Coming close and then pulling away.

Interventional cardiologists have focused great interest and resources on vascular healing. The obvious reasons for this interest relate to what happens after vascular segments have been manipulated—expanded, stretched, cracked, or otherwise broken—during percutaneous intervention. The earliest energies focused on what happened after balloon dilatation alone. There were four possibilities: (i) a significant dissection developed which disrupted flow and resulted in acute or threatened closure, (ii) the artery was initially stretched but then recoiled within the first 24 h, (iii) the artery healed after the initial injury but then developed neointimal hyperplasia which often resulted in significant stenosis or ischaemia which required treatment, and (iv) the artery healed and did not develop significant neointimal hyperplasia but instead became inert and resistant to subsequent instability. With the introduction of stents, the situation became more complex because a foreign body was placed and became part of the enduring landscape. This development either eliminated or greatly decreased the above-mentioned issues of acute or threatened closure and recoil. However, the longer term … Corresponding author. Tel: +1 507 255 2504; fax: +1 507 255 2550. E-mail address : dholmes{at}mayo.edu/hughes.karyn{at}mayo.edu