Cigarette Smoking Accelerates Carotid Artery Intimal Hyperplasia in a Dose-Dependent Manner

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Abstract
Background and Purpose Intimal hyperplasia is the single most important cause of early restenosis after carotid endarterectomy. Cigarette smoking is an independent risk factor associated with peripheral vascular disease and cerebrovascular accidents. We undertook a dose-response experiment to determine the effect of cigarette smoke on development of intimal hyperplasia in a rat carotid artery intimal injury model. Methods Seventy-two rats were divided into six equal groups and underwent standardized balloon injury to the carotid artery. Each group received 0 (controls), 1, 2, 3, 6, or 8 cigarettes per day for 4 weeks. Resultant intimal hyperplasia was expressed as a percentage of original lumen replaced by intimal hyperplasia. Results Percent intimal hyperplasia development (±SD) was as follows: controls (0 cigarettes per day), 17.7±13.2; 1 cigarette per day, 22.8±15.0; 2 cigarettes per day, 20.0±14.7; 3 cigarettes per day, 19.2±12.1; 6 cigarettes per day, 43.5±15.5; and 8 cigarettes per day, 36.7±9.8. Six and 8 cigarettes per day significantly increased the development of intimal hyperplasia after intimal injury (P<.01). Conclusions High-dose cigarette smoke accelerates development of intimal hyperplasia and may pose a significant risk factor in developing carotid restenosis.