichi HASHITMOTO,
Kihachiro KAMIYA, Yusuke TADA, Takayuki KOMAI, Tetsushi TAN, Minako FUJISHIMA,
and Jun YANAI

Abstract: Background: Recurrent stenosis in the coarcted segment of the aorta is widely reported, irrespective of the primary treatment method. In this study, we created an animal model of postcoarctectomy re-stenosis and evaluated the effect of balloon angioplasty on re-stenosis.
Materials & Methods: Four different methods were employed to create vascular stenoses in the thoracic aorta of rabbits. In group I (n=12), the aorta was partially transected then closed with an absorbable suture (Maxon), followed by additional snug wrapping of the aorta with the suture material (Maxon). In group II (n=8) and group III (n=7), the aorta was opened longitudinally, then closed with a single (group II), or doubled (group III) continuous absorbable suture (Maxon). In group IV (n=15), the longitudinal aortotomy was closed with a doubIe continuous non-absorbable suture (Nespirane). Angiography was performed within the initial 60 days after surgery and then on postoperative days 60, 90 and 120. In groups II and III, angiography was performed on days 30, 60 and 90. In group IV, angiography was performed on days 30 and 60. This was followed by balloon angioplasty in elght animals in group I, one animal in group III, and seven animals in group IV.
Results: Healing of the wound was similar regardless of whether absorbable or non-absorbable suture was used. There was scarring Mth fibrous tissue and adhesions around the suture line. The mean stenosis on day 60 was 18% in group I, 11% in group II, 13% in group III, and 15% in group IV. In group I the mean stenosis was 46% before day 60. Thus, absorption of the externally wrapped suture material significantly affected stenosis. Balloon angioplasty resulted in stretching of the neointima, superficial and deep intimal tears, and aneurysms and ruptures of the aorta at the suture line. Balloon angioplasty was not effective in dilating the suture line itself because there were fewer elastic fibers and more fibrous tissue in the scar.
Conclusion: This model closely resembled surgically corrected coarctation. Balloon angioplasty alone was not effective in treating re-stenosis, and was associated with severe complications.

Key words: Balloon angioplasty, Coarctation of the aorta, Re-stenosis




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