Circulation, Vol 79, 1374-1387, Copyright © 1989 by American Heart Association
MW Liu, GS Roubin and SB King 3d
Restenosis after successful PTCA remains a major problem limiting the
efficacy of the procedure. The pathophysiologic mechanism of restenosis has
been enigmatic so far, but accumulated evidence strongly suggests that
intimal hyperplasia is the major mechanism. Based on current understanding
of the process of intimal hyperplasia, one unifying concept may be that
there are at least two major local biologic determinants influencing this
process, lesion characteristics and regional flow dynamics. Lesion
characteristics include the plaque structure and the quantity of smooth
muscle. These may provide the anatomic substrate that determines the extent
of injury and the degree of smooth muscle cell proliferation. The amount of
smooth muscle cells in the stenotic lesion activated by injury to undergo
proliferation may determine the eventual bulk of the restenotic lesion. In
addition, low wall shear stress could promote intimal hyperplasia and cause
structural change of vessels to decrease the lumen, whereas high wall shear
stress exerts the opposite effects. Intimal hyperplasia after balloon
injury is a complex process involving platelets, growth factors,
endothelial cells, smooth muscle cells, mechanical injury, wall shear
stress, and probably other unknown factors. Platelets not only contribute
growth factors such as PDGF but also cause organized thrombus. Different
growth factors may be involved in initiating smooth muscle cell
proliferation and may come from many different sources, including smooth
muscle cells, endothelial cells, and macrophages. Intact confluent
endothelial cells may produce heparin sulfates and inhibit intimal
proliferation; however, regenerating endothelial cells may have the
opposite effect. Thus, the proliferative potential of smooth muscle cells,
endothelial recovery, extent of injury, wall shear stress, and other
unknown factors may all influence this process. Based on these concepts
concerning the biology of restenosis, some research directions concerning
potential forms of therapy are proposed.
ARTICLES
Restenosis after coronary angioplasty. Potential biologic determinants and role of intimal hyperplasia
Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
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A. Lafont and D. Faxon Why do animal models of post-angioplasty restenosis sometimes poorly predict the outcome of clinical trials? Cardiovasc Res, July 1, 1998; 39(1): 50 - 59. [Full Text] [PDF]
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M. V. Autieri and N. Agrawal IRT-1, a Novel Interferon-gamma -responsive Transcript Encoding a Growth-suppressing Basic Leucine Zipper Protein J. Biol. Chem., June 12, 1998; 273(24): 14731 - 14737. [Abstract] [Full Text] [PDF]
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Y. Muranaka, Y. Yamasaki, Y. Nozawa, H. Terakawa, Y. Tanahashi, N. Oda, A. Satoh, T. Asao, H. Miyake, and N. Matsuura TAS-301, an Inhibitor of Smooth Muscle Cell Migration and Proliferation, Inhibits Intimal Thickening after Balloon Injury to Rat Carotid Arteries J. Pharmacol. Exp. Ther., June 1, 1998; 285(3): 1280 - 1286. [Abstract] [Full Text]
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B. J. G. L. de Smet, G. Pasterkamp, Y. J. van der Helm, C. Borst, and M. J. Post The Relation Between De Novo Atherosclerosis Remodeling and Angioplasty-Induced Remodeling in an Atherosclerotic Yucatan Micropig Model Arterioscler Thromb Vasc Biol, May 1, 1998; 18(5): 702 - 707. [Abstract] [Full Text] [PDF]
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K. Kaur, J. Yao, X. Pan, C. Matthews, and A. Hassid NO decreases phosphorylation of focal adhesion proteins via reduction of Ca in rat aortic smooth muscle cells Am J Physiol Heart Circ Physiol, May 1, 1998; 274(5): H1613 - H1619. [Abstract] [Full Text] [PDF]
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S. Janssens, D. Flaherty, Z. Nong, O. Varenne, N. van Pelt, C. Haustermans, P. Zoldhelyi, R. Gerard, and D. Collen Human Endothelial Nitric Oxide Synthase Gene Transfer Inhibits Vascular Smooth Muscle Cell Proliferation and Neointima Formation After Balloon Injury in Rats Circulation, April 7, 1998; 97(13): 1274 - 1281. [Abstract] [Full Text] [PDF]
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E. Van Belle, C. Bauters, T. Asahara, and J. M. Isner Endothelial regrowth after arterial injury: from vascular repair to therapeutics Cardiovasc Res, April 1, 1998; 38(1): 54 - 68. [Full Text] [PDF]
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K. O. Mercurius and A. O. Morla Inhibition of Vascular Smooth Muscle Cell Growth by Inhibition of Fibronectin Matrix Assembly Circ. Res., March 23, 1998; 82(5): 548 - 556. [Abstract] [Full Text] [PDF]
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G. M. Jenkins, M. T. Crow, C. Bilato, Y. Gluzband, W.-S. Ryu, Z. Li, W. Stetler-Stevenson, C. Nater, J. P. Froehlich, E. G. Lakatta, et al. Increased Expression of Membrane-Type Matrix Metalloproteinase and Preferential Localization of Matrix Metalloproteinase-2 to the Neointima of Balloon-Injured Rat Carotid Arteries Circulation, January 13, 1998; 97(1): 82 - 90. [Abstract] [Full Text] [PDF]
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J.-M. Lablanche, E. P. McFadden, N. Meneveau, J. R. Lusson, B. Bertrand, J.-P. Metzger, V. Legrand, G. Grollier, C. Macaya, B. de Bruyne, et al. Effect of Nadroparin, a Low-Molecular-Weight Heparin, on Clinical and Angiographic Restenosis After Coronary Balloon Angioplasty : The FACT Study Circulation, November 18, 1997; 96(10): 3396 - 3402. [Abstract] [Full Text]
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M. Kollum, S. Kaiser, R. Kinscherf, J. Metz, W. Kubler, and C. Hehrlein Apoptosis After Stent Implantation Compared With Balloon Angioplasty in Rabbits : Role of Macrophages Arterioscler Thromb Vasc Biol, November 1, 1997; 17(11): 2383 - 2388. [Abstract] [Full Text]
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H.-I Yeh, F. Lupu, E. Dupont, and N. J. Severs Upregulation of Connexin43 Gap Junctions Between Smooth Muscle Cells After Balloon Catheter Injury in the Rat Carotid Artery Arterioscler Thromb Vasc Biol, November 1, 1997; 17(11): 3174 - 3184. [Abstract] [Full Text]
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R. Pakala, J. T. Willerson, and C. R. Benedict Effect of Serotonin, Thromboxane A2, and Specific Receptor Antagonists on Vascular Smooth Muscle Cell Proliferation Circulation, October 7, 1997; 96(7): 2280 - 2286. [Abstract] [Full Text]
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M. W. Liu, P. G. Anderson, J. F. Luo, and G. S. Roubin Local Delivery of Ethanol Inhibits Intimal Hyperplasia in Pig Coronary Arteries After Balloon Injury Circulation, October 7, 1997; 96(7): 2295 - 2301. [Abstract] [Full Text]
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R. von Essen, R. Ostermaier, E. Grube, W. Maurer, U. Tebbe, R. Erbel, M. Roth, W. Oel, J. Brom, G. Weidinger, et al. Effects of Octreotide Treatment on Restenosis After Coronary Angioplasty : Results of the VERAS Study Circulation, September 2, 1997; 96(5): 1482 - 1487. [Abstract] [Full Text]
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J. Wong, C. Rauhoft, R. J. Dilley, A. Agrotis, G. L. Jennings, and A. Bobik Angiotensin-Converting Enzyme Inhibition Abolishes Medial Smooth Muscle PDGF-AB Biosynthesis and Attenuates Cell Proliferation in Injured Carotid Arteries : Relationships to Neointima Formation Circulation, September 2, 1997; 96(5): 1631 - 1640. [Abstract] [Full Text]
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J. A. Ormiston, F. M. Stewart, A. H. G. Roche, B. J. Webber, R. M. L. Whitlock, and M. W. I. Webster Late Regression of the Dilated Site After Coronary Angioplasty : A 5-Year Quantitative Angiographic Study Circulation, July 15, 1997; 96(2): 468 - 474. [Abstract] [Full Text]
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R. L. Harrell, M. A. S. Rajanayagam, A. M. Doanes, R. J. Guzman, E. A. Hirschowitz, R. G. Crystal, S. E. Epstein, and T. Finkel Inhibition of Vascular Smooth Muscle Cell Proliferation and Neointimal Accumulation by Adenovirus-Mediated Gene Transfer of Cytosine Deaminase Circulation, July 15, 1997; 96(2): 621 - 627. [Abstract] [Full Text]
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C. Amant, C. Bauters, J.-C. Bodart, J.-M. Lablanche, G. Grollier, N. Danchin, M. Hamon, F. Richard, N. Helbecque, E. P. McFadden, et al. D Allele of the Angiotensin I–Converting Enzyme Is a Major Risk Factor for Restenosis After Coronary Stenting Circulation, July 1, 1997; 96(1): 56 - 60. [Abstract] [Full Text]
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J. M. Bosmans, M. M. Kockx, C. J. Vrints, H. Bult, G. R. Y. De Meyer, and A. G. Herman Fibrin(ogen) and von Willebrand Factor Deposition Are Associated With Intimal Thickening After Balloon Angioplasty of the Rabbit Carotid Artery Arterioscler Thromb Vasc Biol, April 1, 1997; 17(4): 634 - 645. [Abstract] [Full Text]
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Y.-H. Chen, Y.-L. Chen, S.-J. Lin, C.-Y. Chou, G.-Y. Mar, M.-S. Chang, and S.-P. Wang Electron Microscopic Studies of Phenotypic Modulation of Smooth Muscle Cells in Coronary Arteries of Patients With Unstable Angina Pectoris and Postangioplasty Restenosis Circulation, March 4, 1997; 95(5): 1169 - 1175. [Abstract] [Full Text]
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D. I. Simon, H. Xu, S. Ortlepp, C. Rogers, and N. K. Rao 7E3 Monoclonal Antibody Directed Against the Platelet Glycoprotein IIb/IIIa Cross-reacts With the Leukocyte Integrin Mac-1 and Blocks Adhesion to Fibrinogen and ICAM-1 Arterioscler Thromb Vasc Biol, March 1, 1997; 17(3): 528 - 535. [Abstract] [Full Text]
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M. J. Vonesh, L. F. Mockros, C. J. Davidson, K. B. Chandran, and D. D. McPherson In Vitro Identification of Angioplasty-Induced Injury by Use of Vascular Acoustic Emissions Circulation, February 18, 1997; 95(4): 1022 - 1029. [Abstract] [Full Text]
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 U. Blum, B. Krumme, P. Flugel, A. Gabelmann, T. Lehnert, C. Buitrago-Tellez, P. Schollmeyer, and M. Langer Treatment of Ostial Renal-Artery Stenoses with Vascular Endoprostheses after Unsuccessful Balloon Angioplasty N. Engl. J. Med., February 13, 1997; 336(7): 459 - 465. [Abstract] [Full Text] [PDF]
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 K. Ovunc, M. Kabukcu, S. Aksoyek, G. Kabakci, K. Aytemir, L. Tokgozoglu, F. Ozmen, M. Ali Oto, and K. Ovunc Is There Any Association Between Dissection After Successful Percutaneous Transluminal Coronary Angioplasty and Late Restenosis? An Angiographic Study Angiology, February 1, 1997; 48(2): 111 - 116. [Abstract] [PDF]
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T. Igura, S. Kawata, J.-i. Miyagawa, Y. Inui, S. Tamura, K. Fukuda, K. Isozaki, K. Yamamori, N. Taniguchi, S. Higashiyama, et al. Expression of Heparin-Binding Epidermal Growth Factor–Like Growth Factor in Neointimal Cells Induced by Balloon Injury in Rat Carotid Arteries Arterioscler Thromb Vasc Biol, December 1, 1996; 16(12): 1524 - 1531. [Abstract] [Full Text]
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R. Forough, N. Koyama, D. Hasenstab, H. Lea, M. Clowes, S. T. Nikkari, and A. W. Clowes Overexpression of Tissue Inhibitor of Matrix Metalloproteinase-1 Inhibits Vascular Smooth Muscle Cell Functions In Vitro and In Vivo Circ. Res., October 1, 1996; 79(4): 812 - 820. [Abstract] [Full Text]
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D. M. Brown, N. M. Kania, E. T. Choi, L. A. Lantieri, E. N. Pasia, T.-C. Wun, and R. K. Khouri Local Irrigation With Tissue Factor Pathway Inhibitor Inhibits Intimal Hyperplasia Induced by Arterial Interventions Arch Surg, October 1, 1996; 131(10): 1086 - 1090. [Abstract] [PDF]
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L. Hofstra, J. H.M. Tordoir, P. J.E.H.M. Kitslaar, A. P.G. Hoeks, and M. J.A.P. Daemen Enhanced Cellular Proliferation in Intact Stenotic Lesions Derived From Human Arteriovenous Fistulas and Peripheral Bypass Grafts: Does It Correlate With Flow Parameters? Circulation, September 15, 1996; 94(6): 1283 - 1290. [Abstract] [Full Text]
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G. S. Mintz, J. J. Popma, A. D. Pichard, K. M. Kent, L. F. Satler, S. Chiu Wong, M. K. Hong, J. A. Kovach, and M. B. Leon Arterial Remodeling After Coronary Angioplasty : A Serial Intravascular Ultrasound Study Circulation, July 1, 1996; 94(1): 35 - 43. [Abstract] [Full Text]
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A. R. Brooks, D. Shiffman, C. S. Chan, E. E. Brooks, and P. G. Milner Functional Analysis of the Human Cyclin D2 and Cyclin D3 Promoters J. Biol. Chem., April 12, 1996; 271(15): 9090 - 9099. [Abstract] [Full Text] [PDF]
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S.-i. Ozeki, A. Ohtsuru, S. Seto, S. Takeshita, H. Yano, T. Nakayama, M. Ito, T. Yokota, M. Nobuyoshi, G. V. Segre, et al. Evidence That Implicates the Parathyroid Hormone–Related Peptide in Vascular Stenosis : Increased Gene Expression in the Intima of Injured Rat Carotid Arteries and Human Restenotic Coronary Lesions Arterioscler Thromb Vasc Biol, April 1, 1996; 16(4): 565 - 575. [Abstract] [Full Text]
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J. Seki, N. Koyama, N. L. Kovach, T. Yednock, A. W. Clowes, and J. M. Harlan Regulation of ß1-Integrin Function in Cultured Human Vascular Smooth Muscle Cells Circ. Res., April 1, 1996; 78(4): 596 - 605. [Abstract] [Full Text]
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M. Ragosta, W. L. Barry, L. W. Gimple, S. D. Gertz, K. W. McCoy, G. A. Stouffer, C. A. McNamara, E. R. Powers, G. K. Owens, and I. J. Sarembock Effect of Thrombin Inhibition With Desulfatohirudin on Early Kinetics of Cellular Proliferation After Balloon Angioplasty in Atherosclerotic Rabbits Circulation, March 15, 1996; 93(6): 1194 - 1200. [Abstract] [Full Text]
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