Role of adhesion molecules in the induction of restenosis after angioplasty in the lower limb

Objective: The adhesion molecules P selectin, E selectin, intercellular adhesion molecule, vascular cellular adhesion molecule (VCAM), and monocyte chemoattractant protein 1 play a important role in the development of arteriosclerotic lesions and are considered main contributors to restenosis after angioplasty. We expected that the serum levels of these markers would increase in the early phase of the first few weeks after angioplasty. Methods: We assessed prospectively the levels of soluble forms of adhesion molecules on the day before and then 24 hours and 2 and 4 weeks after angioplasty in arteries of the lower limb by using enzyme-linked immunosorbent assays. We investigated the distribution pattern of these markers in 44 patients (25 male and 19 female; age, 67.7 +/- 8.5 years [mean +/- SD]) presenting with intermittent claudication (Fontaine stage IIb). Twelve patients (27.3%) underwent diagnostic angiography, 32 (72.2%) received interventional treatment, 22 (68.8%) received balloon angioplasty, and 10 (31.2%) required stent placement. Results: Ten (31.3%) of the treated patients developed restenosis within 6 months. These patients had significantly higher levels of P selectin (P =.034), E selectin (P =.006), and VCAM (P =.050) at all time points. E selectin, VCAM, and monocyte chemoattractant protein 1 levels increased between 24 hours and 4 weeks after angiographic procedures, thus indicating that the angiographic procedure itself leads to activation and inflammation of the endothelium. Conclusions: This study emphasizes a meaningful role of the adhesion molecules E selectin, P selectin, and VCAM as interesting contributors to restenosis formation after percutaneous transluminal angioplasty.