Table 6.

Summary of the most important findings of our review of the literature.

Although the introduction of DESs into the clinical practice was a significant advance, restenosis remains an important factor limiting the effectiveness of the percutaneous revascularisation.

The inflammatory process in response to vascular injury plays an important role in the pathogenesis of restenosis. The role of the complement system seems to be an interesting direction for future research in patients with DM. The ratio of the number of neutrophils to lymphocytes in the peripheral blood has prognostic value for the risk of restenosis in patients treated endovascularly.

Inflammation, endothelial dysfunction, platelets’ dysfunction, coagulation, rheology, and smooth muscle cell proliferation in patients living with diabetes have a slightly different course, thus playing a special role in the pathogenesis of atherosclerosis.

The expression of Cx43, the TWEAK/Fn14 pathway, the AMPK/Nox4 pathway, the PI3K/Akt pathway, the activation of PKG by the translocator protein, and the increased expression of BMP-2 are examples of cellular phenomena involved in the smooth muscle cell proliferation process in patients with diabetes, which contributes to neointimal hyperplasia.

The mechanisms by which patients with DM may develop resistance to drugs used to coat drug-eluting stents (mTOR kinase inhibitors and paclitaxel) have been described. The research conducted so far mainly concerns the use of these drugs in the chemotherapy of malignant neoplasms. The influence of individual cytostatic resistance on the predisposition to restenosis in coated stents is an interesting direction for future research.

The process of allergic inflammation may also play a role in the development of restenosis.

The role of genetic polymorphisms is an interesting and promising direction in the research on the pathogenesis of restenosis. However, for now, the knowledge on this subject is not developed enough to allow genetic testing to influence the routine medical practice in the context of restenosis prevention.