Prevention of In‐Stent Restenosis After PCI by Saponin Natural Products: Inhibition of Platelet Activation

Percutaneous coronary intervention (PCI) enables coronary revascularisation and restores haemodynamic stability but also carries risks of delayed complications including in-stent restenosis (ISR), a chronic progressive disease with endovascular damage after PCI, which compromises the long-term efficacy of PCI. Currently, the main treatment strategies for ISR include interventional and drug therapies. From the era of using aspirin as a single antiplatelet agent to the 'gold standard' era of dual antiplatelet therapy, the risk of ISR after PCI has been reduced. However, long-term use of antiplatelet drugs inevitably causes a series of side effects such as gastrointestinal mucosal damage and bleeding, which have become key limiting factors in clinical treatment. Saponin natural products have been used to mitigate ISR progression by targeting platelet dysfunction. Specifically, these compounds directly bind to platelet membrane receptors, block ligand-receptor interactions, inhibit the secretion of α-granule and dense-granule contents, regulate intracellular signalling pathways and platelet metabolism, inhibit release of inflammatory mediators, and suppress platelet aggregation. This article reviews the progresses on the application of the active components in saponin natural products to inhibit platelet activation in the development of ISR after PCI, aiming to provide a superior approach for the comprehensive treatment of ISR after PCI.