ARTERIAL REMODELING IN ATHEROSCLEROSIS AND RESTENOSIS - A VAGUE CONCEPT OF A DISTINCT PHENOMENON

Geometric remodeling in atherosclerosis and restenosis comprises a cha nge of the total arterial circumference that, together with plaque gro wth or neointima formation, determine the lumen of the artery. The cha nge in total arterial circumference relative to a reference cross sect ion ranges from excessive enlargement with an actual increase in lumen to a shrinkage contributing to lumen narrowing. The forces that deter mine whether an artery shrinks or is able to enlarge as a consequence of atherosclerotic lesions or of post-interventional intimal hyperplas ia are unknown but are likely to affect matrix and specifically collag en redistribution. Identifying these forces is of importance because t hey might be used to promote favorable remodeling. The cellular and hu moral triggers of collagen degradation and synthesis, as well as confo rmation changes of collagen matrices after their deposition, need to b e investigated. As with injury-induced intimal hyperplasia and plaque growth in de novo atherosclerosis, injury models may serve as a paradi gm for geometric remodeling in atherosclerosis.