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Review
. 2018 Mar 15;114(4):601-610.
doi: 10.1093/cvr/cvy021.

Role of smooth muscle cells in coronary artery bypass grafting failure

Kerry Wadey  1 , Joshua Lopes  2 , Michelle Bendeck  2 , Sarah George  1
Affiliations
Review

Role of smooth muscle cells in coronary artery bypass grafting failure

Kerry Wadey et al. Cardiovasc Res. .

Abstract

Atherosclerosis is the underlying pathology of many cardiovascular diseases. The formation and rupture of atherosclerotic plaques in the coronary arteries results in angina and myocardial infarction. Venous coronary artery bypass grafts are designed to reduce the consequences of atherosclerosis in the coronary arteries by diverting blood flow around the atherosclerotic plaques. However, vein grafts suffer a high failure rate due to intimal thickening that occurs as a result of vascular cell injury and activation and can act as 'a soil' for subsequent atherosclerotic plaque formation. A clinically-proven method for the reduction of vein graft intimal thickening and subsequent major adverse clinical events is currently not available. Consequently, a greater understanding of the underlying mechanisms of intimal thickening may be beneficial for the design of future therapies for vein graft failure. Vein grafting induces inflammation and endothelial cell damage and dysfunction, that promotes vascular smooth muscle cell (VSMC) migration, and proliferation. Injury to the wall of the vein as a result of grafting leads to the production of chemoattractants, remodelling of the extracellular matrix and cell-cell contacts; which all contribute to the induction of VSMC migration and proliferation. This review focuses on the role of altered behaviour of VSMCs in the vein graft and some of the factors which critically lead to intimal thickening that pre-disposes the vein graft to further atherosclerosis and re-occurrence of symptoms in the patient.

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Figures

Figure 1
Figure 1
Early and late vein graft failure. Normal vein structure showing the three layers within the vessel wall: intima, media, and adventitia. Processes involved in early and late vein graft failure. Early vein graft failure is driven by thrombosis. Late vein graft failure is driven by intimal thickening and superimposed atherosclerosis.
Figure 2
Figure 2
Comparison of venous and arterial cells. Differences in the properties of venous and arterial cells that alter cell behaviour and may contribute to the poor patency of coronary artery vein grafts.
Figure 3
Figure 3
Comparison of veins and arteries. Structural and compositional differences of veins and arteries that may contribute to the poor patency of coronary artery vein grafts.
See this image and copyright information in PMC

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