Balloon Dilation of Atheroma

Pathophysiological Changes and Clinical Implications

Professor Atef Allam • Interventional Techniques • Pathophysiology
The pathophysiological changes following balloon dilation involve a cascade of mechanical and biological processes that lead to both immediate relief of arterial obstruction and potential complications. Understanding these mechanisms is crucial for optimizing interventional outcomes.
1

Mechanical Plaque Alteration

Compression and Fracture

Balloon inflation compresses the atheroma against the arterial wall, fracturing the plaque and expanding the lumen.

Endothelial Injury

Procedure damages endothelial layer, exposing subendothelial collagen and plaque components, activating platelets.

2

Acute Vascular Responses

Elastic Recoil

Artery may partially collapse post-deflation, especially in calcified plaques, reducing lumen gain.

Dissection & Vasospasm

Overstretching causes microtears; endothelial dysfunction impairs nitric oxide release.

3

Thrombotic & Inflammatory

Thrombosis Formation

Exposed components trigger platelet adhesion. Antiplatelet therapy critical for prevention.

Inflammatory Response

Neutrophils and macrophages infiltrate, releasing cytokines and growth factors driving SMC activation.

4

Healing & Remodeling

Neointimal Hyperplasia

Migrating SMCs proliferate in intima, producing extracellular matrix. Key contributor to restenosis.

Vascular Remodeling

Negative: vessel contraction reduces lumen. Positive: external membrane expansion preserves patency.

Long-Term Outcomes

Restenosis Risk

Historically, 30–50% experienced renarrowing. Drug-eluting stents reduce this by releasing antiproliferative agents like sirolimus.

Disease Progression

Balloon dilation doesn't halt underlying atherosclerosis. Comprehensive medical management remains essential for long-term outcomes.

Clinical Summary

Balloon dilation induces acute mechanical benefits but triggers complex healing responses. Understanding these mechanisms underscores the importance of adjunctive therapies and advanced technologies to optimize patient outcomes.