Effect of low-grade conductive heating on vascular compliance during in vitro balloon angioplasty

Heat acclimation increases arterial elasticity in young men

The major physiological adaptations that occur during heat acclimation (HA) are well documented. However, no studies have provided compelling evidence about the effect of HA on arterial elastic properties. The aim of this study was to examine the changes in large artery elasticity (LAE) and small artery elasticity (SAE) concomitant with HA and to determine the potential relationships among changes in arterial elasticity, baseline aerobic fitness level, and improvement in endurance capacity (EC). During 10-day HA, the subjects (n = 21) exercised daily on a treadmill for 110 min at an intensity of 55%–60% of peak oxygen uptake in a climatic chamber preset to 42 °C and 18% relative humidity. EC was tested in the heat before and after HA. Arterial elasticity was assessed by diastolic pulse wave analysis (HDI/Pulse Wave CR-2000) at baseline and after HA. Blood samples were drawn at baseline. After HA, there was a 17% increase in LAE (from 21.19 ± 4.72 mL·mm Hg−1 × 10 to 24.77 ± 5.91 mL·mm Hg−1 × 10, p < 0.05) and an 18% increase in SAE (from 9.32 ± 1.76 mL·mm Hg−1 × 100 to 10.98 ± 1.75 mL·mm Hg−1 × 100, p < 0.01). EC increased by 86% (from 88.62 ± 27.51 min to 161.95 ± 47.80 min, p < 0.001) as a result of HA. No significant associations were revealed between changes in arterial elasticity parameters and improvement in EC or baseline aerobic fitness level. We demonstrated, for the first time, that HA has a positive impact on the parameters of arterial elasticity. Further investigations are needed to determine the mechanisms underlying these changes and the potential relationships among arterial elasticity, aerobic fitness level, and EC.

The Deformation Rate of Smooth Muscle Cells in Vessel Walls After Short-Duration Heating Dilatation in a Porcine Model Ex Vivo and In Vivo

We have proposed a novel short-duration thermal angioplasty with uniform temperature distribution. Although the dilatation mechanism of our short-duration heating dilatation was reported in our previous study, the influences on smooth muscle cells (SMCs) are not sufficiently understood. We studied the influences on SMCs in terms of shape change and discussed the relationship between the SMCs' shape change and dilatation mechanism ex vivo and in vivo. We found that the SMCs were fixed in the stretched condition after our short-duration heating dilatation both ex vivo and in vivo. The deformation rate of SMCs' shape, measured by the cells' nuclei, was increased with rising balloon maximum temperature (T(balloon)), and the same tendency was observed for the arterial dilatation rate. We hypothesize that the SMCs were fixed in the stretched condition because the arterial dilatation with our short-duration heating dilatation was performed without any plastic deformations of the vessel wall, causing the vessel wall itself to be stretched. We also prospect that the reasons for the positive correlation between the deformation rate of SMCs' shape and T(balloon) are that (i) the area heated over 60 °C was expanded with rising T(balloon), and (ii) the arterial dilatation rate was also increased with rising T(balloon).

A new endovascular radiofrequency device for dilatation of vascular stenosis in a rabbit model

PURPOSE

To investigate the use of a new endovascular radiofrequency (RF) device, the Habib™ VesCoag™ Catheter, to induce vascular remodeling and dilatation of arterial stenosis in a rabbit model.

MATERIALS AND METHODS

RF was used to induce arterial stenosis in 10 rabbits and this was confirmed by angiography and color Doppler ultrasound. Two groups of five animals were then subjected to (1) balloon dilatation of the stenosis (intervention group), (2) no intervention (control group). Two rabbits from each group were sacrificed following the procedures to investigate vessel histopathology. At six weeks, the remaining six rabbits underwent follow-up angiogram and color Doppler ultrasound to assess vessel patency. They were then sacrificed and the vessels prepared for histopathological analysis. Three-dimensional images with confocal microscopy of the arterial lumen were also acquired.

RESULTS

In the intervention group, stenosis was reversed and patency confirmed by angiography and color Doppler ultrasound six weeks later in all surviving rabbits. Histopathology revealed degenerative changes of elastic fibers, focal losses of elastica lamella, disorganization of myocytes and extensive hyalinization of the tunica adventitia. Focal elastin changes of the arterial elastic lamella were also shown by three-dimensional confocal microscopy images.

CONCLUSION

We have developed a novel endovascular RF catheter that can be safely and effectively used to induce vascular remodeling and dilatation of arterial stenosis in an experimental rabbit model.

Effect of passive heat stress on arterial stiffness

Arterial compliance, the inverse of arterial stiffness, is a prognostic indicator of arterial health. Central and peripheral arterial compliance decrease with acute cold stress and may increase postexercise when exercise-induced elevations in core temperature are likely still to be present. Increased blood flow through the conduit arteries associated with elevated core temperature increases shear stress, which in turn releases nitric oxide and other endothelium-derived factors. These changes, in conjunction with supportive in vitro data, suggest that elevated core temperature may indirectly increase central and peripheral arterial compliance (i.e. decrease arterial stiffness). The purpose of this study was to test the hypothesis that increased core temperature decreases central and peripheral arterial stiffness, as measured with pulse wave velocity (PWV). Using Doppler ultrasound, carotid-femoral (central) and carotid-radial (peripheral) arterial PWVs were measured from eight subjects (age 37 ± 11 years; mass 68.8 ± 11.1 kg; height 171 ± 3 cm) before and during passive heat-stress-induced increases in core temperature of 0.47 ± 0.05, 1.03 ± 0.12 and 1.52 ± 0.07°C (i.e. baseline, 0.5, 1.0 and 1.5°C, respectively). Changes in PWV were evaluated with one-way repeated-measures ANOVA. When analysed as group means, neither central (677 ± 161, 617 ± 72, 659 ± 74 and 766 ± 207 cm s(-1); P = 0.12) nor peripheral PWV (855 ± 192, 772 ± 95, 759 ± 49 and 858 ± 247 cm s(-1); P = 0.56) changed as core temperature increased from baseline to 0.5, 1.0 and 1.5°C, respectively. However, individual changes in central (average r = -0.89, P < 0.05) and peripheral PWV (average r = -0.93, P < 0.05) with heat stress were significantly correlated with normothermic baseline PWV. In conclusion, these data suggest that the magnitude by which heat stress reduced PWV was predicated upon normothermic PWV, with the individuals having the highest normothermic PWV being most responsive to the heat-stress-induced reductions in PWV.

Reduction of arterial graft smooth muscle mass by moderate heat therapy

Radial artery (RA) graft spasm is a major cause of early graft failure in coronary artery bypass grafting surgeries. We explored the feasibility of thermal reduction of smooth muscle mass to attenuate vasoconstriction. Rat and rabbit femoral arteries were treated thermally in situ (45°C to 65°C; 0 s to 120 s) and then excised at various time points for histological and physiological study (pressure-diameter relationships). Human radial arteries were treated in vitro and studied in similar fashion. Weeks after thermal treatment, no overt indication was noted of vasospasm, thrombosis, or scarring in the arterial wall; however, this intervention led to a thermal dose-dependent reduction of vasoconstriction (to phenylephrine or potassium chloride) and to a conspicuous loss of smooth muscle. Pressure-diameter relationships showed no aneurismal dilation of these demuscularized arteries up to 200 mmHg. Qualitatively identical results were obtained in human radial arteries. Thermal ablation of RAs may provide a simple, safe, and effective solution to postsurgical vasospasm.

A mechanical device for aortic compliance modulation: In vitro simulation of aortic dissection treatment

Stanford type A aortic dissection often rapidly leads to death from aortic rupture. We considered the possibility of introducing a passive counterpulsating damper into the dissected aorta in order to limit the physical stress associated with ventricular ejection and increase the diastolic aorto-ventricular pressure gradient. We conceived a damping device comprising an intravascular balloon connected to an adjustable external reservoir to regulate the air pressure inside the balloon, and performed a simulation study using a mechanical model of the cardiovascular system, mimicking aortic dissection. When the balloon was completely deflated, the behavior of the aortic pressure signal was typical of low-compliance aortic dissection, as characterized by an augmented maximum systolic value, accentuated diastolic decay, and a very low end-diastolic value. Balloon inflation (at incremental steps to 90 mmHg) progressively restored the aorto-ventricular pressure gradient and reduced peak systolic pressure values, leading to progressive improvements in the characteristics of the aortic pressure curve in terms of reduction in the maximum systolic value and slower diastolic decay. The proposed mechanism might exert beneficial effects at two levels: (1) directly, by reducing mechanical stress on the arterial wall; (2) indirectly, by allowing safer use of pharmaceutical agents (beta-blockers etc.). In vivo animal simulation studies are warranted to verify the effects of the device and optimize balloon shape and volume in a realistic pathophysiological setting.

Histological findings after angioplasty using conventional balloon, radiofrequency thermal balloon, and stent for experimental aortic coarctation

BACKGROUND

Use of balloon angioplasty or stent implantation has been reported to be effective in relieving coarctation of the aorta. However, restenosis frequently occurs after balloon angioplasty for native aortic coarctation in small infants, and sometimes develops after stent implantation because of vessel growth. The causes of restenosis remain uncertain. The purpose of this study was to assess the histologic differences in vascular responses to angioplasty using conventional balloon, radiofrequency thermal balloon (RFTB), or stent for experimental aortic coarctation.

METHODS

The authors surgically created an aortic coarctation model using 14 puppies. Angioplasty using conventional balloon, RFTB, or stent was performed 1 month after the initial operation. At the acute or chronic phase after angioplasty, the animals were killed and histologic studies were performed.

RESULTS

More vascular injuries were noted in the specimens from animals undergoing conventional angioplasty than in those with RFTB or stent. However, neointimal hyperplasia was seen more often after RFTB or stent because of the proliferation of smooth muscle cells from the tunica media, caused by secretion of growth factors. Apoptosis reached a peak 1-2 weeks after angioplasty, regardless of the type of intervention.

CONCLUSIONS

The authors conclude that angioplasty with RFTB or stent can provide relatively small injuries in the vessel wall for aortic coarctation, but care must be taken to prevent restenosis caused by intimal hyperplasia, because neointima hyperplasia is more frequent after RFTB or stent.