Insights into coronary angioplasty-induced restenosis from examination of atherogenesis

Atherogenesis is a complex tissue reaction involving both vascular and circulating cells and components. The former include endothelial and smooth muscle cells, the latter circulating monocytes, platelets and lipoproteins. The role of growth factors secreted by platelets and all the cells involved in setting into motion a fibrocellular vascular reaction has been recently elucidated. Repeated injury or the presence of hyperlipidemia leads to occlusive disease. Many of these cellular events are also likely to be stimulated by the vascular injury that occurs as part of the angioplasty procedure. Restenosis, a major complication of the latter, may reflect the vascular response to iatrogenic injury. Progress in understanding the mechanisms involved in restenosis should also clarify important aspects of atherogenesis.