Regression Of Stenosis Research Articles

Hemodynamic changes associated with bypass stenosis regression

Ultrasound scanning is used to detect velocity increases indicative of a bypass stenosis. Subsequent examinations have shown regression of some stenotic lesions. This study examined hemodynamic changes that coincided with stenosis regression. Duplex ultrasound scans were used to record the peak systolic velocity (PSV) and volume flow from proximal and distal segments of infrainguinal bypasses. Valve remnants or other image defects were also noted. The PSV ratio (Vr) was calculated as the PSV at a stenosis divided by the PSV proximal to the lesion. A stenosis was defined as Vr >/=2.0. An initial ultrasound scan performed 31 +/- 6 days after surgery revealed a stenosis in 68 of 565 bypasses. In six bypasses, the increased PSV (272 +/- 61 cm/s) and Vr (3.4 +/- 1.3) were sustained during the follow-up period of 8 +/- 3 months. In 27 bypasses with a PSV of 335 +/- 63 cm/s and a Vr of 4.0 +/- 1.6, the stenosis was repaired. In 35 bypasses with a PSV of 261 +/- 82 cm/s and Vr of 3.2 +/- 1.2, stenosis regression occurred with no increases in PSV observed on later scans. In this group, proximal bypass flow decreased during the follow-up interval from 247 +/- 130 mL/min to 151 +/- 135 mL/min and distal flow from 180 +/- 102 mL/min to 103 +/- 54 mL/min ( P < .05, paired t test). Ultrasound image abnormalities were noted in 4 bypasses (67%) with persistent stenoses, 14 with repaired stenoses (52%), and 10 with resolved stenoses (29%). These data indicate early postoperative hyperemia is present in bypasses, demonstrating focal velocity increases. Such velocity increases may be the result of the bypass conduit acting as a flow-limiting lesion until the hyperemia subsides. As the blood flow decreases so does the PSV, giving the appearance of stenosis regression.

Duplex‐Doppler Long‐term Follow‐up of Renal Transplant Artery Stenosis: Case Controlled Study

The aim of this retrospective clinical study was to assess a long-term course of renal transplant artery stenosis with duplex-Doppler ultrasound, and its influence upon serum creatinine, hemoglobin concentration and hypertension, as well as to investigate a possible association between stenosis and the number of acute rejections. Thirty-four renal transplant recipients, aged 43 +/- 13 years, with significant (>50%) renal transplant artery stenosis as seen on Doppler ultrasound were compared with 34 renal transplant recipients without stenosis (excluded by Doppler). Patients of both groups were matched by age, sex, time of transplantation, type of renal transplant, and number of previous transplantations. We analyzed peak systolic velocity (PSV) in the renal transplant artery, resistance index (RI) at the level of intra-renal arteries, serum creatinine, hemoglobin concentration, blood pressure, the number of antihypertensive medications, and the number of acute rejections on a yearly basis. In the stenosis group, PSV was 2.1 +/- 0.5 m/s at 1 year after transplantation (controls 1.1 +/- 0.4), 1.9 +/- 0.5 at 2 years (0.9 +/- 0.4), 1.9 +/- 0.5 at 3 years (0.9 +/- 0.4); RI was 62 +/- 10% at 1 year (controls 68 +/- 7), 65 +/- 9 at 2 years (67 +/- 7), 63 +/- 9 at 3 years (67 +/- 7); serum creatinine was 128 +/- 58 micromol/L at 1 year (controls 129 +/- 43), 119 +/- 47 at 2 years (121 +/- 33), 125 +/- 54 at 3 years (127 +/- 32). Long-term course of renal transplant artery stenosis (>50%), treated medically or interventionally, seems to be stable and non-progressive (during a 3-year follow up). Spontaneous regression of stenosis to non-significant level is possible. No difference in graft function, blood pressure or the number of acute rejections was observed comparing the stenotic and non-stenotic groups.

Beyond the Statins: New Therapeutic Perspectives in Cardiovascular Disease Prevention

Reduction of low-density lipoprotein cholesterol (LDL-C) with statin therapy is currently identified in treatment guidelines as the primary focus for patients with or at risk of coronary heart disease (CHD). Yet despite effective statin therapy there is still an unacceptably high residual coronary risk. A substantial proportion of patients with CHD have mixed dyslipidemia, including low levels of high-density lipoprotein cholesterol (HDL-C), an independent and predictive risk factor for CHD. Although effective in reducing LDL-C, statin therapy has only modest effects in raising HDL-C. Fibrate therapy is an alternative lipid-modifying strategy, and is effective in reducing CHD mortality and morbidity, with the magnitude of clinical benefit similar to statin therapy. Multi-drug therapy with complementary mechanisms of action has been proposed as a means of improving lipid-modifying efficacy. Nicotinic acid is the most potent agent for increasing HDL-C and also substantially reduces LDL-C and triglycerides. Addition of nicotinic acid to statin therapy would be a logical management approach, given the potential for complementary therapeutic benefit. The clinical benefits of this combination are supported by the results of the HDL Atherosclerosis Treatment Study, which showed reduction of 60-90% in the incidence of major coronary events when both agents were administered. In addition, combination treatment led to angiographic regression of stenosis, compared with placebo, rather than slowed progression as previously reported with statin monotherapy. Given that the prevalence of low HDL-C, particularly amongst individuals with CHD, is higher than previously anticipated, combining nicotinic acid and a statin represents an innovative approach to further reducing CHD risk.

Post-varicella arteriopathy of childhood

To determine the course of vascular changes in childhood post-varicella arteriopathy (PVA) and its relationship to recurrent arterial ischemic stroke or TIA (AIS/TIA). Subjects were children with AIS/TIA occurring <1 year after varicella, ischemic localization consistent with unilateral disease affecting the supraclinoid internal carotid artery or proximal anterior or middle cerebral arteries, and no identified AIS/TIA etiology other than PVA. Charts, brain MRI, and sequential cerebral vessel imaging (selective cerebral angiography or MR angiography [SCA/MRA]) were retrospectively reviewed. Twenty-three children had varicella at age 1.0 to 10.4 years and had single or multiple AIS/TIAs 4 to 47 weeks later. Initial SCA/MRA was performed within 1 month of presentation, and each child had one to five repeat SCA/MRAs during a 4- to 87-month period. There was vascular stenosis in 19 children, maximal on initial studies in 15 of these. Subsequent stenosis regression occurred in 17 children. In 11 of these, one or two additional SCA/MRAs showed further regression as long as 48 months after presentation; there was no restenosis. Eight of 23 children had recurrent AIS/TIA with antithrombotic therapy within 33 weeks of presentation, including 1 of 17 children with documented stenosis regression. Vascular stenosis of childhood post-varicella arteriopathy takes a monophasic course, generally with subsequent stenosis regression and only occasional stenosis progression after arterial ischemic stroke/TIA. Arterial ischemic stroke/TIA rarely recurs with antithrombotic prophylaxis after stenosis regression occurs.

38 Long-term Follow-up of Renal Transplant Artery Stenosis: Case Controlled Study

Background Renal transplant artery stenosis is relatively frequent. It can cause hypertension, deterioration of renal function or graft loss. It seems that it can be treated conservatively provided graft perfusion is not jeopardized. The aim of our retrospective clinical study was to assess a long-term course of renal transplant artery stenosis by duplex-Doppler and its influence upon serum creatinine, hemoglobin concentration, and hypertension, as well as to investigate possible association between stenosis and the number of acute rejections. Methods Thirty-four renal transplant recipients, aged 43 ± 13 years, with significant (>50%) renal transplant artery stenosis on Doppler were compared with 34 renal transplant recipients, in whom stenosis was excluded on Doppler; patients of both groups were matched by age, sex, time of transplantation, type of renal transplant and number of previous transplantations. We analyzed peak systolic velocity in renal transplant artery, resistance index at the level of intrarenal arteries, serum creatinine, hemoglobin concentration, blood pressure, number of antihypertensive medications, and number of acute rejections on a yearly basis. Results In the stenosis group, peak systolic velocity was 2.1 ± 0.5 m/s at 1 year after transplantation (controls 1.1 ± 0.4 m/s), 1.9 ± 0.5 m/s at 2 years (0.9 ± 0.4 m/s), 1.9 ± 0.5 m/s at 3 years (0.9 ± 0.4 m/s); resistance index was 62 ± 10% at 1 year (controls 68 ± 7%), 65 ± 9% at 2 years (67 ± 7%), 63 ± 9% at 3 years (67 ± 7); serum creatinine was 128 ± 58 µmol/L at 1 year (controls 129 ± 43 µmol/L), 119 ± 47 µmol/L at 2 years (121 ± 33 µmol/L), 125 ± 54 µmol/L at 3 years (127 ± 32). Conclusion Long-term course of renal transplant artery stenosis (>50%), treated medically or interventionally, seems to be stable and nonprogressive (during 3-year follow-up). Spontaneous regression of stenosis to nonsignificant level is possible. No significant difference in graft function, blood pressure, or the number of acute rejections was observed when comparing the stenotic and nonstenotic group.

Lipid Triad or Atherogenic Lipoprotein Phenotype: A Role in Cardiovascular Prevention?

The term "lipid triad" or "atherogenic lipoprotein phenotype" has been introduced to describe a common form of dyslipidemia, characterized by three lipid abnormalities: increased plasma triglyceride levels, decreased HDL-cholesterol concentrations and the presence of small, dense LDL particles. It has been suggested that the clinical importance of the atherogenic lipoprotein phenotype probably exceeds that of LDL-cholesterol, because many more patients with coronary artery disease are found to have this trait than hypercholesterolaemia. There is a body of evidence that therapies effective against plasma HDL-cholesterol and triglycerides are associated with a strong reduction of cardiovascular risk; in addition, hypolipidemic treatment is able to increase LDL particle size and this increment correlates with regression of coronary stenosis. Recently, the Coordinating Committee of the National Cholesterol Education Program suggested that very high-risk patients may benefit from stronger lipid-lowering measures, a category of individuals that includes those with the atherogenic lipoprotein phenotype. Since the therapeutical modulation of each of the three components of the lipid triad is associated with a strong reduction in the risk of cardiovascular events, LDL size measurement may be extended as much as possible to patients at high risk of cardiovascular diseases.

M.691 Conversion to large/buoyant LDL with simvastatin plus niacin plays a key role in coronary stenosis regression: Results from the HDL-atherosclerosis treatment study (HATS)

M.691 Conversion to large/buoyant LDL with simvastatin plus niacin plays a key role in coronary stenosis regression: Results from the HDL-atherosclerosis treatment study (HATS)

M.691 Conversion to large/buoyant LDL with simvastatin plus niacin plays a key role in coronary stenosis regression: Results from the HDL-atherosclerosis treatment study (HATS)

Long and very long chain fatty acids (LCFAs and VLCFAs) may play an active role in coronary artery diseases (CAD) etiology. Our aim was to evaluate the associations between LCPUFAs (C20:4n-6; C20:5n-3 and C22:6n-3) and VLCSFAs (C22:0, C24:0; and C26:0), as well as markers of peroxisomal integrity evaluated by phytanic acid and plasmalogen-C16:0 (PL-C16:0) in addition to the markers of lipid peroxidation (malondialdehyde [MDA] and conjugated dienes [CD]) and inflammation (high sensitivity C-reactive protein [hs-CRP]) with vascular severity evaluated by Gensini score in order to determine their possible effects on CAD in Tunisian population. Lipidomic strategy based on GC/MS-SIM was used to quantify LCPUFAs, VLCSFAs, and PL-C16:0 in red blood cells of CAD patients, non-CAD patients, and controls. We observed a significant increase in phytanic acid, PL-C16:0 and VLCFAs, particularly C26:0, in CAD group compared to controls. Further our findings showed positive correlations of C26:0 with MDA and with vascular severity score (Gensini score).In addition, a significant negative correlation was shown between hs-CRP and C22:6 n-3 (r = −0.297; p = 0.002) and a significant positive association was observed between hs-CRP and C20:4 n-6 levels (r = 0.196; p = 0.039). Our results show changes in LCPUFAs and VLCSFAs concentrations in RBC among study groups, and suggest alterations in fatty acids metabolism regulated by elongase and desaturase enzymes. The positive correlations of C20:4n-6 and the negative correlations of C22:6n-3, simultaneously with Gensini score and hs-CRP, suggest a link of both inflammation and vascular severity complication of CAD with LCPUFAs and VLCSFAs. Induction of lipid oxidation, can be one of the outcomes of LCFAs and VLCFAs accumulation in vascular tissues and, thus, playing an important role in the pathogenesis of atherosclerosis. Quantification of LCPUFAs and VLCSFAs, phytanic acid and PL-C16:0 simultaneously, would be of great value for the screening of peroxisomal disorders in vascular tissue of CAD patients.

Is endoscopic drainage of common bile duct stenoses in chronic pancreatitis up-to-date?

Common bile duct (CBD) stenoses often complicate chronic pancreatitis (CP). Although endoscopic drainage is employed as a standard procedure in malignant CBD stenoses, it is not yet the approved standard therapy of CBD stenosis in CP. The records of 31 patients with CBD stenosis in CP who had undergone endoscopic placement of plastic endoprostheses into the bile duct between January 1991 and February 1997 were analyzed retrospectively. In all, 18 patients suffered from jaundice and 13 patients exclusively showed serological cholestasis. Upstream dilation of the CBD (19 +/- 6.6 mm, 12-35 mm) was detected by ERCP in all patients. In total, 101 endoprostheses were implanted endoscopically, exchanged after 3 +/- 2 months, and removed after 10 +/- 8 months. All jaundiced patients showed immediate improvement of cholestasis after drainage. At the time of last exchange or after stent removal, prestenotic CBD dilation was reduced in 55% of all patients. Complete regression of stenosis and prestenotic dilation was accomplished only in 13%; dilation remained unchanged in 10%, and even showed progression in 22%. A total of 29 patients were followed-up over 24 months. Cholestatic parameters remained normal in all patients with complete normalization of the CBD, and were only moderately increased in another 10 patients, 7 and 28 months after stent removal, respectively. Technical and immediate clinical success of CBD stenting in patients with CBD stenoses due to CP is high; however, long-term complete normalization of the bile duct is rare. Endoscopic drainage of CBD-stenosis in patients with CP can be recommended to alleviate acute cholestasis, but not yet as a definite treatment.

Is endoscopic drainage of common bile duct stenoses in chronic pancreatitis up-to-date?

OBJECTIVE: Common bile duct (CBD) stenoses often complicate chronic pancreatitis (CP). Although endoscopic drainage is employed as a standard procedure in malignant CBD stenoses, it is not yet the approved standard therapy of CBD stenosis in CP. METHODS: The records of 31 patients with CBD stenosis in CP who had undergone endoscopic placement of plastic endoprostheses into the bile duct between January 1991 and February 1997 were analyzed retrospectively. In all, 18 patients suffered from jaundice and 13 patients exclusively showed serological cholestasis. Upstream dilation of the CBD (19 ± 6.6 mm, 12–35 mm) was detected by ERCP in all patients. In total, 101 endoprostheses were implanted endoscopically, exchanged after 3 ± 2 months, and removed after 10 ± 8 months. RESULTS: All jaundiced patients showed immediate improvement of cholestasis after drainage. At the time of last exchange or after stent removal, prestenotic CBD dilation was reduced in 55% of all patients. Complete regression of stenosis and prestenotic dilation was accomplished only in 13%; dilation remained unchanged in 10%, and even showed progression in 22%. A total of 29 patients were followed-up over 24 months. Cholestatic parameters remained normal in all patients with complete normalization of the CBD, and were only moderately increased in another 10 patients, 7 and 28 months after stent removal, respectively. CONCLUSIONS: Technical and immediate clinical success of CBD stenting in patients with CBD stenoses due to CP is high; however, long-term complete normalization of the bile duct is rare. Endoscopic drainage of CBD-stenosis in patients with CP can be recommended to alleviate acute cholestasis, but not yet as a definite treatment.

Improvement of myocardial perfusion by short-term fluvastatin therapy in coronary artery disease

Patients with hypercholesterolemia have impairedcoronary and peripheral endothelial function. In patients with coronary artery disease, intracoronary acetylcholine infusion or mental stress causes paradoxical vasoconstriction, whereas lowering cholesterol restores endothelial function. The impact of lipid lowering by fluvastatin on myocardial perfusion in hypercholesterolemic patients with perfusion abnormalities was assessed by thallium-201 single photon-emission computed tomography (SPECT). A total of 22 patients were treated with fluvastatin (40 mg once daily) for 6 weeks, followed by 40 mg twice daily if low density lipoprotein cholesterol (LDL-C) levels were decreased by ≤30%. During the 12-week treatment period, myocardial perfusion was measured by quantitative SPECT after standardized stress testing at baseline and after 12 weeks. Preliminary results for 17 male patients (mean age, 59.3.± 6.7 years) are presented here. LDL-C decreased from 191 ± 26 to 146 ± 28 mg/dL (p < 0.001). In ischemic segments myocardial perfusion increased by 30% (280 ± 100 to 365 ± 110 counts per matrix; p < 0.001). In normal segments perfusion increased by only 5% (451 ± 74 to 3 473 ± 69 counts per matrix; p < 0.005). The change in perfusion rate between ischemic and normal segments was significant (p < 0.005). In conclusion, LDL-C lowering with short-term fluvastatin therapy improved myocardial perfusion, especially in areas of ischemia. This suggests that improvement is due to functional restoration of coronary endothelium by fluvastatin, before anatomic regression of stenosis can occur following long-term treatment.

Long-term angiographic follow-up of lesions patent 6 months after percutaneous coronary angioplasty

To determine long-term angiographic prognosis after successful angioplasty (<50% residual stenosis, ≥20% reduction of stenosis, and no major complications), coronary angiography was performed 2 to 4 years after angioplasty in patients who were ≤70 years old at the time of treatment and who showed patency (≤50% stenosis) 6 months after the initial procedure. Among 407 lesions that were dilated in 333 patients between 1983 and 1989, 298 (73.2%) lesions were reviewed by long-term angiography after 177 ± 34 weeks. At long-term follow-up, 4 (1.3%) lesions were totally occluded, 3 (1.0%) had severe stenosis (≥75% stenosis), 9 (3.0%) had mild stenosis (>50% to <75% stenosis), and 282 (94.6%) were patent (≤50% stenosis). The percentage of stenosis of patent lesions decreased from 24% ± 14% at 6 months to 21% ± 13% at long-term follow-up ( p < 0.0001). No specific clinical or angiographic characteristics were identified in patients with severe stenosis at long-term follow-up. These findings indicate that when patency is obtained 6 months after angioplasty, a 95% long-term patency rate with regression of stenosis can be expected.

Follow-up patency of side branches covered by intracoronary Palmaz-Schatz stent

To assess the risk of late side branch occlusion after Palmaz-Schatz stent deployment, we analyzed the angiographic evolution of 62 patients treated by successful stent implantation who had a total of 85 side branches starting from the stented segment. Side branches were considered minor ( n = 39) when the diameter was <1 mm and intermediate ( n = 46) when the vessel had ≥1 mm diameter. One angiographic follow-up study was available in all patients at 8 ± 5 months. Eight minor branches presented some degree of stenosis at origin before stent deployment (4 totally occluded). After stent deployment, 32 (82%) of 39 remained unchanged and 3 became occluded. Late progression at origin occurred in 4 of 34 (3 occluded). Before stent deployment, 48% of the intermediate branches had some compromise degree at their starting point (1 totally occluded). Eight of 45 intermediate branches became occluded after stent implantation. Late progression at origin happened in 5 of 32 branches (2 occluded). Some degree of follow-up stenosis regression at the origin was observed in 22 (26%) of 85 arteries. Neither clinical nor angiographic factors could be identified as predictors of late side branch occlusion or stenosis progression at its origin. Later occlusion or progression at origin of a side branch covered by a Palmaz-Schatz stent seems to be an uncommon occurrence (7% and 12% respectively) that cannot be predicted by angiographic or clinical factors. On the contrary, regression at follow-up of a side branch—origin stenosis can also come about.

768-5 Evolution of Infarct-related Stenoses After Clinical Stabilization

The evolution of infarct-related stenoses (IRS) was prospectively studied in 106 patients (pts) with myocardial infarction (MI) after clinical stabilization. All pts underwent diagnostic angiography (6 ± 5 months after MI, range 1 to 25) and were put on a routine waiting list for PTCA of the IRS. Coronary angiography was repeated (8 ± 4 months after first angiogram) immediately preceding PTCA (79 pts) or soon after the occurrence of coronary events (MI: 6 pts, unstable angina: 21 pts). IRS was identified and classified as “complex” (irregular borders, overhanging edges, orintracoronarythrombus) or “smooth”. Stenosis progression, assessed by computerized angiography, was defined as &gt;20% diameter reduction or new total occlusion and regression as &gt;20% decrease in severity. At initial angiography, there were 279 stenoses (≥50:138, &lt;50%:141). Of 106 IRS, 74 (70%) were complex and 32 (30%) were smooth. At restudy, 24 of 106 IRS had progressed compared with 9 of 173 non-IRS (23% vs. 5%, p = 0.001). Twenty-two of the 24 IRS and 3 of 9 of non-IRS that had progressed developed into total occlusion (92% vs. 33%, P = 0.01). Twenty-two of 74 complex IRS progressed, compared with only 2 of 32 smooth IRS (30% vs. 6%, P = 0.008). During follow up, coronary events occurred in 27 pts, of which 15 (56%) were associated with IRS progression. Remoulding of stenosis morphology (from complex to smooth) was found in 8 patients (resolution of thrombus or ulceration), of these 3 were associated wilh stenosis regression. Pts age, gender, coronary disease risk factors, number of diseased vessel, anti platelet and antithrombotic therapy, interval between onset of MI and diagnostic angiogram, and interval between the 2 coronary angiograms were not associated with IRS progression. Changes of percent stenosis (%) and minimal stenosis diameter (mm) in the different subgroups were as following: 1st angio (%) 2nd anglo (%) Δ (%) 1st angio (mm) 2nd angio (mm) Δ (mm) IRS 66.2 ± 6.6 72.8 ± 16.9 * 6.6 ± 15.8 1.15 ± 0.28 0.91 ± 0.52 * 0.24 ± 0.47 non-IRS 44.6 ± 14.5 48.0 ± 15.8 * 3.4 ± 12.2 § 1.71 ± 0.50 1.61 ± 0.53 * 0.10 ± 0.31 § Com IRS 66.9 ± 7.1 76.5 ± 16.3 * 9.6 ± 17.2 1.13 ± 0.28 0.79 ± 0.54 * 0.34 ± 0.51 Smo IRS 64.8 ± 5.3 65.5 ± 12.1 0.71 ± 10.6 † 1.18 ± 0.27 1.13 ± 0.38 0.05 ± 0.30 † Data are mean ± SD. * p &lt; 0.01 vs. 1st angio by paired t-test; § p &lt; 0.05 vs. IRS. and † p &lt; 0.01 vs. Com IRS by unpaired t-test. Com = complex. Smo = smooth Despite clinical stabilization, IRS are unstable and at high risk for rapid progression to total occlusion, which is usually associated with coronary events.

Oat bran lowers total and low-density lipoprotein cholesterol but not lipoprotein(a) in exercising adults with borderline hypercholesterolemia

Elevated total and low-density lipoprotein (LDL) cholesterol (LDL-C) levels have been related to increased risk of heart disease (1). Reduction of total and LDL-C levels has been shown to decrease heart disease risk (2) and to regress some atherosclerotic lesions in coronary arteries (3). Dietary change, with a focus on reducing dietary fat and cholesterol, has been recommended as the initial method of intervention (4) and has been shown to contribute to a regression of stenosis in coronary arteries (5). Cholesterol-lowering medications have been effective, but they have been accompanied by side effects (6) and great cost to the individual patient (7). Oat bran has repeatedly been shown to lower cholesterol levels (8,9) and to be cost-effective compared with cholesterol-lowering medications (7).

Long-term follow-up and clinical outcome of carotid restenosis

The efficacy of carotid endarterectomy is dependent on the inherent ability of the operation to prevent stroke as well as the incidence of restenosis and associated symptoms. To examine the long-term effects of restenosis, 301 patients having carotid endarterectomy were followed by serial duplex scanning for an average of 4 years. Carotid restenosis, defined as 50% or greater diameter reduction by duplex scanning, occurred after 78 of the endarterectomies; regression of recurrent stenosis occurred in 20 arteries. By life-table analysis the cumulative incidence of restenosis at 7 years was 31%, and the cumulative incidence of regression was 10%. Thus the prevalence of recurrent stenosis at 7 years was 21%. Restenosis developed in women more frequently than men (p = 0.01). Transient ischemic attack occurred in 12% of patients with restenosis, and stroke occurred in 3%; however, the cumulative incidence of stroke or transient ischemic attack was not statistically different in those patients with and without restenosis. Similarly, cumulative survival at 7 years was no different. Carotid restenosis usually occurs early in the postoperative period and tends to regress or remain stable during long-term follow-up. A conservative approach to treatment appears justified, since transient ischemic attacks and stroke were rarely associated with restenosis.

Carotid artery stenosis following endarterectomy.

Duplex scanning and spectral analysis were used to detect carotid artery stenosis following 89 endarterectomies in 76 patients with a mean postoperative follow-up interval of 16 months. Operative arteriography was used in all cases to verify the technical result. Spectral changes indicating greater than 50%-diameter internal carotid stenosis were observed postoperatively in 32 of the 89 sides. Serial follow-up of 22 stenotic sides showed persistent stenosis in 12, regression of stenosis in nine, and internal carotid occlusion in one. The estimated overall incidence of persistent high-grade stenosis was 19%. Recurrent neurologic symptoms occurred in eight patients. This incidence of postoperative carotid stenosis is higher than estimates based on clinical criteria. The transient nature of some early postoperative stenosis is consistent with proliferation and regression of myointimal lesions in response to arterial injury.

Benign Mesenchymal Tumor of the Heart: Spontaneous Regression and Disappearance of Pulmonary Artery Stenosis

We describe a patient who was found to have a large benign mesenchymal tumor of the right ventricular wall and right pulmonary artery stenosis at the age of 20 months. Following biopsy of the tumor, the patient’s respiratory distress improved gradually and cardiac catheterization at the age of ten years showed normal intracardiac pressures and disappearance of right pulmonary artery stenosis. He remained asymptomatic at age 20. Possible factors for the spontaneous regression of the tumor are discussed. We describe a patient who was found to have a large benign mesenchymal tumor of the right ventricular wall and right pulmonary artery stenosis at the age of 20 months. Following biopsy of the tumor, the patient’s respiratory distress improved gradually and cardiac catheterization at the age of ten years showed normal intracardiac pressures and disappearance of right pulmonary artery stenosis. He remained asymptomatic at age 20. Possible factors for the spontaneous regression of the tumor are discussed.