Abstract-Neointimal proliferation occurring after vascular or endovascular procedures is a major complication leading to end-organ or limb ischemia. In experimental models, balloon injury has been shown to induce NAD(P)H oxidase to produce vascular superoxide anion (O 2 ·Ϫ ) production, which has been implicated in cell proliferation, but a direct link is still unclear. We postulated that inhibition of arterial NAD(P)H oxidase, resulting in decreased O 2 ·Ϫ , would lessen the neointimal hyperplasia caused by balloon injury to the common carotid artery (CCA). Sprague-Dawley rats were implanted with osmotic minipumps containing either vehicle, a cell-permeant peptide that inhibits NAD(P)H oxidase (gp91ds-tat, 10 mg/kg per day), or a scrambled peptide control (scrmb-tat). Two days after pump implantation, the left CCA was injured using an intravascular balloon embolectomy catheter (2F Fogarty). Systolic blood pressure was monitored by tail cuff. Fourteen days after injury, CCAs were harvested and analyzed by digital morphometry. Rats in both groups remained normotensive, with no significant differences in systolic blood pressure. Reactive oxygen species measurements after injury indicated a significant reduction in vascular O 2 ·Ϫ in rats infused with gp91ds-tat, and the neointima/media area and thickness ratios were significantly lower in their arteries compared with control. On the contrary, no significant change in overall CCA diameter was observed in any group. Our data indicate that in response to balloon injury of the rat carotid artery, NAD(P)H oxidase activity contributes to neointimal hyperplasia and is involved in vascular cell proliferation and migration during restenosis. Key Words: superoxide Ⅲ NAD(P)H oxidase Ⅲ balloon angioplasty Ⅲ neointima formation P roliferation and migration of vascular smooth muscle cells, and more recently fibroblasts, have been implicated in narrowing of the arterial lumen in response to injury, mimicking some of the hallmark characteristics in the pathogenesis of atherosclerosis. [1][2][3][4][5] Although the mediators are not fully understood, they include angiotensin II (Ang II), growth factors, and proto-oncogenes; indeed, in the rat both ACE inhibitors and Ang II receptor antagonists have been shown to prevent neointima formation in response to balloon injury. 6 -10 One factor stimulated by Ang II that is involved in the process of vascular cell proliferation and neointimal growth appears to be superoxide anion (O 2 ·Ϫ ) derived from vascular NAD(P)H oxidase. 11-17 Neointimal proliferation and stenosis after vascular or endovascular procedures in animal models coincide with elevated levels of reactive oxygen species (ROS) implicated in a variety of growth-related signaling pathways 18,19 and smooth muscle cell and fibroblast proliferation and migration. 20,21 Recent reports have suggested that activation of various isoforms of NAD(P)H oxidase leads to increased O 2 ·Ϫ in the vascular wall in response to injury. 18,21,22 However, the lack of specific and effective in viv...