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

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.

Association between Clinical Use of Colchicine and Risk of Type 2 Diabetes Mellitus among Gouty Patients: A Nationwide Cohort Study

“…Therefore, anti-inflammatory medications may ameliorate diabetes, preventing its progression and vascular complications. More importantly, prospective studies have indicated that diabetic patients have a two- to four-fold risk of developing coronary artery disease and myocardial infarction [ 25 ], establishing that T2DM is an independent risk factor for cardiovascular disease (CVD) [ 25 , 26 , 27 ]. Indeed, there is evidence that the interaction of T2DM and related cardiovascular risk underpins the progressive nature of the vascular damage, leading to atherosclerosis [ 25 ].…”

The Role of Early Revascularization and Biomarkers in the Management of Diabetic Foot Ulcers: A Single Center Experience

“…In addition, biomarker monitoring can be used during the follow-up to evaluate the adequacy of therapy and the evolution of the disease. Jakubiak GK et al, in a review of the literature, about the current state of knowledge of mechanisms and the clinical significance of restenosis and in-stent restenosis (ISR), in patients with diabetes and PAD, reported an association between an elevated postoperative high-sensitivity C-Reactive Protein (hs-CRP) level, associated with an increased risk of ISR in one-year follow-up in patients who have undergone angioplasty [ 26 ]. In another study, the average hs-CRP level was shown to be significantly higher in patients in whom ISR had occurred [ 27 ].…”

Frailty Syndrome—Fall Risk and Rehabilitation Management Aided by Virtual Reality (VR) Technology Solutions: A Narrative Review of the Current Literature

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