title: The importance of the endothelium in atherothrombosis and coronary stenting.
abstract: Deployment of drug-eluting stents instead of bare-metal stents has dramatically                 reduced restenosis rates, but rates of very late stent thrombosis (>1 year                 postimplantation) have increased. Vascular endothelial cells normally provide an                 efficient barrier against thrombosis, lipid uptake, and inflammation. However,                 endothelium that has regenerated after percutaneous coronary intervention is                 incompetent in terms of its integrity and function, with poorly formed cell                 junctions, reduced expression of antithrombotic molecules, and decreased nitric                 oxide production. Delayed arterial healing, characterized by poor                 endothelialization, is the primary cause of late (1 month-1 year                 postimplantation) and very late stent thrombosis following implantation of                 drug-eluting stents. Impairment of vasorelaxation in nonstented proximal and distal                 segments of stented coronary arteries is more severe with drug-eluting stents than                 bare-metal stents, and stent-induced flow disturbances resulting in complex                 spatiotemporal shear stress can also contribute to increased thrombogenicity and                 inflammation. The incompetent endothelium leads to late stent thrombosis and the                 development of in-stent neoatherosclerosis. The process of neoatherosclerosis occurs                 more rapidly, and more frequently, following deployment of drug-eluting stents than                 bare-metal stents. Improved understanding of vascular biology is crucial for all                 cardiologists, and particularly interventional cardiologists, as maintenance of a                 competently functioning endothelium is critical for long-term vascular health.
authors.affiliation: CVPath Institute Inc., 19 Firstfield                 Road, Gaithersburg, MD                 20878, USA.
authors.forename: Fumiyuki
authors.initials: F
authors.lastname: Otsuka
authors.forename: Aloke V
authors.initials: AV
authors.lastname: Finn
authors.forename: Saami K
authors.initials: SK
authors.lastname: Yazdani
authors.forename: Masataka
authors.initials: M
authors.lastname: Nakano
authors.forename: Frank D
authors.initials: FD
authors.lastname: Kolodgie
authors.forename: Renu
authors.initials: R
authors.lastname: Virmani
mesh_terms: D023903:Coronary Restenosis / Q000473:pathology / Q000517:prevention & control*; D003328:Coronary Thrombosis / Q000473:pathology / Q000517:prevention & control*; D054855:Drug-Eluting Stents; D004730:Endothelium, Vascular / Q000473:pathology*; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006439:Hemodynamics; D006801:Humans; D009569:Nitric Oxide; D018384:Oxidative Stress; D012307:Risk Factors; D013997:Time Factors
chemical_list: D005343:Fibrinolytic Agents; D009569:Nitric Oxide