Figure 4.

Endothelial cell (EC) dysfunction caused by Notch signaling leads to neointimal hyperplasia. When vascular injury occurs, Notch signaling is activated, which further triggers EC phenotype change and causes EC dysfunction. In these processes, ECs acquire the senescent phenotype, the apoptotic phenotype or the mesenchymal phenotype and lose their barrier function, which leads to endothelial hyperpermeability, leakage and inflammatory responses. Furthermore, vascular smooth muscle cell -like cells can transmigrate into the media and proliferate, resulting in neointimal hyperplasia.