Guilielmus H. Ellenbroek, Leo Timmers, et al
Cardiovascular disease remains the leading cause of death in the world with rising numbers especially in non-Western countries. The most frequent treatment for coronary artery disease (CAD) is to restore coronary blood flow by percutaneous coronary intervention (PCI). Though superior to solo balloon angioplasty, coronary stent implantation has two complications: in-stent restenosis and stent thrombosis. In-stent restenosis is driven by the inflammatory response that occurs upon inflation of the balloon catheter to restore the lumen and the accompanying endothelial damage. This triggers vascular smooth muscle cell (VSMC) proliferation, leading to neointimal hyperplasia (NIH) and subsequent luminal narrowing. The advent of drug-eluting stents (DES) that reduce VSMC proliferation has largely solved this problem. However, by non-selectively inhibiting endothelial cell proliferation as well, the risk for in-stent thrombosis is increased.