Intimal lesion formation was investigated in rats made thrombocytopenic by a single i.p. injection of a polyclonal antibody made against rat platelets that reduced circulating platelet counts to less than 1% of normal. The carotid artery was then denuded of endothelium with a 2 French balloon catheter, after which no platelets were found adhering to the exposed subendothelium. In control animals, platelets adhered instantly to the denuded artery. Six hours after denudation mRNA for ornithine decarboxylase, a marker for early G1 events, was found to be elevated in both thrombocytopenic and control arteries. Two days after injury the smooth muscle cell replication rate in thrombocytopenic rats was found to be significantly elevated as compared with that in uninjured carotids (13.7% +/- 8.4% vs. 0.65% +/- 0.23%) but was similar to the replication rate observed in denuded carotid arteries from animals treated with nonimmune IgG. One important difference between these animals was that no intimal thickening was observed in thrombocytopenic animals at day 4, and by day 7 the intimas were still significantly smaller than those from control rats. In a separate group of animals which were thrombocytopenic for the entire experiment, no intimal lesions were observed 7 days after injury by balloon catheter. From these results, we conclude that platelets do not play a role in the initiation of smooth muscle cell proliferation after injury by balloon catheter but may regulate their movement into the intima.