PubMed · 8561649
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D Bialostozky, A Lechuga, E Alexánderson, D Victoria, Y Elizonda. [Myocardial viability].. https://pubmed.ncbi.nlm.nih.gov/8561649/
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BACKGROUND: There is evidence that tissue factor (TF) is a major contributor to the thrombogenicity of a ruptured atherosclerotic plaque. Nitric oxide (NO) has antiatherogenic and antithrombotic properties. We investigated whether L-arginine (L-arg), the endogenous precursor of NO, might affect the ability of monocytes to produce TF. METHODS AND RESULTS: We studied TF expression in 18 rabbits with atherosclerosis induced by bilateral iliac damage and 10 weeks of a 2% cholesterol diet. Six weeks after the initiation of the diet, an angioplasty was performed. After angioplasty, the surviving rabbits (n=15) were randomized to receive L-arg (2.25%) supplementation in drinking water (L-arg group, n=8) or no treatment (untreated group, n=7). TF expression was evaluated in mononuclear cells from arterial blood in the presence and absence of endotoxin stimulation. Monocyte TF expression, as assessed with an amidolytic assay, did not differ significantly before or after the induction of atherosclerotic lesions (87+/-15 versus 70+/-12 mU of TF/1000 monocytes, P=NS). Endotoxin-stimulated TF activity increased significantly 4 weeks after angioplasty (138+/-22 versus 70+/-12 mU of TF/1000 monocytes, P=0.02). This increase was blunted by L-arg (43+/-16 mU of TF/1000 monocytes, P=0.01). CONCLUSIONS: This study demonstrates that angioplasty-induced plaque rupture is associated with a marked increase in monocyte TF response that is blunted by the oral administration of L-arg. This suggests that the documented antithrombotic properties of NO may be related in part to an inhibitory effect on monocyte TF response.
Atheromatous stenosis of the intracranial arteries is a major cause of ischemic cerebral events. To date, treatment has been medical. Percutaneous balloon angioplasty can be used to dilate intracranial arterial stenosis with an 80% success rate. This technique is still under evaluation but can be indicated in symptomatic patients after failure of a well-conducted anti-thrombotic regimen.
ADVANTAGES AND RISKS: Widely advocated as reliable and cost-effective, carotid angioplasty offers many advantages. Theoretically, general anesthesia can be avoided and no incision is required, authorizing its indication in patients with a contraindication for conventional open surgery although the risks of vascular complications--emboli, dissection, acute thrombosis--and general complications must not be underestimated. NEED FOR VALID ASSESSMENT: Few studies evaluating this new technique have been published. Among the open trials including over 100 patients, indications have generally been limited to patients with a high surgical risk and combined morbidity and mortality has been reported to vary from 2.8% to 9.6%. No rigorously controlled comparison with conventional surgery has been published although several projects are currently under way or in the planning stages (CAST in Europe and CASET and CREST in North America). LESSONS FROM THE CURRENT SITUATION: Carotid angioplasty requires a highly equipped facility and a multidisciplinary team with competence in catheterization and micro-catheterization, thrombolysis, and stenting techniques. Technical advances in material engineering are also needed to provide flexible, stable and modulable stents. Despite the still imprecise nature of the current situation, one can predict that these techniques will come to be complementary, if not competitive, alternatives to conventional carotid surgery.