Inhibition of coronary restenosis by antithrombin III in atherosclerotic swine

M. Nadir Ali, Wojciech Mazur, Neal S. Kleiman, George P. Rodgers, John M. Abukhalil, Brent A. French, Albert E. Raizner

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Background: Thrombin-mediated vascular smooth muscle cell proliferation has been implicated in coronary restenosis. Attempts to inhibit this mitogenic activity have recently focused on non-physiologic direct thrombin inhibitors, whereas endogenous thrombin inhibitors such as antithrombin III (ATIII) have received little attention. ATIII is the main physiologic inhibitor of thrombin and may thus be a potential therapeutic agent for prevention of restenosis. Methods: Human ATIII (125 U/kg) and heparin (200 U/kg) were administered to 12 atherosclerotic swine 30 min prior to inducing restenosis by oversized stent (left anterior descending and right coronary arteries; stent-to-artery ratio =1.2) and balloon injury (circumflex; balloon artery ratio ≃ 1.2). Eleven control swine received only heparin every 6 h for 24 h and were subjected to similar stent and balloon injury. Quantitative coronary angiography [change in minimal lumen diameter (ΔMLD)] and morphometric analysis [percentage area stenosis (PAS)] were performed 4 weeks later. Results: ATIII activity (mean ± SD) of treated swine increased from a baseline of 103 ± 10% to a peak of 266 ± 48%, whereas trough levels were maintained at 259 ± 55% for 72 h by drug infusions every 6 h. The ΔMLD, the primary angiographic endpoint in the balloon injured vessel was -0.57 ± 0.33 mm in heparin group versus -0.26 ± 0.27 mm in the ATIII group (P ≤ 0.03). For stented vessels the ΔMLD was -0.61 ± 0.33 mm in the heparin group versus -0.41 ± 0.37 mm in the ATIII group (P ≤ 0.06). The PAS for the balloon injured vessels was 30 ± 12% in the heparin group versus 19 ± 14 in the ATIII group (P ≤ 0.06). In stented vessels the PAS was 45 ± 16% in the heparin group versus 38 ± 16% in the ATIII group (P ≤ 0.1). Conclusion: Supraphysiologic ATIII levels in combination with heparin inhibits the reduction in MLD in coronary arteries subjected to oversized balloon injury and demonstrates a beneficial trend in arteries subjected to oversized stent injury. These data provide cautious optimism for further investigation with ATIII to prevent coronary restenosis.

Original languageEnglish (US)
Pages (from-to)851-861
Number of pages11
JournalCoronary Artery Disease
Issue number11
StatePublished - 1996


  • animal model
  • antithrombin III
  • restenosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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