ABSTRACT
Rapamycin, or sirolimus, is a macrocyclic lactone that inhibits vascular smooth muscle cell proliferation and migration (Figure 39.1). It also possesses immunosuppressive properties and is used clinically to prevent acute renal allograft rejection. Ongoing clinical trials are evaluating its use in preventing cardiac transplant rejection and allograft vasculopathy. Since smooth muscle cell proliferation and chronic inflammation are prominent features of in-stent restenosis, rapamycin has been evaluated as a prophylactic treatment of restenosis. In that in-stent restenosis is a local, self-limited phenomenon and that rapamycin possesses systemic toxic effects, rapamycin may be an ideal antirestenotic agent to be delivered locally from a stent-based platform.
