Document Detail


The importance of the endothelium in atherothrombosis and coronary stenting.
MedLine Citation:
PMID:  22614618     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Deployment of drug-eluting stents instead of bare-metal stents has dramatically reduced restenosis rates, but rates of very late stent thrombosis (>1 year postimplantation) have increased. Vascular endothelial cells normally provide an efficient barrier against thrombosis, lipid uptake, and inflammation. However, endothelium that has regenerated after percutaneous coronary intervention is incompetent in terms of its integrity and function, with poorly formed cell junctions, reduced expression of antithrombotic molecules, and decreased nitric oxide production. Delayed arterial healing, characterized by poor endothelialization, is the primary cause of late (1 month-1 year postimplantation) and very late stent thrombosis following implantation of drug-eluting stents. Impairment of vasorelaxation in nonstented proximal and distal segments of stented coronary arteries is more severe with drug-eluting stents than bare-metal stents, and stent-induced flow disturbances resulting in complex spatiotemporal shear stress can also contribute to increased thrombogenicity and inflammation. The incompetent endothelium leads to late stent thrombosis and the development of in-stent neoatherosclerosis. The process of neoatherosclerosis occurs more rapidly, and more frequently, following deployment of drug-eluting stents than bare-metal stents. Improved understanding of vascular biology is crucial for all cardiologists, and particularly interventional cardiologists, as maintenance of a competently functioning endothelium is critical for long-term vascular health.
Authors:
Fumiyuki Otsuka; Aloke V Finn; Saami K Yazdani; Masataka Nakano; Frank D Kolodgie; Renu Virmani
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review     Date:  2012-05-22
Journal Detail:
Title:  Nature reviews. Cardiology     Volume:  9     ISSN:  1759-5010     ISO Abbreviation:  Nat Rev Cardiol     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-07-24     Completed Date:  2012-12-17     Revised Date:  2013-07-09    
Medline Journal Info:
Nlm Unique ID:  101500075     Medline TA:  Nat Rev Cardiol     Country:  England    
Other Details:
Languages:  eng     Pagination:  439-53     Citation Subset:  IM    
Affiliation:
CVPath Institute Inc., 19 Firstfield Road, Gaithersburg, MD 20878, USA.
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MeSH Terms
Descriptor/Qualifier:
Coronary Restenosis / pathology,  prevention & control*
Coronary Thrombosis / pathology,  prevention & control*
Drug-Eluting Stents*
Endothelium, Vascular / pathology*
Fibrinolytic Agents / therapeutic use
Hemodynamics
Humans
Nitric Oxide
Oxidative Stress
Risk Factors
Time Factors
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; 10102-43-9/Nitric Oxide
Comments/Corrections
Erratum In:
Nat Rev Cardiol. 2013 Jun;10(6):300

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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