Endothelial dysfunction and collagen accumulation: two independent factors for restenosis and constrictive remodeling after experimental angioplasty

Background —Constrictive remodeling plays a prominent role in restenosis after balloon angioplasty, but its regulation remains unclear. Because endothelial dysfunction and changes in extracellular matrix have been reported after angioplasty, this study was designed to simultaneously evaluate endothelial function and collagen and elastin changes after restenosis and arterial remodeling. Methods and Results —Atherosclerosis was induced in femoral arteries of 22 New Zealand White rabbits by air-desiccation and a high-cholesterol diet. One month later, angioplasty was performed. Histomorphometry and in vitro assessment of endothelial function were performed 4 weeks after angioplasty. Restenosis correlated with constrictive remodeling ( r =0.60, P =0.01) but not with neointimal growth ( r =−0.06, P =0.79). Restenosis correlated with an impaired relaxation to acetylcholine (ACh; r =0.61, P =0.02) but not with the response to the endothelium-independent vasodilator sodium nitroprusside ( r =−0.25, P =0.40). Restenosis correlated positively with collagen accumulation ( r =0.69, P =0.004) and inversely with elastin density ( r =−0.48, P =0.05). Relaxations to ACh were significantly more decreased in arteries with constrictive remodeling than in those with enlargement remodeling (3.7±7.9% versus 35.5±15.0%, P =0.04). Neointimal collagen density was significantly higher in arteries with constrictive remodeling than in those with enlargement remodeling (34.5±4.5% versus 18.2±4.7%, P =0.03). Endothelial function and collagen and elastin density were independent predictors of restenosis in the study. Conclusions —These results demonstrate that the severity of restenosis after angioplasty correlated with both defective endothelium-dependent relaxation and increased collagen density.