Platelets do not adhere to surfaces to which flowing blood is normally exposed in vivo. When the lining of a blood vessel is altered or damaged, however, platelets do adhere to the injured site. Platelet adhesion is one of the first events in the formation of hemostatic plugs and thrombi, and plays a part in the development of atherosclerotic lesions. Other surfaces to which platelets adhere include particulate matter in the blood stream, bacteria and other microorganisms, the artificial surfaces of prosthetic devices, and some altered cells in the blood, particularly macrophages. The majority of investigators have studied the interaction of platelets with the subendothelium of normal vessels of young animals, or with isolated vessel wall constituents such as collagen. There are very few studies of platelet adhesion to repeatedly damaged or diseased blood vessels, although it is generally assumed that platelets interact with the connective tissue, fibrin, and cholesterol crystals in atherosclerotic lesions. Underlying the endothelium of blood vessel is the basement membrane, which has been shown to contain type IV collagen, elastin with its associated microfibrils, von Willebrand Factor, fibronectin, thrombospondin, laminin, and heparan sulfate. If only the endothelium is removed, the main structure exposed is the basement membrane with its associated proteins, but deeper injuries expose fibrillar type III collagen and microfibrils. In most studies in which large arteries have been injured by passage of a balloon catheter, basement membrane, type III collagen and the microfibrils around elastin have been exposed. Platelets do not react strongly with basement membrane and the type IV collagen in it is relatively inert. In contrast, platelets adhere firmly to type III (and type I) collagen and spread on it. Although in vitro studies have shown that platelets can interact with collagen in artificial media without plasma proteins, investigations of platelet adhesion at high shear rates indicate that von Willebrand Factor is necessary for firm platelet adhesion under these conditions. Fibronectin and thrombospondin may also have a role in platelet adhesion. However, platelets do not bind von Willebrand Factor or fibronectin until the platelets have been stimulated to release their granule contents, so these binding sites probably do not become available until the platelets have interacted with collagen or another release-inducing agent such as thrombin.(ABSTRACT TRUNCATED AT 400 WORDS)