R E V I E W Restenosis after percutaneous angioplasty: the role of vascular inflammation Martin Schillinger Erich Minar Department of Angiology, University of Vienna Medical School, Vienna, Austria Correspondence: Martin Schillinger Department of Internal Medicine II, Division of Angiology, University of Vienna Medical School, Waehringer Guertel 18-20, A-1090 Vienna, Austria Tel +43 1 40400 4670 Fax +43 1 40400 4665 Email martin.schillinger@meduniwien.ac.at Abstract: Restenosis after endovascular treatment of atherosclerotic lesions in the peripheral, cerebrovascular, and coronary circulation is the major drawback of this minimally invasive technique. Although certain advances have been made during recent years to improve patency rates after percutaneous angioplasty, restenosis remains a challenging clinical problem. Understanding factors that contribute to the pathophysiology of late lumen loss is an effective strategy to improving patients’ postangioplasty outcome. Vascular inflammation after balloon angioplasty or stent implantation has been identified as a cornerstone of the restenotic process, and several markers of inflammation have been referred to as potential predictors of outcome. This article reviews recent findings on the issue of inflammation and restenosis after percutaneous angioplasty with special attention given to the role of inflammatory parameters as markers for the restenosis risk in the peripheral vessel area. Keywords: percutaneous transluminal angioplasty, restenosis, inflammation Introduction Percutaneous transluminal angioplasty (PTA) is a minimally invasive revascularization procedure for treatment of atherosclerotic lesions in the peripheral, cerebrovascular, and coronary vessel area. Late clinical failure after primarily successful interventions due to recurrent stenosis (restenosis) occurring in up to 60% of the patients within the first 12 months remains the major drawback of percutaneous angioplasty and limits a widespread application of this minimally invasive technique (Gallino et al 1984; Krepel et al 1985; Maca et al 1996; Minar et al 1998; Cejna et al 2001; Exner et al 2001; Schillinger et al 2001). As competitive surgical approaches yield better long-term results, the indications for endovascular revascularisation are a matter of debate (Diegeler et al 2002). Furthermore, with increasing numbers of procedures performed, late sequelae due to recurrent stenoses and the need for costly reinterventions become more frequent. Understanding the factors that contribute to the pathophysiology of late lumen loss is the foundation to develop effective strategies for improvement of patients’ postangioplasty outcome. Endovascular brachytherapy (Minar et al 1998, 2000) and the upcoming drug eluting stents (Sousa et al 2001; Suzuki et al 2001; Morice et al 2002) are suggested to reduce the rate of intermediate term restenosis in the peripheral as well as in the coronary vessel area, but selection criteria for patients who are candidates for these expensive procedures with limited availability are indeterminate. Once identified, reliable predictors of the restenosis risk could facilitate the targeted use of measures for prevention of restenosis and help to save healthcare resources. Accumulating data indicate that insights gained from the link between inflammation and restenosis can yield predictive and prognostic information of considerable clinical utility. Inflammation in the vessel wall in response to balloon Vascular Health and Risk Management 2005:1(1) 73–78 © 2005 Dove Medical Press Limited. All rights reserved 73