View
213
Download
0
Category
Preview:
Citation preview
218
CONCLUSION: In patients with severe PVD, significantsubclavian artery stenosis is common, is frequently bilateral and may lead to a considerable underestimationof the severity of hypertension. When the opportunityarises, blood pressure measurements by cuff should becompared with aortic pressure. Large differences mayindicate the need for more aggressive medical or percutaneous therapy and have implications for post-procedure monitoring.
Contrast Media in CT Angiography: FactorsInfluencing the Enhancement of Portal Systemjoan Koo Han, MD, Seoul, Korea. Ki Yeol Lee, MD.
Hong Dae Kim, MD. Byung Ihn Choi, MD. jae
Hyung Park, MD. Man Chung Han, MD
PURPOSE: To know the factors influencing the enhancement of portal venous system.
SUBJECTS AND METHODS: In eight dogs, single leveldynamic CT through the liver was done at 5 secondsinterval just after the contrast media injection for 3 minutes. We used combination of three different amount (1,2, 3 cc/kg), concentration (150, 200, 300 mgVrnl), andinjection speed (0.5, 1, 2 cclkg). In each CT scans,enhancement curve of aorta (Ao) , portal vein (PV) andliver (L) was obtained. The degree of maximum enhancement (Imax), time to reach peak enhancement(Tmax) and time to equilibrium (Teq) were analyzed in216 graphs.
RESULTS: With increasing amount of contrast media,Imax, Tmax and Teq of Ao, PV and L increased significantly. With increasing speed of injection, Imax of Aoincreased, Tmax and Teq of Ao decreased significantly.However, Imax of PV and L did not show significantchange. Use of more concentrated contrast result insignificant increase in Tmax of Ao, slight increase inTmax of PV & 1. Teq and Tmax did not show Significantchange.
CONCLUSIONS: Volume of the contrast had most significant effect on the degree of contrast enhancement. Injection speed has prominent effect on arterial enhancement, however, has limited effect on portal venoussystem.
Renal Angiomyolipomas: Relationship Betweenan Aneurysmal Size and a RuptureNaoshi Tanaka, MD, TSU, MIE. Koichiro Yamakado,
MD. Toshio Nakagawa, MD. Tandanori Hirano, MD
• Kaname Matsumura, MD. Kan Takeda, MD
PURPOSE: A spontaneous rupture is the major complication of renal angiomyolipomas (AMLs). The tumor sizeand the symptoms have been considered factors to predict a rupture of AMLs. It is known that AMLs frequentlyassociate aneurysms. But there were no reports studyinga relationship between the aneurysmal size and the rupture. In this study, we evaluated whether aneurysmalsize can be a predictor for the rupture.
MATERIALS AND METHODS: Eighteen patients withAMLs were retrospectively studied. Five patients underwent angiography just following spontaneous ruptureand rest thirteen patients underwent angiography without any history of rupture. A relationship between theaneurysmal size and the rupture was evaluated in theruptured and unruptured AMLs.
RESULTS: Aneurysmal formation was found in all '; patients with ruptured AMLs and 9 of 13 patients withunruptured AMLs. Mean aneurysmal size of rupturedAMLs was significantly larger than that of unrupturedAMLs (13.4 mm vs 2.8 mm; p < 0.01). AMLs with large(;:::9 mm) aneurysms ruptured more frequently thanthose with small «9 mm) aneurysms (83.3% vs 0%; P <0.01).
CONCLUSIONS: Aneurysmal size can be considered afactor to predict a spontaneous rupture of AMLs in addition to the tumor size and the symptoms.
Arterial Intervention
Acute and Follow up Results With Cutting BalloonInfrapopliteal Angioplastyjean Marc Pemes, PhD, Antony, France. Mario
Auguste, PhD. Eduardo Aptecar, PhD. jean Louis
Lasry, PhD. Denis Hovasse, PhD. jean Paul
Convard, PhD
PURPOSE: The cutting balloon (CB), an innovative newdevice which dilates the atherosclerotic plaque by longitudinal scoring with 3-4 metal blades mounted on theballoon, may lead to minimization of disorderly arterialinjury and reduction of restenosis. We examined theacute and follow up results and effects in cases whichunderwent infrapopliteal angioplasty using CB.
MATERIALS AND METHODS: CB Angioplasty was attempted in 11 patients with chronic critical leg ischemia(6 with rest pain, 5 with tissue necrosis, and 11 withankle pressure < 50 mmHg). Sixteen infrapopliteallesions were treated (12 stenosis and 4 short occlusions of4 anterior tibial arteries, 4 peroneal arteries and 3 posterior tibial arteries). The 3.6 F coaxial device was inserted through a SF antegrade femoral sheath. Infrapopliteal angioplasty was performed with 2- and 4-mmdiameter CB in conjunction with 0.014 "guide wire. At 6attn of pressure, an inflation time of one minute wasused. Angiographic follow-up was performed at an average of 7.2 months.
RESULTS: CB alone with a single, short inflation and noadjunctive balloon was performed with technical successin 95% of the cases. Local dissection, visible angiographically was present in 1 patient. Stenting was never required. No complications were encountered. All patientsshowed clinical improvement at 1 month. The restenosisrate was 26%.
CONCLUSION CB dilates well in less procedural time.Sharp and regular endovascular surgical incision leads tofewer dissections and a relatively low restenosis rate.
Long Term Patency Rate in Post-Angioplasty DiacArtery Dissection Treated With self-Expandable StentMarc Robert Sapoval, MD, PhD, Paris, France.Hernan Gabriel Bertoni, MD. Alain Claude Raynaud,
MD • Bernard Marie Beyssen, MD. Thierry Carreres,
MD • jean-Claude Gaux, MD
PURPOSE: To evaluate long-term patency rate of iliacstent as treatment of post-angioplasty dissection.
MATERTALS AND METHODS: Between October 1988 andAugust 1997, 40 consecutive patients were treated foracute arterial dissection following iliac angioplasty byimplantation of a Wallstent in the same session.
Patients were followed-up clinically and by intravenous angiography or dupplex scanning.
Clinical success was defined as relieved or improvedsymptoms.
Angiographical success during follow-up was defined
as absence of total occlusion or restenosis >50%. Patency rates were calculated using the life table method.
RESULTS: The initial technical success rate was 97%.Three complications were observed during the firstmonth (7.5%). Mean angiographical follow-up was 31months [8d-103 months].
Angiographic primary (secondary) patency were95 ::':: 3,6% (95 ::':: 3.6%) at 6 months and 68 ::':: 12.8%(78 ::':: ] 1%) at 4 years. At the end of clinical follow-up(mean = 3 years), 30 patients (75%) had maintainedclinical success and 10 (25%) were not improved.
CONCLUSION Wallstent implantation is an effective and safemethod to treat PTA induced dissection with a high primarysuccess rate and satisfactory long term patency rate.
Placement of Palmaz-Midsize-Stent inSymptomatic Peripheral Occlusive Artery DiseaseStefan Mueller-Huelsbeck, MD, Kiel, Germany.Helmut Schwarzenberg, MD. johann Link, MD.joachim Brossman, MD. johann Christian Stefens,MD • Martin Heller, MD
PURPOSE: To evaluate effectiveness, success and patency rates after endovascular treatment with mid-sizePalmaz-Stents in high-grade stenoses or short-distanceocclusions of femoral arteries.
MATERIALS AND METHODS: Twenty-seven patientswith 10 occlusions (average length of 3.2 ::':: 1.4 cm [SD])and 17 severe stenoses of the superficial femoral arterywere treated with 33 mid-size Palmaz-Stents. Accuratestent deployment was controlled with intravascular ultrasound to achieve complete expansion. The follow-upprovided Doppler ultrasound at 1, 3, 6 and 12 monthsand an angiography at 6 months and was 6.1 month inmean.
RESULTS: Stent placement succeeded in 100%. Final angiography depicted complete stent deployment. The ankle-brachial-index improved from 0.57 ::':: 0.28 [SD] pretreatment to 0.86 ::':: 0.12 [SD] within 24 hours. Acutethrombosis occurred in two patients «3 weeks). Angiography at 6 months revealed restenosis rates of 11%«50% n = 2; >50% n = 1). Survival analysis revealed6-month primary and secondary patency rates of 88.9%
and 96.3%.
CONCLUSION With regard to our limited data, the implantation of mid-size Palmaz stents in femoral arteriesseems promising in treatment of short-distance occlu
sions and stenoses of the femoral artery.
Endoprostheses Prevent Recurrent Restenosis inTransplant Renal ArteriesSergio David Sierre, MD, Paris, France. Alain ClaudeRaynaud, MD. Thierry Carreres, MD. Marc Robert
Sapoval, MD, PhD. Bernard Marie Beyssen, MD.
jean-Claude Gaux, MD
PURPOSE: To evaluate the efficacy of stent placement inthe treatment of recurrent restenosis of transplant renalartery (TRA).
PATIENTS AND METHODS: Retrospective study including 6 consecutive patients who underwent a mean of
3.66 previous treatments of TRA stenosis/patient beforestent implantation (20 angioplasties and 2 surgical procedures). The endoprostheses were a Wallstent in 4patients and a Palmaz stent in 2. Clinical, biological andduplex scanning follow-up was performed every six
months after stent placement in all patients.
RESULTS: The procedure was a technical success in allpatients, without complications. At six months, meansystolic blood pressure decreased from 179 to 152mmHg (P = .018), mean diastolic blood pressure from102 to 90 mmHg (P = .09). Mean serum creatinine leveldropped from 269 to 182 mmolll (P = .03) and thenumber of antihypertensive drugs/patient from 2.5 to1.6. At a mean follow-up of 28.3 months all TRA werepatent, with a stenosis of 40% without clinical consequences in 1 patient. No secondary procedure was necessary.
CONCLUSION Stenting is an effective treatment of TRArecurrent restenosis. Long term follow-up shows satisfactory clinical results and TRA patency rates. Stent implantation should be considered as the first-choice treatment of iterative TRA restenosis.
Polyethylene Terephthalate Covered Wallstents™With and Without TetrafIuoroethylene Coating ina Canine ModelYonghua Dong, MD, Cleveland, OH. Bart Dolmatch,MD • Randy LaBounty. Luke Brennecke
PURPOSE: To evaluate the in vivo performance of twotypes of Polyethylene Terephthalate (PET) covered Wall-
219
stents™ implanted in canine iliac arteries with regard tohealing response and patency.
METHODS AND MATERiALS: Two types of PET covered
Wallgrafts™ were prepared; one without any additional
treatment (PET-WS), and one with a Tetrafluoroethylene
coating (TFE-WS). These devices were implanted in the
iliac arteries of 22 mongrel dogs; TFE-WS on the right,
PET-WS on the left. Angiography, intravascular ultra
sound (IVUS) and histology were obtained at 0.5, 1, 3,
and 6 months. Five dogs remain alive for 12 month
follow-up.
RESULTS: Data on 16 dogs was evaluated. There were 3
occlusions; 1 TFE-WS and 2 PET-WS's. These was no
significant difference between two Wallgrafts™ in tissue
response, both showing previously reported monocyte
and giant cell foreign body reaction.
CONCLUSION TFE coating did not alter the cellular re
sponse related to Wallstents™ covered with PET.
Gender Differences in Outcome of PeripheralAngioplasty-Results of the STAR RegistryMichael C. Soulen, MD, Philadelphia, PA • Nitin
Kumar, MD
PURPOSE: 1. To evaluate gender differences in the
success and complications for peripheral angioplasty.
2. To evaluate gender differences in the relationship of
the common femoral artery (CFA) to the underlying
bone.
METHODS: 1. Technical success and complication rates
were determined for 232 patients 026 men, 106 women)
undergoing peripheral angioplasty randomly selected
from the SCVIR Transluminal Arterial Revascularization
(STAR) Registry. 2. The relationship of the CFA to theunderlying bone was measured on pelvic CT examina
tions of 100 men and 100 women.
RESULTS: Technical success was achieved in 76% ofmen and 81% of women (p = NS). Procedure sitecomplications (dissection, perforation, thromboembo
lism) occurred in 12% of men and 8% of women (p =
NS). Puncture site complications (hematoma> 4 cm.,
pseudoaneurysm, arteriovenous fistula, thrombosis)
occurred in 4 men (3%) and 17 women 06%), p < .01.
Men have fatter groins than women (57 vs. 53 mm,
p < .04). The femoral artery lies a similar distance
from the skin in women and men (28 mm, p = NS),
but closer to the underlying bone in women (24 vs. 30
mm, p < .0001).
CONCLUSION Peripheral angioplasty is equally suc
cessful in men and women. Puncture site complica
tions occur five times more frequently in women.
Body habitus does not appear to account for this.
Possible causes include differences in vessel size or
220 fragility.
Prostaglandin El Reduces Neointimal HyperplasiaAfter Stent Implantation Without SystemicAnticoagulation: Experimental Study in CanineKazumasa Seiji, MD, Sendai, Miyagi. Toshio
Matsuhashi, PhD, MD • Hideo Miyachi. Tadashi
Ishibashi, PhD, MD • Shoki Takahashi, PhD, MD •
Shogo Yamada, PhD, MD
PURPOSE: Endovascular stenting is accepted widely as a
treatment for stenotic vascular lesions. However, acutethrombosis and late neointimal formation remain a concern. In this study we investigated the effectiveness ofprostaglandin El (PGEl), which has anti-platelet aggregating activity, in the prevention of neointimal hyperplasia after stent implantation.
MATERiALS AND METHODS: Eight mongrel dogs wereevenly assigned either to a control group infused withsaline solution or to a treatment group infused with
PGE1. Z-stents were placed in the right iliac veins of thedogs. Both saline solution and PGEI (0.3 micrograms/
kg/hour) were administered intravenously beginning 30minutes before stent implantation and until 4 hours afterstenting. At 4 weeks, the dogs were sacrificed, and neo
intimal thickening was measured by light microscopy.Measurements were analyzed statistically.
RESULTS: All vessels were patent at the time of harvest.Mean neointimal thickness was significantly less in thetreated group compared with the control group (0.48
mm ± 0.69 standard deviation versus 0.82 mm ± 0.87standard deviation, respectively; P < .01).
CONCLUSIONS: PGEI effectively prevents neointimalhyperplasia after stent implantation.
Early Results of AAA Stenting May Be MisleadingAndrew Brown. Newcastle upon Tyne, England.John D.G. Rose, • Michael G. Wyatt
PURPOSE: This paper examines early changes in AAAsize following apparently successful aortic stenting.
METHODS: Thirty six AAA's have been repaired using abifurcate system. The maximum aortic diameter was recorded for each patient on a pre-operative CT scan.Follow-up scans have been performed at regular postoperative intervals 0, 3, 6 and 12 months)/ All scanshave been examined for endoleak and change in AAAdiameter by a consultant interventional radiologist. Patients have been grouped dependent upon initial AAA
size (Group 1, 45-54mm; Group 2, 55-64mm; Group 3,
>65mm).
RESULTS: Twenty eight of these patients have reached1 month follow up (range 1-18 months; median 6
months). The median diameter has reduced in all
groups:Eighteen aneurysms have decreased in size (64%),
one despite a small persisting endoleak. In 10 patients,the aneurysm sac has either remained the same (4) or
increased (6) in diameter. In only one of these has CT
detected an endoleak, and this closed spontaneously at
3 months.
CONCLUSION Despite median diameter decrease in all
groups, CT scanning has revealed shrinkage of the sac in
only 64% of patients. AAA diameter is actually increasing
in 21%, despite an apparently successful procedure.
These early findings are worrying and may reflect inad
equate exclusion of the AAA from the systemic circula
tion. Conventional CT may not be detecting small en
doleaks and interpretation of 'stenting success' must be
guarded until long term results are available.
Role of Urokinase in the Treatment of AcuteArteriall Occlusion of the Small Vessels of theHand and ForearmStephen P. johnson, MD, Denver, CO. Salman Bashir,
MD. janette D. Durham, MD. Stephen W Subber,
MD • joseph Krysl, MD. David A. Kumpe, MD
PURPOSE: We reviewed our experience with regional
thrombolytic therapy in acute arterial occlusions of the
forearm and hand.
MATERlALS AND METHODS: Twelve patients with acute
(n = 8) or subacute (n = 4) arterial ischemia secondary
to occlusion of arteries of the forearm and hand who
underwent regional urokinase infusion were retrospec
tively identified. Pre and post treatment arteriograms
were compared to document arterial patency prior to
and following therapy. Medical and radiological records
were reviewed to assess improvement in ischemic cate
gory and extremity viability.
RESULT'S: Following therapy, 12 patients demonstrated
angiographic improvement and 8 patients had viable
extremities without ischemia. Tissue necrosis in 4 pa
tients led to partial amputation of one (n = 2) and three
(n = 2) digits. The level of amputation was altered
favorably in all but one patient. Three of these patientshad category 3 ischemia at presentation. One patient
required surgery to control two puncture site hemorrhages. There were no other complications.
CONCLUSIONS: Thrombolysis with regional urokinasecan opti!llize digital run-off, improve ischemic symp
toms, limit tissue loss, and obviate or improve the op
tions for digital surgical bypass in patients with forearmand hand ischemia.
In Vitro Effectiveness Study for HydrodynamicThrombectomy DevicesStefan Mueller-Huelsbeck, MD, Kiel, Germany.
Helmut Schwarzenberg, MD. Christopher Bangard •
Martin Heller, MD
PURPOSE: To determine the efficacy for the hydrody
namic thrombectomy devices Angiojet™ (AD, Hydrolyser™ (HL) and S.E.T.TM (SET).
MATERIALS AND METHODS: Thrombectomy of clots(n = 70; 7,31 g) from 7-day old porcine blood wasperformed with either A], HL or SET in an in vitroflow-model simulating the superficial femoral artery. Allcatheters were used with and without recommendedguidewires (SET.014 inch/A] and HL.018 inch!HL.025
inch).
RESULTS: Mean thrombectomy time ranged from 10.2 s
(HL) to 37.7 s (AJ018) and was prolonged, if AJ and HL
were used with a guidewire (p < 0.01). AJ, AJ018 and
HL.018 worked isovolumetrically, mean quotients of ap
plied saline and aspirated fluid decreased (p < 0.01) for
HL to 0.5 and SET to 0.6. Overall weight of emboli inmean determined for 10, 100 and 1000 j1.m seize and
percentage emboli weight related to thrombus weight in
mean were 56.4 mg/0.78% (AD, 23 mg/0.31% (A].018),
3.2 mg/0.04% (SET; p < .01), 1.9 mg/0.03% (SET.014;
p < .01), 9.9 mg/0.13% (HL; p < .05), 66.5 mg/0.91%
(HL.018) and 24.7 mg/0.34% (HL.025).
CONCLUSIONS: Emboli rates of all used devices are low.
Thrombectomy time and emboli rate in vitro depend on
the chosen device and on the use of guidewires. Using
SET and HL, aspirated fluid exceeded applied salinevolumina. In vivo this may lead to blood loss and a
decrease of hemoglobin, additional to hemolysis caused
by high pressure saline jets.
The Management of Peripheral ArterialAneurysms Using Percutaneous Injection ofFibrin AdhesiveHenry William Loose, MD, Newcastle upon Tyne,
England. Philip Haslam, MD. Ian Morris, MD.
Patrick Kesteven, MD
PURPOSE: To investigate a method of occlusion of an
eurysms maintaining preservation of the artery of origin
and avoid the use of metallic coils and endovascular
stents.
MATERIALS AND METHODS: An angioplasty balloon
catheter is placed across the neck of the aneurysm andinflated to occlude flow within the sac. This is confirmedby Doppler ultrasound examination and guided percutaneous needle puncture is directed into the aneurysmcavity. 3 rnls of fibrin tissue adhesive (Beriplast-P) isinjected into the cavity while the balloon catheter remains inflated. The production of clot within the cavity isconfirmed by ultrasound and the needle is then withdrawn.
RESULTS: Nine patients with peripheral aneurysms (6
femoral, 2 popliteal and 1 posterior tibial) have been
successfully treated. Two femoral aneurysms demon
strated very minor residual flow on follow-up ultrasound
at 12 hours but both thrombosed at 24 hours. No complications have resulted.
CONCLUSION The technique adds to the availablemethods of treatment of aneurysms with preservation of
221
222
an intact vessel of origin. It is cost effective, requiresminimal hospitalisation and avoids the use of generalanaesthetic.
Embolization of Aortic Branch Vessels Prior toEndovascular Repair of Abdominal AorticAneurysms: Technical and Early Clinical ResultsRichard Edwards, FRCR, Glasgow, England. Derek
Gould, FRCR. Jonathan Moss, FRCR
PURPOSE: Communicating endoleaks are a recognizedcomplication of endovascular repair of abdominal aorticaneurysms (AAA) and may result from antegrade or
retrograde flow through patent lumbar branches or theinferior mesenteric artery (IMA). Continued pressuriza
tion of the aneurysm sac places the patient at risk of
delayed rupture and pre-operative embolization may
avoid this complication. We present our experience of
pre-operative embolization of aortic branch vessels in 11patients prior to endovascular repair of AAA.
MATERIALS AND METHODS: Detailed visceral angiography was performed in all cases. Coil embolization was
attempted in 11 IMA's and 4 lumbar arteries. Coaxial
catheter techniques were used in 5 cases and a brachialapproach was used in 6 patients. Antibiotics were administered for 24 hours and endovascular repair was
performed within this period.
RESULTS: IMA embolization was technically successful in
10 of 11 patients and 4 lumbar arteries were embolized
in 2 patients. There was no clinical evidence of post
procedural colonic or distal limb ischaemia.
CONCLUSIONS: Embolization of patent aortic branches
appears to be technically feasible and in this series noSignificant complications were encountered.
Preoperative Embolization of MeningiomasOlivier Christian D'Archambeau, MD, Edegem,Antwerp, Belgium. Luc van den Hauwe, MD. Arthur
Marcel De Schepper, MD, PhD
PURPOSE: The feaSibility of preoperative devascularization of meningiomas depends on the localization of thetumor and on the pattern of vascularization. We evalu
ated the potential risk that the ophthalmic artery mayrepresent during the embolization procedure.
MATERIALS AND METHODS: From January 1990 until
January 1997, 81 patients with CT or MRl diagnosis of
meningioma have been investigated angiographically.The average tumor size was 4.5 cm (range 1-12 cm).
In all patients we performed a selective catheterizationusing a vertebral or Simmons shaped diagnostic cath
eter and a microcatheter, followed by preoperative embo
lization with PYA particles in 42 patients. No embolization was attempted in 23 patients because of internal carotid artery vascularization (n = 10), technical failure (n =
7), feeders not clearly identified (n = 5) and allergic reac
tion prior to embolization (n = 1). In 16 patients no pre-
operative embolization was required by the referring clini
cians.
RESULTS: Complete tumor devascularization was
achieved in 16 patients, subtotal devascularization (50%
99%) in 18 patients, and partial devascularization (less
than 50%) in 8 patients. Major complications occurred
in 3 patients, 2 related to the ophthalmic artery, One
patient left the angio suite with a transient hemiplegia
as a consequence of reflux of contour particles
through the ophthalmic artery in the internal carotid
artery. He recovered completely after a period of one
week. In another patient the ophthalmic artery origi
nated from the feeding middle meningeal artery. Dis
tal catheterization was difficult resulting in a epidural
extravasation.
CONCLUSION Preoperative meningioma embolization is
a safe and effective procedure when performed by
skilled radiologists. However, anatomical variants and
collateral circulation to the ophthalmic artery have to be
recognized prior to embolization in order to avoid po
tential severe complications.
Effect of Oral Anti-allergic Medicine in PreventingAdverse Intimal Hyperplasia After StentPlacementNobushige Hayashi, MD, Yoshida-gun, FukUi, Japan.
Rika Inagaki, MD. Toru Yamamoto, MD. Toyohiko
Sakai, MD. Yasushi Ishii, MD
PURPOSE: To investigate the effectiveness of oral anti
allergic medicine (Tranilast), in preventing the undesir
able intimal hyperplasia of the aortic wall after stent
placement.
MATERIALS AND METHODS: Ten rabbits in whichexpandable metallic stents were placed in the aorta
were studied. Five of them started a diet mixed with
Tranilast one week before the stent placement, and
continued it until they were sacrificed. As controls, the
other rabbits were administered a normal diet. All the
animals were sacrificed four weeks after the stent
placement. Their aorta, including the stents, were
fixed with formalin, and the extent of intimal hyper
plasia was measured under the microscope using the
area measuring device.
RESULTS: The mean area of intima of the aortic wall in
the Tranilast-fed group was measured as 1.08 mm2,
which was significantly smaller than that in the control
group (2.45 mm2). The stenosis ratio also was signif
icantly smaller in the Tranilast group (23.1% Vs
37.2%).
CONCLUSION: Tranilast effectively prevented the intimal
hyperplasia of the aortic wall in the rabbits after stent
placement. It appears to hold promise as an adjunct to
prevent adverse intimal hyperplasia in human beings.
Recommended