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J Am Coll Cardiol, 2004; 44:733-739, doi:10.1016/j.jacc.2004.04.048
© 2004 by the American College of Cardiology Foundation
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STATE-OF-THE-ART PAPER

Role of the endothelium in modulating neointimal formation

Vasculoprotective approaches to attenuate restenosis after percutaneous coronary interventions

Nicholas Kipshidze, MD, PhD, FACC*,*, George Dangas, MD, PhD, FACC*, Mykola Tsapenko, MD, PhD§, Jeffrey Moses, MD, FACC*, Martin B. Leon, MD, FACC*, Michael Kutryk, MD{dagger} and Patrick Serruys, MD, PhD, FACC{ddagger}

* Lenox Hill Heart and Vascular Institute and Cardiovascular Research Foundation, New York, New YorkUSA
{dagger} St. Michael's Hospital, Toronto, Canada
{ddagger} Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
§ Veterans Administration Hospital, Bronx, New YorkUSA

Manuscript received February 20, 2004; revised manuscript received April 10, 2004, accepted April 27, 2004.

* Reprint requests and correspondence: Dr. Nicholas Kipshidze, Lenox Hill Heart and Vascular Institute, 130 East 77th Street, New York, New York 10021 (Email: NKipshidze{at}Lenoxhill.net).

Restenosis at the site of an endoluminal procedure remains a significant problem in the practice of interventional cardiology. We present current data on intimal hyperplasia, which identify the major role of endothelial cells (ECs) in the development of restenosis. Considering endothelial denudation as one of the most important mechanisms contributing to restenosis, we focus more attention on methods of accelerating restoration of endothelial continuity. Prevention of restenosis may be achieved by promoting endothelial regeneration through the use of growth factors, EC seeding, vessel reconstruction with autologous EC/fibrin matrix, and the use of estrogen-loaded stents and stents designed to capture progenitor ECs.

Abbreviations and Acronyms
  EC = endothelial cell
  LPLI = low-power laser irradiation
  NO = nitric oxide
  PTCA = percutaneous transluminal coronary angioplasty
  SMC = smooth muscle cell
  VEGF = vascular endothelial growth factor




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