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Biological responses in stented arteries

Otsuka, Fumiyuki
Virmani, Renu
Published in Cardiovascular research. 2013, vol. 99, no. 2, p. 353-63
Abstract Vascular walls change their dimension and mechanical properties in response to injury such as balloon angioplasty and endovascular stent implantation. Placement of bare metal stents induces neointimal proliferation/restenosis which progresses through different phases of repair with time involving a cascade of cellular reactions. These phases just like wound healing comprise distinct steps consisting of thrombosis, inflammation, proliferation, and migration followed by remodelling. It is noteworthy that animals show a rapid progression of healing after stent deployment compared with man. During stenting, endothelial cells are partially to completely destroyed or crushed along with medial wall injury and stretching promoting activation of platelets, and thrombus formation accompanied by inflammatory reaction. Macrophages and platelets play a central role through the release of cytokines and growth factors that induce vascular smooth muscle cell accumulation within the intima. Smooth muscle cells undergo complex phenotypic changes including migration and proliferation from the media towards the intima, and transition from a contractile to a synthetic phenotype; the molecular mechanisms responsible for this change are highlighted in this review. Since studies in animals and man show that smooth muscle cells play a dominant role in restenosis, drugs like rapamycin and paclitaxel have been coated on stent with polymers to allow local slow release of drugs, which have resulted in dramatic reduction of restenosis that was once the Achilles' heel of interventional cardiologists.
Keywords AnimalsArteries/drug effects/injuries/metabolism/pathology/physiopathologyBiomechanical PhenomenaCardiovascular Agents/therapeutic useCell MovementCell ProliferationConstriction, PathologicEndothelial Cells/metabolism/pathologyEndovascular Procedures/adverse effects/instrumentationHemodynamicsHumansMechanotransduction, CellularMuscle, Smooth, Vascular/metabolism/pathologyMyocytes, Smooth Muscle/metabolism/pathologyNeointimaPhenotypeRegional Blood FlowStentsStress, MechanicalVascular System Injuries/etiology/pathology/physiopathology/prevention & controlWound Healing
PMID: 23667187
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Article (Published version) (688 Kb) - document accessible for UNIGE members only Limited access to UNIGE
Research group Bochaton-Piallat Marie-Luce (pathologie et immunologie) (646)
Swiss National Science Foundation: 310030_146790
Autre: Fondation Simone et Gustave Prévot, Fondation Artères
(ISO format)
CHAABANE, Chiraz et al. Biological responses in stented arteries. In: Cardiovascular research, 2013, vol. 99, n° 2, p. 353-63. doi: 10.1093/cvr/cvt115 https://archive-ouverte.unige.ch/unige:41352

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Deposited on : 2014-10-30

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