Key result
Platelets drive neointimal hyperplasia and ISR via inflammation and VSMC migration.
Why the study?
Despite newer stent generations reducing in-stent restenosis rates, a large number of patients still experience ISR, necessitating further investigation into its underlying pathophysiology.
Platelets play a fundamental role in the pathophysiology of in-stent restenosis through inflammation and neointimal hyperplasia, suggesting that platelet activity profiling could have prognostic value.
Platelet profiling may aid in-stent restenosis prognosis; Level 5 review leaves open therapeutic implications for neointimal hyperplasia.
Background: Introduction of new generations of stents has decreased the percentage of patients experiencing in-stent restenosis (ISR) following the implantation of stent.However, a large number of patients are still afflicted with this phenomenon, which necessitates further study of ISR pathophysiology.Methods: Relevant English literature was searched up to 2018 and retrieved form the PubMed database and Google Scholar search engine.The following keywords were used: "In-stent restenosis", "Platelet", "Chemokine", "Inflammation", "Vascular smooth muscle cell" and "Neointima".Results: Previous studies have shown that ISR is a pathophysiologic response to damage of the artery wall after its elongation and separation of the atherosclerotic plaque.Development of neointimal hyperplasia (NIH) following this pathophysiologic response is a function of inflammation caused by platelets, monocytes, macrophages, and lymphocytes, as well as rapid migration and proliferation of generally quiescent cells in the median layer of the artery wall. Conclusion:After damage to the artery wall, platelets play an essential role in the incidence of NIH by contributing to inflammation and migration of vascular smooth muscle cells and extracellular matrix remodeling, especially via secretion of different chemokines; therefore, developing therapeutic strategies for platelet inhibition in a controlled manner could be the basis of preventive treatments in the near future.In this study, for the first time, we hypothesize that evaluation of platelet activity profile in patients before and after stent implantation may determine the prognosis and likelihood of ISR.
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Habib Haybar (2020) conducted a review in In-stent restenosis. Platelets was evaluated on Pathophysiologic role of platelets in neointimal hyperplasia and in-stent restenosis. Platelets play an essential role in the incidence of neointimal hyperplasia and in-stent restenosis by contributing to inflammation and migration of vascular smooth muscle cells.
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