MicroRNAs (miRNAs) are short non-coding RNAs, which post-transcriptionally regulate gene expression. miRNAs are important in governing cell differentiation, development and disease. Our work spans the role of miRNA in the development of vascular pathologies associated with remodeling and with the vascular regenerative strategies in ischaemic conditions. We have focused on miRNA in the development of pulmonary arterial hypertension and vein graft disease. In consideration of the role played by miRNAs in cell proliferation and vascular remodeling, we evaluated the involvement of the smooth muscle cell-associated miRNAs miR-143 and miR-145 in the development of PAH, as well as the role of miRNA-21 which is more widely expressed. Significant dysregulation of these miRNAs in PAH and VG disease has been observed in animal models and in pathological samples and manipulation has been shown to the beneficial in prevention of pathological remodelling. Manipulation of miR-21 and miR-145 may therefore represent a novel strategy to prevent the development of these pathologies that have substantial unmet clinical need. Strategies to efficiently delivery these therapeutics to the vessel wall will also be discussed.