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Pathogenesis and Clinical Significance of In-Stent Restenosis in Patients with Diabetes

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  • Grzegorz K. Jakubiak

    (Department and Clinic of Internal Medicine, Angiology, and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Batorego 15 St., 41-902 Bytom, Poland)

  • Natalia Pawlas

    (Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Jordana 38 St., 41-800 Zabrze, Poland)

  • Grzegorz Cieślar

    (Department and Clinic of Internal Medicine, Angiology, and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Batorego 15 St., 41-902 Bytom, Poland)

  • Agata Stanek

    (Department and Clinic of Internal Medicine, Angiology, and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Batorego 15 St., 41-902 Bytom, Poland)

Abstract

Diabetes mellitus (DM) is a strong risk factor for the development of cardiovascular diseases such as coronary heart disease, cerebrovascular disease, and peripheral arterial disease (PAD). In the population of people living with DM, PAD is characterised by multi-level atherosclerotic lesions as well as greater involvement of the arteries below the knee. DM is also a factor that significantly increases the risk of lower limb amputation. Percutaneous balloon angioplasty with or without stent implantation is an important method of the treatment for atherosclerotic cardiovascular diseases, but restenosis is a factor limiting its long-term effectiveness. The pathogenesis of atherosclerosis in the course of DM differs slightly from that in the general population. In the population of people living with DM, more attention is drawn to such factors as inflammation, endothelial dysfunction, platelet dysfunction, blood rheological properties, hypercoagulability, and additional factors stimulating vascular smooth muscle cell proliferation. DM is a risk factor for restenosis. The purpose of this paper is to provide a review of the literature and to present the most important information on the current state of knowledge on mechanisms and the clinical significance of restenosis and in-stent restenosis in patients with DM, especially in association with the endovascular treatment of PAD. The role of such processes as inflammation, neointimal hyperplasia and neoatherosclerosis, allergy, resistance to antimitotic drugs used for coating stents and balloons, genetic factors, and technical and mechanical factors are discussed. The information on restenosis collected in this publication may be helpful in planning further research in this field, which may contribute to the formulation of more and more precise recommendations for the clinical practice.

Suggested Citation

  • Grzegorz K. Jakubiak & Natalia Pawlas & Grzegorz Cieślar & Agata Stanek, 2021. "Pathogenesis and Clinical Significance of In-Stent Restenosis in Patients with Diabetes," IJERPH, MDPI, vol. 18(22), pages 1-23, November.
    • Handle: RePEc:gam:jijerp:v:18:y:2021:i:22:p:11970-:d:679122
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    References listed on IDEAS

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    1. Grzegorz K. Jakubiak & Natalia Pawlas & Grzegorz Cieślar & Agata Stanek, 2020. "Chronic Lower Extremity Ischemia and Its Association with the Frailty Syndrome in Patients with Diabetes," IJERPH, MDPI, vol. 17(24), pages 1-17, December.
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    2. Xunjie Cheng & Tianqi Ma & Feiyun Ouyang & Guogang Zhang & Yongping Bai, 2022. "Trends in the Prevalence of Cardiometabolic Multimorbidity in the United States, 1999–2018," IJERPH, MDPI, vol. 19(8), pages 1-12, April.
    3. Szymon Mućka & Martyna Miodońska & Grzegorz K. Jakubiak & Monika Starzak & Grzegorz Cieślar & Agata Stanek, 2022. "Endothelial Function Assessment by Flow-Mediated Dilation Method: A Valuable Tool in the Evaluation of the Cardiovascular System," IJERPH, MDPI, vol. 19(18), pages 1-16, September.
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    8. Vicente Pallarés-Carratalá & Vivencio Barrios & David Fierro-González & Jose Polo-García & Sergio Cinza-Sanjurjo, 2023. "Cardiovascular Risk in Patients with Dyslipidemia and Their Degree of Control as Perceived by Primary Care Physicians in a Survey—TERESA-Opinion Study," IJERPH, MDPI, vol. 20(3), pages 1-11, January.
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