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Coronary artery disease (CAD) remains one of the most important causes of morbidity and mortality worldwide, and the availability of percutaneous or surgical revascularization procedures significantly improves survival. However, both strategies are daunted by complications which limit long-term effectiveness. In-stent restenosis (ISR) is a major drawback for intracoronary stenting, while graft failure is the limiting factor for coronary artery bypass graft surgery (CABG), especially using veins. Conversely, internal thoracic artery (ITA) is known to maintain long-term patency in CABG. Understanding the biology and pathophysiology of ISR and vein graft failure (VGF) and mechanisms behind ITA resistance to failure is crucial to combat these complications in CAD treatment. This review intends to provide an overview of the biological mechanisms underlying stent and VGF and of the potential therapeutic strategy to prevent these complications. Interestingly, despite being different modalities of revascularization, mechanisms of failure of stent and saphenous vein grafts are very similar from the biological standpoint.

Original publication

DOI

10.1093/cvr/cvz214

Type

Journal article

Journal

Cardiovasc Res

Publication Date

01/03/2020

Volume

116

Pages

505 - 519

Keywords

Coronary artery disease, In-stent restenosis, Internal thoracic artery, Myocardial revascularization, Vein graft failure, Animals, Coronary Artery Bypass, Coronary Artery Disease, Coronary Restenosis, Coronary Vessels, Graft Occlusion, Vascular, Humans, Mammary Arteries, Neointima, Percutaneous Coronary Intervention, Risk Factors, Saphenous Vein, Stents, Time Factors, Treatment Failure, Vascular Patency