The aim of this study was to analyse the inpatient and long-term results of hybrid surgery, incorporating percutaneous coronary intervention (PCI) and different types of carotid endarterectomy (CEA). This review summarizes the most recent and promising therapeutic strategies identified in experimental models of (re)stenosis and potentially translatable in patients submitted to revascularization procedures. Molecular analyses are also contributing to the identification of reliable circulating biomarkers predictive of post-interventional restenosis in patients, that could be potentially helpful in the establishment of an early diagnosis and therapy. Also, the advanced, highly-sensitive highthroughput analyses of molecular alterations at transcriptome, proteome and metabolome level occurring in injured vessels in animal models of disease and in human specimens, are serving as a basis to identify novel potential therapeutic targets for restenosis. In particular, microRNAs and vascular progenitor cells recently revealed a key role in this pathophysiological process. The advent of bare metal stents, drug-eluting stents and of the more recent drug-eluting balloons, significantly reduced but not eliminated the incidence of restenosis, which remains a clinically relevant problem.īiomedical research in preclinical animal models of (re)stenosis, despite its limitations, enormously contributed to the identification of processes involved in restenosis progression, going well beyond the initial dogma of a primarily proliferative disease.Īlthough the main molecular and cellular mechanisms underlying restenosis have been well described, new signalling molecules and cell types controlling the progress of restenosis are continuously discovered. It can be considered as an excessive healing reaction of the vascular wall submitted to arterial/venous bypass graft interposition, endarterectomy or angioplasty. Restenosis is pathophysiological process occurring in 10-15% of patients submitted to revascularization procedures of coronary, carotid and peripheral arteries. Our result shows the importance of the observation, and the evaluation by three dimensions. 3D measurements provide more information on ERS than 2D measurements. The greatest difference in ERS between 2D and 3D measurements was 5.2%. ERS ranged from 2.4% to 9.2% during observation form proximal and distal positions in each component. The expansion behavior of each structural component of the stent varied, as did the ERS and eccentricity. We performed 3D reconstruction using high spatial resolution images obtained with a Micro-CT system to observe the 3D expansion behavior of a test stent and quantitatively evaluate ERS. However, the stent geometry is changed in 3D space, and 3D measurements will provide further information on factors such as the risk for asymmetric ERS. Many previous studies have observed stent properties in 2D.
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Quantitative evaluation of stent expanding should provide further information on how to decrease the incidence of re-stenosis. This may occur because of the reduced luminal area after implantation, insufficient stent expansion, or by the elastic recoil of the stent ERS. However, restenosis after stent implantation frequently reported by intravascular ultrasound evaluation. Percutaneous transluminal coronary angioplasty PTCA with stent implantation is widely used for the treatment of coronary stenosis.
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