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(Circulation. 2005;111:8-10.)
© 2005 American Heart Association, Inc.

Editorial

Restenosis

Another "Dysfunction" of the Endothelium

Amir Lerman, MD

From the Division of Cardiovascular Disease and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minn.

Correspondence to Amir Lerman, MD, Division of Cardiovascular Disease and Department of Internal Medicine, Mayo College of Medicine, 200 First St SW, Rochester, MN 55902. E-mail lerman.amir@mayo.edu

Key Words: Editorials • restenosis • stents • endothelium

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Atherosclerosis is a chronic, systemic, and diffuse disease with focal complications in different vascular beds. The precise mechanisms by which a specific site is rendered more prone to the development of symptomatic disease and cardiovascular events are not known. Both the systemic and local manifestations of the disease can vary, depending on the stage, location, and other factors affecting the integrity of the vascular wall. Atherosclerosis, and specifically coronary atherosclerosis, can be manifested as endothelial dysfunction at the very early stage of the disease and as in-stent restenosis at the later stage. Both endothelial dysfunction and in-stent restenosis are pathophysiological processes that involve the vascular wall, may share common pathways, and may be regarded as an abnormal vascular response or healing to injury. However, the treatment effect of mechanical coronary interventions is generally confined to discrete coronary artery segments, whereas the pathological process of coronary atherosclerosis is diffuse. Coronary interventional therapy should thus constitute a part of a comprehensive strategy that includes additional therapeutic approaches, such as intensive efforts to lower lipid levels, which may halt the generalized progression of disease and reduce the risk of death or myocardial infarction.

See p 70

The ability to predict restenosis and thus the local response of the vascular wall to injury remains a major and an important target in cardiovascular disease, not only because of the potential to predict clinical events but also as a clue to the mechanism of the disease. One of the early indications that vascular reactivity may predict . . . [Full Text of this Article]

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