Chapter 5 - Intimal hyperplasia

Question 1

Stages of intimal hyperplasia development

Answer 1

Stage 1: hyperacute min-hours Stage 2: acute hours to weeks Stage 3: chronic weeks to months

Question 2

Stage 1 intimal hyperplasia

Answer 2

FIGURE 5.1

Question 3

Stage 2 intimal hyperplasia

Answer 3

FIGURE 5.1

Question 4

Stage 3 intimal hyperplasia

Answer 4

FIGURE 5.1

Question 5

Platelet adhesion requires the interaction of subendothelial collage with what

Answer 5

Platelet membrane glycoproteins: GPIb, GPIc/GPIIa, GPIa/GPIIa von Willebrand factor Fibronectin

Question 6

Pathobiology of the injury response after angioplasty leading to intimal hyperplasia

Answer 6

FIGURE 5.1

Question 7

Drive for the first phase of SMC proliferation

Answer 7

bFGF released from dead and damaged cells

Question 8

Diabetes increases production of what in the vascular tissues

Answer 8

Advanced glycosylation end productsion also occurs with normal aging

Question 9

4 categories of in-stent restenosis

Answer 9

1) Focal < 10 mm 2) diffuse > 10 mm 3) proliferative > 10 mm, extends outside 4) occlusion

Question 10

Benefit of stenting over balloon only on a cellular level

Answer 10

Removes elastic recoin and negative remodelling cannot stop thrombus formation and intimal hyperplasia

Question 11

Consequences and cures of angioplasty

Answer 11

FIGURE 5.3

Question 12

DES on intimal hyperplasia

Answer 12

stops SMC proliferation but also stops endothelial cell migration and proliferation increase thrombogenic potential polymer can also increase thrombotic potential

Question 13

Pathobiology of vein graft response to implantation

Answer 13

FIGURE 5.4

Question 14

Factors associated with vein bypass intimal hyperplasia

Answer 14

1) dyslipidemia 2) high fibrinogen 3) high homocysteine 4) high antibodies to cardiolipin 5) smoking 6) platelet dysfunction 7) lipoprotein ?

Question 15

Differing accelerated atherosclerosis from spontaneous atherosclerosis

Answer 15

Accelerated = diffuse, concentric, greater cellularity

Question 16

Endothelialization of prosthetic bypass graft

Answer 16

limited to the first few CM near anastomoses rest is covered in thin irregular layer of organized fibrin (platelet, leukocyte) mostly collagen type III (no type II)

Question 17

Two process of neo-endotehlium formation in prosthetic graft

Answer 17

1) from anastomosis 2) penetrating though graft pores with capillary ingrowth

Question 18

6 stages of neoendothelial healing

Answer 18

STAGE 1: Platelet aggregation phase STAGE 2: fibrin network phase STAGE 3: bridging phase STAGE 4A: progression phase STAGE 4B:transmural migration phase STAGE 5: intimal closure phase STAGE 6: endothelial thromboresistance phase

Question 19

Use of ASA in prosthetic grafts

Answer 19

prevent graft thrombosis at 2-4 weeks but does not prevent intimal hyperplasia

Question 20

pathobiology of prosthetic graft after implantation

Answer 20

FIGURE 5.5

Question 21

Most common regions of intimal thickening in dialysis access grafts

Answer 21

1) anastomotic site (worse with PTFE) 2) floor of artery

Question 22

Most common stenosis in dialysis access

Answer 22

within 1 cm from venous anastomoses