Search PubMedSearch

PubMed · 9050818

Vascular endothelial dysfunction.

Abstract

Injury or activation of the endothelium changes its regulatory functions and results in abnormal endothelial cell function. Dysfunction of the endothelium has been defined as an imbalance between relaxing and contracting factors, between procoagulant and anticoagulant mediators or between growth-inhibiting and growth-promoting substances. The first part of this review describes endothelial dysfunction in hypercholesterolemia, and atherosclerosis in intimal thickening induced by perivascular and intravascular techniques. We focus on the implications of endothelial dysfunction in these conditions and the role of nitric oxide, endothelium-dependent hyperpolarization, endothelin, cytokines, adhesion molecules, growth factors, and thrombosis. In the second part, the endothial dysfunction in other diseases including hypertension, syndrome X, and diabetes is discussed. Finally, a short overview of therapeutic approaches of the dysfunctional endothelium is given.

Explore related subjects

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

G R De Meyer, A G Herman. Vascular endothelial dysfunction.. https://doi.org/10.1016/s0033-0620(97)80031-x

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

Expression of IGF-1, IGF-1 receptor and TGF-beta following balloon angioplasty in atherosclerotic and normal rabbit iliac arteries: an immunocytochemical study.

Growth factors have been implicated in the pathogenesis of restenosis (myointimal hyperplasia after coronary interventions). In this study, we examined the expression of insulin-like growth factor-I (IGF-1), IGF-1 receptor, and transforming growth factor-beta (TGF-beta) in atherosclerotic and normal rabbit iliac arteries following overstretch balloon angioplasty of the iliac arteries to create a vascular lesion. Animals were sacrificed at 0, 3, 7, 15 and 42 days post angioplasty. The iliac arteries were processed for immunocytochemical localization of IGF-1, IGF-1 receptor and TGF-beta using colloidal gold and the data were quantitatively analyzed. IGF-1, IGF-1 receptor and TGF-beta immunoreactivity were all significantly increased in atherosclerotic arteries compared to control at all of the time points examined. Following balloon angioplasty, the levels of IGF-1 and IGF-1 receptor increased significantly in both control and even further in hypercholesterolemic vessels. In control vessels, the IGF-1 levels returned to preintervention levels, while in atherosclerotic vessels, the levels of IGF-1 and IGF-1 receptor remained elevated. In addition, TGF-beta levels in control vessels showed an initial rise in the first week following injury but then returned to baseline levels. In contrast, atherosclerotic vessels demonstrated a sustained expression of TGF-beta. Thus, IGF-1 and TGF-beta expression is different in normal vs. atherosclerotic vessels following vascular injury. The intensity of expression of IGF-1 and its receptor, which is not reduced at 42 days compared to 15 days following injury, support a role for IGF-1 in smooth muscle cell proliferation and migration. The sustained increase in TGF-beta could facilitate extracellular matrix (ECM) accumulation. Local vascular therapy that is directed towards modulating the effects of IGF-1 and TGF-beta could reduce restenosis.

Angioplasty, Balloon

[Endovascular brachytherapy for the prevention of recurrence after PTA].

PURPOSE: Recurrent stenosis after PTA is caused by intimal hyperplasia and constrictive arterial remodeling. In experimental and first clinical studies, ionizing radiation has demonstrated its potential to control excessive intimal proliferation. We wanted to evaluate the safety, feasibility and efficacy of endoluminal irradiation after PTA and/or stent implantation. MATERIAL AND METHODS: From September 1996, 24 patients (24 lesions) who had a stenosis or occlusion measuring more than 5 cm in length in the superficial femoral artery or a restenosis after PTA underwent endoluminal irradiation. An isodose of 14 Gy was applied to the vessel wall using an Ir-192-HDR afterloading unit. The radiation was tolerated well; the additional time needed for the procedure was 30-45 min. RESULTS: In a mean follow-up time of 15 months we found a cumulative patency rate of 60%. No side effects were observed. CONCLUSION: Endovascular brachytherapy is a safe and brief procedure. In our selection of patients, a patency rate of approx. 40% after 1 year has to be expected. Thus, these first results are promising, although first published studies of endoluminal irradiation in peripheral vessels with stent implantation showed higher patency rates. No randomized data are currently available. We conclude that endovascular irradiation should be performed together with stent implantation in long lesions or recurrent stenosis after PTA, in order to control not only excessive intimal proliferation but also constrictive arterial remodeling.

Angioplasty, Balloon

[Interventional treatment of arteriosclerotic carotid stenosis].

PURPOSE: Angioplasty and stent placement of atherosclerotic internal carotid artery stenosis (ICA) are evaluated based on own experiences with the method and reports of other groups and are compared with vascular surgery. METHODS: ICA-stenoses of more than 70% were treated by angioplasty and stent placement mainly using the Wallstent. The patients had follow-up examinations with an angiogram after 6 months and colour-coded duplex ultrasound at regular intervals. RESULTS: In 633 patients 799 ICA stenoses were treated, 70% of them were symptomatic and 30% asymptomatic. In 99% of the patients the stenoses could be removed with a reduction of the degree of stenosis from 82% to 12%. Transient neurological deficits occurred in 5% and permanent deficits in 2.7% of the patients with decreasing incidence over the years. Five-year patency was 91.6%. CONCLUSION: Endoluminal treatment of atherosclerotic ICA stenosis is an efficient procedure which can be applied in patients, in whom carotid surgery is indicated, but also in cases with an increased operative risk or inoperability from technical or medical reasons.

Angioplasty, Balloon