Restenosis pathology

Yutani, C., Imakita, M., Ishibashi-Ueda, H., Tsukamoto, Y., Nishida, N. and Ikeda, Y. (1999) Coronary atherosclerosis and interventions pathological sequences and restenosis. PatholInt., 49, 273-290. 

Our understanding of the pathological mechanisms of restenosis is constantly evolving and the targets of therapy are changing. 

I 9 Virmani R, Farb A. Pathology of in-stent restenosis. Curr Opin Lipidol 1999 l0(6) 499-506. 

Rabbit muscle 27 HA is a major constituent in the pathological matrix that occludes the artery in coronary restenosis. 

Platelets provide the initial hemostatic plug at sites of vascular injury. They also participate in pathological thromboses that lead to myocardial infarction, stroke, and peripheral vascular thromboses. Potent inhibitors of platelet function have been developed. These drugs act by discrete mechanisms, and thus in combination their effects are additive or even synergistic. Their availabihty has led to a revolution in cardiovascular medicine, whereby angioplasty and vascular stenting of lesions now is feasible with low rates of restenosis and thrombosis when effective platelet inhibition is employed. 

A more frequent complication is restenosis of the angioplasty site which occurs in 25-30% of patients over 6-9 months " . Pathological studies in patients with recurrence of symptoms are infrequent but demonstrate proliferation of fibroblasts and vascular smooth muscle cells overlying and distinct from the traumatized atherosclerotic plaque . Similar lesions have been described in early atherosclerosis and there is evidence to suggest a role for platelets in the development of such lesions , possibly through release of platelet-derived growth factors which stimulate fibroblast and vascular smooth muscle proliferation . Thus, depletion or inhibition of platelets prevents the development of atherosclerosis in animal models and aspirin inhibits the accelerated coronary atherosclerosis which occurs in cardiac transplant recipients. Furthermore, restenosis is more frequent when there is evidence of a thrombus at the angioplasty site consistent with previous... 

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