Gene therapy for restenosis after balloon angioplasty and stenting.

Percutaneous coronary revascularization is an increasingly attractive alternative to medical therapy and surgical revascularization for coronary artery disease. The leading drawback of this procedure continues to be restenosis-the process of late arterial renarrowing at the site of initially successful intervention. Restenosis after balloon angioplasty seems to be determined primarily by the direction and magnitude of vessel wall remodeling. In contrast, the major limitation of stent implantation is the initiation of neointimal tissue proliferation within and adjacent to the stent. The goal of this review is to summarize recent laboratory and clinical investigations of the transmission of mitogenic signals from the membrane to the nucleus in smooth muscle cells. The mechanisms responsible for restenosis after balloon angioplasty and stenting and the possibility of transferring specific genes into somatic vascular cells with molecular tools to inhibit smooth muscle cell proliferation also will be reviewed.