Coronary Artery Restenosis Following Balloon Angioplasty

Insights into the Mechanisms of Neointimal Hyperplasia and Molecular Strategies for Prevention
  • Kenneth P. Sunnergren
Chapter

Abstract

Since its advent in 1978, the nonsurgical technique of coronary balloon angioplasty has enjoyed widespread popularity as a means of revascularizing ischemic myocardium. In excess of 250,000 procedures are done each year in the USA alone. While the technique has a high primary success rate, 30% to 50% of patients have evidence of recurrent myocardial ischemia within six months of angioplasty.1,2 This is due to the development of a restenotic lesion. Coronary atherectomy3 and postmortem4 histologic studies have demonstrated that the restenotic lesion is largely due to neointimal proliferation of smooth muscle cells. Thus, the process of restenosis, the excessive proliferation of smooth muscle cells, represents an enormous problem in clinical cardiology.

Keywords

Catheter Aspirin Angiotensin Luminal Propranolol 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Holmes DR, Vliestra RE, Smith HC, et al. Restenosis after PTCE: a report of the PTCA registry of the NHLBI. Am J Cardiol 1984;53:77C–81C.PubMedCrossRefGoogle Scholar
  2. 2.
    Serruys PW, Luijten HE, Beatt KJ, et al. Incidence of restenosis after successful coronary angioplasty: a time related phenomenon. A quantitative sutdy in 342 consecutive patints at 1, 2, and 3 months.PubMedCrossRefGoogle Scholar
  3. 3.
    Waller BF Johnson DE, Schmitt SJ, et al. Histologic analysis of directional coronary atherectomy. A review of findings and clinical relevance. Am J Cardiol 199372-80E–7EPubMedCrossRefGoogle Scholar
  4. 4.
    Waller BF, Pinkerton CA, Orr CM, et al. Restenosis 1 to 24 months after successful balloon angioplasty anecropsystudyof20patients.JAmCollCardiol 1991:17:58B–70BPubMedCrossRefGoogle Scholar
  5. 5.
    Schwartz L, Bourassa MG, Lesperance J, et al. Aspirin and dipyridamole in the prevention of restenosis after percutaneous transluminal coronary angioplasty. N Engl J Med 1988 318,1714– 9PubMedCrossRefGoogle Scholar
  6. 6.
    Ellis SG, Roubin GS, Wilentz J et al. Effects of 18 to 24 hour heparin administration for prevention of restenosis after uncomplicated coronary angioplasty. Am Heart J 1989-117777–82PubMedCrossRefGoogle Scholar
  7. 7.
    Faxon DP, Spiro TE, Minor S, et al. Low molecular weight heparin in prevention of restenosis after angioplasty. Results of the enoxparin restenosis (ERA) trial. Circulation 1994-90908–14PubMedCrossRefGoogle Scholar
  8. 8.
    Stone GW, Rutherford BD, McConahay DR, et al. A randomized trial of corticosteroids for the prevention of restenosis in 102 patients undergoing coronary angioplasty. Cathet Cardiovas Diagn 1989-18227–31CrossRefGoogle Scholar
  9. 9.
    O ’Keefe JH, Giorgi LV, Hartzler GO, et al. Effects of diltiazem on complications and restenosis after coronary angioplasty. Am Heart J 1991;67:373–6.Google Scholar
  10. 10.
    Whitworth HB, Roubin GS, Hollman J, et al. Effects of nifedipine on recurrent stenosis after percutaneous transluminal balloon angioplasty. J Am Coll Cardiol 1986;8:1271–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Hermans WR, Rensing BJ, Foley et al. Patient, lesion and procedural variables as risk factors for luminal renarrowing after successful coronary angioplasty; a quantitative analysis in 653 patients with 777 lesions. The multicenter European research trial with cilazapril after angioplasty to prevent transluminal coronary obstruction and restenosis. J Cardiovas Pharm 1993;22:S45–57.CrossRefGoogle Scholar
  12. 12.
    Kaul U, Chandra S, Bahl YK, et al. Enalapril for prevention of restenosis after coronary angioplasty. Ind Heart J 1993;45:469–73.Google Scholar
  13. 13.
    Onaka H, Hirota Y, Kita Y, et al. The effect of pravastatin on prevention of restenosis after successful percutaneous transluminal balloon angioplasty. Jpn Circ J 1994;52:100–6.CrossRefGoogle Scholar
  14. 14.
    Gershlick AH, Spriggins D, Davies SW, et al. Failure of epoprostenol (prostacyclin, PGI2) to inhibit platelet aggregation and prevent restenosis after coronary angioplasty, results of a randomized placebo controlled trial. Br Heart J 1993;45:469–73.CrossRefGoogle Scholar
  15. 15.
    Serruys PW, Rutsch W, Heyndrickx GR, et al. Prevention of restenosis after percutaneous transluminal coronary angioplasty with thromboxane A2 receptor blockade. A randomized, double-blind, placebo controlled trial. Circulation 1994;84:1568–80.CrossRefGoogle Scholar
  16. 16.
    Serruys PW, Klein W, Tijssen JP, et al. Evaluation of ketanserin in the prevention of restenosis after percutaneous transluminal coronary angioplasty. A multicenter, randomized, double-blind placebo con-trolled trial. Circulation 1993;88:1588–601.PubMedCrossRefGoogle Scholar
  17. 17.
    Frazen D, Schannwell M, OetteK, et al. A prospective, randomized and double-blind trial on the effect of fish oil on the incidence of restenosis following percutaneous transluminal coronary angioplasty. Cathet Cardiovas Diag 1993;28:301–10.CrossRefGoogle Scholar
  18. 18.
    Holmes DR, Topol ED, Adelman AG, et al. Randomized trials of directional coronary atherectomy, implications for clinical practice and future investigations. J Am Coll Cardiol 1994;24:431–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Koller RT, Freed M, Grines CL, et al. Success, complications and restenosis following rotational and transluminal atherectomy of ostial stenosis. Cathet Cardiovas Diagn 1994;31:255–60.CrossRefGoogle Scholar
  20. 20.
    Buchwald AB, Werner GS, Unterberg C, et al. Restenosis after excimer laser angioplasty of coronary stenosis and chronic total occlusions. Am Heart J 1992;123:878–85.PubMedCrossRefGoogle Scholar
  21. 21.
    Foley JB, Penn IM, Brown RI, et al. Safety, success and restenosis after elective coronary implantation of the Palmaz-Schatz stent in 100 patients at a single center. Am Heart J 1993;125:686–94.PubMedCrossRefGoogle Scholar
  22. 22.
    McBride W, Lange RA, Hillis LD. Restenosis after successful coronary angioplasty. Pathophysiology and prevention. N Engl J Med 1988:318,1734–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Lam JYT, Chesebro JH, Steele PM, et al. Deep arterial injury during experimental angioplasty: relation-ship to a positive 111 Indium-labeled platelet scintigram, quantitative platelet deposition, and mural thrombus. J Am Coll Cardiol 1986;8:1380–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Harker LA. Role of platelets and thrombosis in mechanisms of acute occlusion and restenosis after angioplasty. Am J Cardiol 1987;60:20B–8BPubMedCrossRefGoogle Scholar
  25. 25.
    Ip JH, Fuster V, Israel D, et al. The role of platelets, thrombin and hyperplasia in restenosis after coronary angioplasty. J Am Coll Cardiol 1991;16:77B–88B.CrossRefGoogle Scholar
  26. 26.
    Bowen-pope DF, Ross R, Seifert RA. Locally acting growth factors for vascular smooth muscle cells: endogenous synthesis and release from platelets. Circulation 1985:72;735–40.PubMedCrossRefGoogle Scholar
  27. 27.
    Walker LN, Bowen-Pope DF, Ross R, Reidy MA. Production of platelet-derived growth factor-like molecules by cultured arterial smooth muscle cells accompanies proliferation after arterial injury. Proc Natl Acad Sci USA 1986;83:7311–5.PubMedCrossRefGoogle Scholar
  28. 28.
    Libby P, Warner SJC, Salomen RN, Birinyi LK. Production of platelet-derived growth factor-like mitogen by smooth muscle cells from human atheroma. N Engl J Med 198;318:1493–8.Google Scholar
  29. 29.
    Ross R, Raines EW, Bowen-Pope DF. The biology of platelet-derived growth factor. Cell 1986;46:155–69.PubMedCrossRefGoogle Scholar
  30. 30.
    Ferns GA, Raines EW, Sprugel KA et al. Inhibition of neointimal smooth muscle cell accumulation after angioplasty by an antibody to PDGF. Science 1991;253:1129–32.PubMedCrossRefGoogle Scholar
  31. 31.
    McNamara CA, Sarembock, IJ, Gimple LW Thrombin stimulates proliferation of cultured rat aortic smooth muscle cells by proteolytically activated receptor. J Clin Invest 1993;91:94–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Weiss RH, Maduri M. The mitogenic effects of thrombin in vascular smooth muscle cells is largely due to basic fibroblast growth factor. J Bio Chem 1993;268:5724–7.Google Scholar
  33. 33.
    Stouffer GA, Sarenbock lJ, McNamara CA. Thrombin-induced mitogenesis of vascular smooth muscle cells is partially mediated by autocrine production of PDGF-AA. Am J Physiol 1993;265:C806–11.PubMedGoogle Scholar
  34. 34.
    Walters TK, Gorog DA, Wood DF. Thrombin generation following arterial injury is a critical initiating event in the pathogenesis of the proliferative stages of the atherosclerotic process. J Vas Res 1994;31:173– 7.CrossRefGoogle Scholar
  35. 35.
    Winkles JA, Friesel R, Burgess WH, et al. Human vascular smooth muscle cells both express and respond to heparin-binding growth factor 1 (endothelial cell growth factor). Proc Natl Acad Sci USA 1987;84:7124–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Casscells W, Lappi DA, Olwin BB, et al. Elimination of smooth muscle cells in experimental restenosis: targeting of fibroblast growth factor receptors. Proc Nat Acad Sci USA 1992;7159–63.Google Scholar
  37. 37.
    Biro S, Siegall CB, Fu YM, et al. In vitro effects of a recombinant toxin targeted to the fibroblast growth factor on rat vascular smooth muscle and endothelial cells. Circ Res 1992;71:640–5.PubMedCrossRefGoogle Scholar
  38. 38.
    Linder V, Reidy MA. Proliferation of smooth muscle cell after vascular injury is inhibited by an antibody against basic fibroblast growth factor. Proc Natl Acad Sci USA 1991;88:3739–43.CrossRefGoogle Scholar
  39. 39.
    Hirata Y, Takagi Y, Eukuda Y, et al. Endothelin is a potent mitogen for rat vascular smooth muscle cell. Atherosclerosis 1989; 78:225–8.PubMedCrossRefGoogle Scholar
  40. 40.
    Douglas SA, Ohlstein EH. Endothelin-1 promotes neointimal formation after balloon injury in the rat. J CardiovasRes 1993;22:S371–3.CrossRefGoogle Scholar
  41. 41.
    Ferns GA, Motani AS, Angard EE. The insulin-like growth factors: their putative role in atherogenesis. Artery 1991;18; 197–225.PubMedGoogle Scholar
  42. 42.
    Cercek B, Fishbein MC, Forrester JS, et al. Induction of insulin-like growth factor I messenger RNA in rat aorta after balloon denudation. Circ Res 1990;66:1755–60.PubMedCrossRefGoogle Scholar
  43. 43.
    Bjorkerud S. Effects of transforming growth factor on human arterial smooth muscle cells in vitro. Arterioscler Thromb 1991; 11:892–902.PubMedCrossRefGoogle Scholar
  44. 44.
    Nikol S, Isner JM, Pickering et al. Expression of transforming growth factor beta-1 is increased in human vascular restenotic lesions. J Clin Invest 1992;90:1582–92.PubMedCrossRefGoogle Scholar
  45. 45.
    Biennis J. Signal transduction via the MAP kinases: proceed at your own RSK. Proc Natl Acad Sci USA 1993;90:5889–92.CrossRefGoogle Scholar
  46. 46.
    Pines J. Cyclins and cyclin-dependent kinases: take your partner. Trend Biochem Sci 1993;18:195–8.PubMedCrossRefGoogle Scholar
  47. 47.
    Graves LM, Bornfeldt KE, Raines EW, et al. Protein kinase A antagonizes platelet-derived growth factor induced signaling by the mitogen activated kinase in human arterial SMC. Proc Natl Acad Sci USA 1993;90:10300–4.PubMedCrossRefGoogle Scholar
  48. 48.
    Davies RJ. The mitogen activated protein kinase signal transduction pathway. J Bio Chem. 1993;268:14553–6.Google Scholar
  49. 49.
    van den Heuvel S, Harlow E. Distinct role for cyclin-dependent kinase in cell cycle control. Science 1993;262:2050–4.PubMedCrossRefGoogle Scholar
  50. 50.
    Helene C, Toulme J. Specific regulation of gene expression by sense, antisense and antigene nucleic acids. Biochim Biophys Acta 1990; 1049: 99–125.PubMedCrossRefGoogle Scholar
  51. 51.
    Speir E, Epstein SE. Inhibition of smooth muscle cell proliferation by antisense oligodeoxynucleotides targeting the messenger RNA encoding proliferating nuclear cell antigen. Circulation 1992;86:1190–5.CrossRefGoogle Scholar
  52. 52.
    Moriishita R, Gibbons GH, Ellison KE, et al. Single intraluminal delivery of antisense to cdc-2 kinase and proliferating cell nuclear antigen oligonucleotides results in chronic inhibition of neointimal hyper-plasia. Proc Natl Acad Sci USA 1993;90:8474–8.CrossRefGoogle Scholar
  53. 53.
    Simons M, Edelmann ER, DeKeyser JL, et al. Antisense c-myb oligonucleotides inhibit intimal arterial smooth muscle cell accumulation in vivo. Nature 1992;359:67–80.PubMedCrossRefGoogle Scholar
  54. 54.
    Shi Y, Hutchinson HG, Hall DJ, et al. Downregulation of c-myc expression by antisense oligonucleotides inhibits proliferation of human smooth muscle cells. Circulation 1993;88:1190–5.PubMedCrossRefGoogle Scholar
  55. 55.
    Biro S, Fu YM, Yu ZX, et al. Inhibitory effects of antisense oligodeoxynucleotides targeting c-myc mRNA on smooth muscle cell proliferation and migration. Proc Natl Acad Sci USA 1993;90:654–8.PubMedCrossRefGoogle Scholar
  56. 56.
    Shi Y, Fard A, Galeo A, et al. Transcatheter delivery of c-myc antisense oligomers reduces neointimal formation in a porcine model of coronary balloon injury. Circulation 1994;90:944–51.PubMedCrossRefGoogle Scholar
  57. 57.
    Ohno T, Gordon D, San H, Pompili VJ, et al. Gene therapy for vascular smooth muscle cell proliferation after arterial injury. Science 1994;265:781–4.PubMedCrossRefGoogle Scholar
  58. 58.
    Chang MW, Barr E, Seltzer J et al. Cytostatic gene therapy for vascular proliferative disorders with a constitutively active form of the retinoblastoma gene product. Science 1995;267:518–22.PubMedCrossRefGoogle Scholar
  59. 59.
    Pastan IH, Johnson GS, Andersen WB. Role of cyclic nucleotides in growth control. Ann Rev Biochem 1975;44:491–522.PubMedCrossRefGoogle Scholar
  60. 60.
    Owen NE. Effects of prostaglandin El on DNA synthesis in vascular smooth muscle cells. Am J Physio 1986;250:584–8.Google Scholar
  61. 61.
    Takahashi S, Oida K, Fujiwara R, et al. Effects of cilostazol, a cAMP phosphodiesterase inhibitor, on the proliferation of rat aortic smooth muscle cells in culture. J Cardiovas Pharm 1992;20:900–6.CrossRefGoogle Scholar
  62. 62.
    Majack RA, Cook SC, Bornstein P. Control of smooth muscle cell growth by components of the extracellular matrix: autocrine role for thrombospondin. Proc Natl Acad Sci USA 1986;83:9050–4.PubMedCrossRefGoogle Scholar
  63. 63.
    Majack RA, Mildbrandt J, Dixit VM. Induction of the thrombospondin messenger RNA levels occurs as an immediate primary response to platelet-derived growth factor. J Bio Chem 1987; 262:8821–5.Google Scholar
  64. 64.
    Wu J, Dent P, Jelinek T, et al. Inhibition of the EGF-activated MAP kinase signaling pathway by adenosine 3 ‘5 ’-monophosphate. Science 1993;262:1065–9.PubMedCrossRefGoogle Scholar
  65. 65.
    Cook SJ, McCormickF. Inhibition by cAMP of Ras-dependent activation of Raf. Science 1993;262:1069– 72.PubMedCrossRefGoogle Scholar
  66. 66.
    Kato JY, Matsuka M, Polyak K, et al. Cyclic AMP-induced Gl phase arrest mediated by an inhibitor (p27 Kipl) of cyclin-dependent kinase 4 activator. Cell 1994;79:487–96.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1995

Authors and Affiliations

  • Kenneth P. Sunnergren
    • 1
  1. 1.Robert Wood Johnson Medical School, Cooper Hospital/University Medical CenterUniversity of Medicine and Dentistry of New JerseyCamdenUSA

Personalised recommendations