MicroRNAs (miRNAs) are pivotal regulatory molecules involved in numerous cellular processes, including apoptosis, differentiation, proliferation, and migration. Recent research highlights specific miRNAs, such as the miR-221/222 cluster, which modulate key signaling pathways related to vascular smooth muscle cell (VSMC) proliferation, inflammation, and endothelial function. This function of miR-221/222 is accompanied by influencing the expression of certain proteins implicated in VSMCs and endothelial cells regulatory processes. miRNAs have been increasingly recognized for their roles in cardiovascular diseases, particularly in the mechanisms underlying in-stent restenosis and stent thrombosis. Elevated levels of miR-221/222 have been reported to be associated with severe adverse events following stenting and affect VSMC behavior and inflammatory responses. This image makes them promising candidates for new therapeutic strategies to address the most complex inferences of stenting, in-stent restenosis/stent thrombosis. Therefore, a discussion over the involvement of miR-221/222 in vascular pathophysiology could lead to finding possible signaling pathways and better stent designing for improving outcomes in patients undergoing stenting. Emerging therapeutic approaches, such as anti-miR oligonucleotides, offer the potential for translating these findings into clinical practice. This review article systematically investigates the biogenesis and functions of the miR-221/222 cluster along with its contributions to angiogenesis, vascular calcification, and neointimal formation. It aims to provide readers and researchers with insights into the signaling pathways that underpin vascular pathology linked to the miR-221 and miR-222 involvement.
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