Developmental stages of restenotic neointimal hyperplasia following porcine coronary artery injury: A morphologic review

R. S. Schwatz, W. D. Edwards, A. R. Camrud, David Holmes

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


This study reviews the histopathologic development of neointimal hyperplasia through time following arterial injury in a porcine coronary model. The temporal development of obstructive neointimal hyperplasia was studied in 36 lesions from 24 pigs using oversized stent-induced coronary injury. Animals were killed at times ranging from 6 hours to 28 days following coronary artery injury. Three stages in the development of neointimal hyperplasia were identified. Stage I was thrombotic, within the first 24 hours, and consisted of platelets and fibrin, followed by trapping of erythrocytes. Stage II was a cellular recruitment phase, from 3 to 9 days, with endothelialization of the thrombus and an influx of blood-borne monocytes and lymphocytes. Stage III was proliferative, from 11 to 30 days, with ingrowth of actin-positive smooth muscle cells (possibly nonmedial in origin), forming a cellular cap over the degenerating thrombus and having little or no medial contact at the injury site. With increasing age, the cap thickened as thrombotic debris was resorbed. The extracellular matrix became less myxoid and more densely fibroelastic. Neovascularization was minimal and occurred primarily near stent wires. Prevention of restenosis may entail measures to limit not only thrombosis but also leukocytic infiltration and smooth muscle cell proliferation.

Original languageEnglish (US)
Pages (from-to)70-78
Number of pages9
JournalJournal of Vascular Medicine and Biology
Issue number2-3
StatePublished - Jan 1 1993


  • balloon angioplasty
  • neointimal hyperplasia
  • restenosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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