PHARMACOLOGICAL APPROACHES TO THE PREVENTION OF RESTENOSIS FOLLOWING ANGIOPLASTY - THE SEARCH FOR THE HOLY-GRAIL .1.

Luminal renarrowing after balloon angioplasty still hampers the long t erm vessel patency in a substantial percentage of patients. Morphologi cally, the restenotic lesion comprises hyperplasia of intimal tissue, which is mainly characterised by proliferation of smooth muscle cells of the synthetic type with abundant extracellular matrix production, c hiefly composed of proteoglycans. Unravelling the underlying pathophys iological process enables more specific intervention in basic interact ions and cell responses. Critical events in the development of resteno tic tissue are platelet aggregation and thrombus formation, while the release of several mediators promotes proliferation and migration of v arious cell types. All of these steps give access for a diversity of p harmacological interventions. With this in mind, antithrombotic, antip latelet, antiproliferative, anti-inflammatory, calcium channel blockin g and lipid-lowering drugs have been investigated in the prevention of restenosis. Part II of this article reviews newer approaches, such as antibodies to growth factors, gene transfer and antisense oligonucleo tides.