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Tzafriri AR, Groothuis A, Price GS, Edelman ER. Stent elution rate determines drug deposition and receptor-mediated effects. J Control Release 2012; 161:918-26. [PMID: 22642931 DOI: 10.1016/j.jconrel.2012.05.039] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 05/16/2012] [Accepted: 05/19/2012] [Indexed: 10/28/2022]
Abstract
Drug eluting stent designs abound and yet the dependence of efficacy on drug dose and elution duration remains unclear. We examined these issues within a mathematical framework of arterial drug distribution and receptor binding following stent elution. Model predictions that tissue content linearly tracks stent elution rate were validated in porcine coronary artery sirolimus-eluting stents implants. Arterial content varied for stent types, progressively declining from its Day 1 peak and tracking with rate-limiting drug elution--near zero-order release was three-fold more efficient at depositing drug in the stented lesion than near first-order release. In vivo data were consistent with an overabundance of non-specific sirolimus-binding sites relative to the specific receptors and to the delivered dose. The implication is that the persistence time of receptor saturation and effect is more sensitive to duration of elution than to eluted amount. Consequently, the eluted amount should be sufficiently high to saturate receptors at the target lesion, but dose escalation alone is an inefficient strategy for prolonging the duration of sirolimus deposition. Moreover, receptor saturating drug doses are predicted to be most efficacious when eluted from stents in a constant zero order fashion as this maximizes the duration of elution and receptor saturation.
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52
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Lockwood NA, Hergenrother RW, Patrick LM, Stucke SM, Steendam R, Pacheco E, Virmani R, Kolodgie FD, Hubbard B. In Vitro and In Vivo Characterization of Novel Biodegradable Polymers for Application as Drug-Eluting Stent Coatings. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2012; 21:529-52. [DOI: 10.1163/156856209x429175] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | | | | | | | - Rob Steendam
- e InnoCore Technologies BV, Groningen, The Netherlands
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53
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Lee CH, Chen CJ, Liu SJ, Hsiao CY, Chen JK. The Development of Novel Biodegradable Bifurcation Stents for the Sustainable Release of Anti-Proliferative Sirolimus. Ann Biomed Eng 2012; 40:1961-70. [DOI: 10.1007/s10439-012-0556-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Accepted: 03/21/2012] [Indexed: 12/18/2022]
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54
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Hsiao HM, Chiu YH. Assessment of mechanical integrity for drug-eluting renal stent with micro-sized drug reservoirs. Comput Methods Biomech Biomed Engin 2012; 16:1307-18. [PMID: 22436070 DOI: 10.1080/10255842.2012.670851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The drug-eluting stent (DES) has become the gold standard worldwide for the treatment of cardiovascular diseases. In recent years, an innovative variation of the DES with micro-sized drug reservoirs has been introduced. It allows programmable drug delivery with both spatial and temporal control and has several potential advantages over traditional DESs. However, creating such reservoirs on the stent struts may weaken the structure of the stent scaffolding and compromise its mechanical integrity. In this study, we propose to use this innovative stent concept in the renal indication for potential treatment of both renal artery stenosis (upstream) and its associated kidney diseases (downstream) at the same time. The effects of these micro-sized drug reservoirs on several key clinically relevant functional attributes of the drug-eluting renal stent were systematically and quantitatively investigated. Finite element models were developed to predict the mechanical integrity of a balloon-expandable stent at various stages. Results show that (1) creating drug reservoirs on a stent could impact the stent fatigue resistance to certain degrees; (2) drug reservoirs on the stent crowns lead to greater loss in all key stent attributes than reservoirs on either bar arms or connectors and (3) the proposed optimised depot stent was proven to be feasible and could triple drug capacity than the current DESs, with marginal trade-off in its key clinical attributes. These results can serve as the guidelines to help future stent designs to achieve the best combination of stent structural integrity and smart drug delivery in the future.
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Affiliation(s)
- Hao-Ming Hsiao
- a Department of Mechanical Engineering , National Taiwan University , Taipei , Taiwan
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55
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Intravascular ultrasound insights from the Cobalt Chromium Stent With Antiproliferative for Restenosis II (COSTAR II) trial comparing CoStar and Taxus paclitaxel-eluting stents. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2012; 13:111-8. [DOI: 10.1016/j.carrev.2012.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Revised: 01/14/2012] [Accepted: 01/20/2012] [Indexed: 11/23/2022]
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56
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57
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Papafaklis MI, Chatzizisis YS, Naka KK, Giannoglou GD, Michalis LK. Drug-eluting stent restenosis: effect of drug type, release kinetics, hemodynamics and coating strategy. Pharmacol Ther 2011; 134:43-53. [PMID: 22212618 DOI: 10.1016/j.pharmthera.2011.12.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 12/07/2011] [Indexed: 11/26/2022]
Abstract
Restenosis following stent implantation diminishes the procedure's efficacy influencing long-term clinical outcomes. Stent-based drug delivery emerged a decade ago as an effective means of reducing neointimal hyperplasia by providing localized pharmacotherapy during the acute phase of the stent-induced injury and the ensuing pathobiological mechanisms. However, drug-eluting stent (DES) restenosis may still occur especially when stents are used in complex anatomical and clinical scenarios. A DES consists of an intravascular metallic frame and carriers which allow controlled release of active pharmaceutical agents; all these components are critical in determining drug distribution locally and thus anti-restenotic efficacy. Furthermore, dynamic flow phenomena characterizing the vascular environment, and shear stress distribution, are greatly influenced by stent implantation and play a significant role in drug deposition and bioavailability within local vascular tissue. In this review, we discuss the performance of DES and the interaction of the different DES components with the hemodynamic milieu emphasizing on the inhibition of clinical restenosis.
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Affiliation(s)
- Michail I Papafaklis
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02120, USA.
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58
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Ahmed TAN, Bergheanu SC, Stijnen T, Plevier JWM, Quax PHA, Jukema JW. Clinical performance of drug-eluting stents with biodegradable polymeric coating: a meta-analysis and systematic review. EUROINTERVENTION 2011; 7:505-16. [PMID: 21764670 DOI: 10.4244/eijv7i4a81] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Different biodegradable-polymer drug-eluting stents have not yet been systematically analysed. We sought to; 1) evaluate the risk of target lesion revascularisation (TLR) and definite stent thrombosis (DST) among different groups of biodegradable-polymer (BioPol) DES, and 2) to compare them with permanent polymer (PermPol) DES. METHODS AND RESULTS We searched PubMed and relevant sources from January 2005 until October 2010. Inclusion criteria were (a) Implantation of a drug-eluting stent with biodegradable polymer; (b) available follow-up data for at least one of the clinical end-points (TLR/DST) at short term (30 days) and/or mid-term (one year). A total of 22 studies, including randomised and observational studies, with 8264 patients met the selection criteria; nine studies (2042 patients) in whom biodegradable-polymer sirolimus eluting stents (BioPol-SES) were implanted, eight studies (1731 patients) in whom biodegradable-polymer paclitaxel eluting stents (BioPol-PES) were implanted, and seven studies (4491 patients) in whom biodegradable-polymer biolimus-A9 eluting stents (BioPol-BES) were implanted. At 30 days, there was a higher risk of DST (p=0.04) and subsequently TLR (p=0.006) in the BioPol-BES compared to BioPol-SES, with no significant difference in the other stent comparisons. At 1-year, there was higher risk of TLR in the BioPol-PES (p=0.01), and the BioPol-SES (p=0.04) compared to BioPol-BES. One-year stent thrombosis was not statistically different between the studied groups (overall p=0.2). In another analysis comprising seven randomised trials comparing BioPol-DES (3778 patients) and PermPol-DES (3291 patients), the risks of TLR and stent thrombosis at 1-year were not significantly different (p=0.5 for both). CONCLUSIONS Performance of different BioPol-DES seems to vary from each other. The short- and mid-term success rates may not be superimposable. Furthermore, they may not be necessarily better than PermPol-DES.
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Affiliation(s)
- Tarek A N Ahmed
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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59
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Affiliation(s)
- Vasim Farooq
- Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
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60
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Silber S, Gutiérrez-Chico JL, Behrens S, Witzenbichler B, Wiemer M, Hoffmann S, Slagboom T, Harald D, Suryapranata H, Nienaber C, Chevalier B, Serruys PW. Effect of paclitaxel elution from reservoirs with bioabsorbable polymer compared to a bare metal stent for the elective percutaneous treatment of de novo coronary stenosis: the EUROSTAR-II randomised clinical trial. EUROINTERVENTION 2011; 7:64-73. [PMID: 21550905 DOI: 10.4244/eijv7i1a13] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS To compare the angiographic and clinical performance of a paclitaxel-eluting stent using reservoirs technology and a bioabsorbable polymer, without surface coating (CoStar), vs. an equivalent bare metal stent (BMS) using an identical metallic platform. METHODS AND RESULTS Three hundred and three (303) patients (335 lesions) with de novo coronary artery stenosis suitable for elective percutaneous treatment were randomised in an international multicentre single-blind trial to receive the CoStar stent (n=152) or the equivalent BMS (n=151). At eight months, the primary endpoint of in-segment binary restenosis was significantly lower in the CoStar than in the BMS group (17.6 vs. 30.3%, p=0.029). In-stent late loss (0.41 vs. 0.81 mm; p<0.0001) and all the other angiographic secondary endpoints also favoured CoStar. The composite of cardiac death, myocardial infarction related to the target vessel and target lesion revascularisation was significantly lower at eight months in the CoStar arm (19.7 vs. 29.1%; hazard ratio 0.54, 95% CI: 0.34-0.87; p=0.010), mainly due to lower incidence of target lesion revascularisation (15.1 vs. 26.5%; 95% CI: hazard ratio 0.45, 95% CI: 0.27-0.76; p=0.002). CONCLUSIONS As compared with a bare metal stent of identical design, the paclitaxel elution from reservoirs results in significantly less binary restenosis, less late loss and lower revascularisation rates at eight months. Therefore, based on these data, the CoStar paclitaxel-eluting stent was found to be effective and safe.
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61
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Raval A, Parikh J, Engineer C. Mechanism and in Vitro Release Kinetic Study of Sirolimus from a Biodegradable Polymeric Matrix Coated Cardiovascular Stent. Ind Eng Chem Res 2011. [DOI: 10.1021/ie102163z] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ankur Raval
- Sardar Vallabhbhai National Institute of Technology, Surat, India
| | - Jigisha Parikh
- Sardar Vallabhbhai National Institute of Technology, Surat, India
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62
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In-vitro release of anti-proliferative paclitaxel from novel balloon-expandable polycaprolactone stents. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2011. [DOI: 10.1016/j.msec.2011.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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63
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Waseda K, Ako J, Yamasaki M, Koizumi T, Sakurai R, Hongo Y, Koo BK, Ormiston J, Worthley SG, Whitbourn RJ, Walters DL, Meredith IT, Fitzgerald PJ, Honda Y. Impact of Polymer Formulations on Neointimal Proliferation After Zotarolimus-Eluting Stent With Different Polymers. Circ Cardiovasc Interv 2011; 4:248-55. [DOI: 10.1161/circinterventions.110.957548] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Polymer formulation may affect the efficacy of drug-eluting stents. Resolute, Endeavor, and ZoMaxx are zotarolimus-eluting stents with different stent platforms and different polymer coatings and have been tested in clinical trials. The aim of this analysis was to compare the efficacy of zotarolimus-eluting stents with different polymers.
Methods and Results—
Data were obtained from the first-in man trial or first randomized trials of each stent, The Clinical RESpOnse EvaLUation of the MedTronic Endeavor CR ABT-578 Eluting Coronary Stent System in De Novo Native Coronary Artery Lesions (RESOLUTE), Randomized Controlled Trial to Evaluate the Safety and Efficacy of the Medtronic AVE ABT-578 Eluting Driver Coronary Stent in De Novo Native Coronary Artery Lesions (ENDEAVOR II), and ZoMaxx I trials. Follow-up intravascular ultrasound analyses (8 to 9 months of follow-up) were possible in 353 patients (Resolute: 88, Endeavor: 98, ZoMaxx: 82, Driver: 85). Volume index (volume/stent length) was obtained for vessel, stent, lumen, peristent plaque, and neointima. Cross-sectional narrowing was defined as neointimal area divided by stent area (%). Neointima-free frame ratio was calculated as the number of frames without intravascular ultrasound–detectable neointima divided by the total number of frames within the stent. At baseline, vessel, lumen, and peristent plaque volume index were not significantly different among the 4 stent groups. At follow-up, percent neointimal obstruction was significantly lower in Resolute compared with Endeavor, ZoMaxx, and Driver (Resolute: 3.7±4.0, Endeavor: 17.5±10.1, ZoMaxx: 14.6±8.1, Driver: 29.4±17.2%;
P
<0.001). Greater maximum cross-sectional narrowing and higher neointima-free frame ratio, suggesting less neointimal coverage, were observed in Resolute compared with other stent groups. Multiple regression analysis confirmed that the biodurable polymer used in Resolute independently correlated with neointimal suppression among 3 zotarolimus-eluting stents.
Conclusions—
The different polymer formulations significantly affect the relative amount of neointima for zotarolimus-eluting stents.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00248079.
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Affiliation(s)
- Katsuhisa Waseda
- From Stanford University, Stanford, CA (K.W., J.A., M.Y., T.K., R.S., Y. Hongo, B.-K.K., P.J.F., Y. Honda); Auckland City Hospital, Auckland, New Zealand (J.O.); Royal Adelaide Hospital, Adelaide, Australia (S.G.W.); St Vincent's Hospital, Melbourne, Australia (R.J.W.); Prince Charles Hospital, Brisbane, Australia (D.L.W.); and Monash Heart and Medical Centre, Clayton, Australia (I.T.M.)
| | - Junya Ako
- From Stanford University, Stanford, CA (K.W., J.A., M.Y., T.K., R.S., Y. Hongo, B.-K.K., P.J.F., Y. Honda); Auckland City Hospital, Auckland, New Zealand (J.O.); Royal Adelaide Hospital, Adelaide, Australia (S.G.W.); St Vincent's Hospital, Melbourne, Australia (R.J.W.); Prince Charles Hospital, Brisbane, Australia (D.L.W.); and Monash Heart and Medical Centre, Clayton, Australia (I.T.M.)
| | - Masao Yamasaki
- From Stanford University, Stanford, CA (K.W., J.A., M.Y., T.K., R.S., Y. Hongo, B.-K.K., P.J.F., Y. Honda); Auckland City Hospital, Auckland, New Zealand (J.O.); Royal Adelaide Hospital, Adelaide, Australia (S.G.W.); St Vincent's Hospital, Melbourne, Australia (R.J.W.); Prince Charles Hospital, Brisbane, Australia (D.L.W.); and Monash Heart and Medical Centre, Clayton, Australia (I.T.M.)
| | - Tomomi Koizumi
- From Stanford University, Stanford, CA (K.W., J.A., M.Y., T.K., R.S., Y. Hongo, B.-K.K., P.J.F., Y. Honda); Auckland City Hospital, Auckland, New Zealand (J.O.); Royal Adelaide Hospital, Adelaide, Australia (S.G.W.); St Vincent's Hospital, Melbourne, Australia (R.J.W.); Prince Charles Hospital, Brisbane, Australia (D.L.W.); and Monash Heart and Medical Centre, Clayton, Australia (I.T.M.)
| | - Ryota Sakurai
- From Stanford University, Stanford, CA (K.W., J.A., M.Y., T.K., R.S., Y. Hongo, B.-K.K., P.J.F., Y. Honda); Auckland City Hospital, Auckland, New Zealand (J.O.); Royal Adelaide Hospital, Adelaide, Australia (S.G.W.); St Vincent's Hospital, Melbourne, Australia (R.J.W.); Prince Charles Hospital, Brisbane, Australia (D.L.W.); and Monash Heart and Medical Centre, Clayton, Australia (I.T.M.)
| | - Yoichiro Hongo
- From Stanford University, Stanford, CA (K.W., J.A., M.Y., T.K., R.S., Y. Hongo, B.-K.K., P.J.F., Y. Honda); Auckland City Hospital, Auckland, New Zealand (J.O.); Royal Adelaide Hospital, Adelaide, Australia (S.G.W.); St Vincent's Hospital, Melbourne, Australia (R.J.W.); Prince Charles Hospital, Brisbane, Australia (D.L.W.); and Monash Heart and Medical Centre, Clayton, Australia (I.T.M.)
| | - Bon-Kwon Koo
- From Stanford University, Stanford, CA (K.W., J.A., M.Y., T.K., R.S., Y. Hongo, B.-K.K., P.J.F., Y. Honda); Auckland City Hospital, Auckland, New Zealand (J.O.); Royal Adelaide Hospital, Adelaide, Australia (S.G.W.); St Vincent's Hospital, Melbourne, Australia (R.J.W.); Prince Charles Hospital, Brisbane, Australia (D.L.W.); and Monash Heart and Medical Centre, Clayton, Australia (I.T.M.)
| | - John Ormiston
- From Stanford University, Stanford, CA (K.W., J.A., M.Y., T.K., R.S., Y. Hongo, B.-K.K., P.J.F., Y. Honda); Auckland City Hospital, Auckland, New Zealand (J.O.); Royal Adelaide Hospital, Adelaide, Australia (S.G.W.); St Vincent's Hospital, Melbourne, Australia (R.J.W.); Prince Charles Hospital, Brisbane, Australia (D.L.W.); and Monash Heart and Medical Centre, Clayton, Australia (I.T.M.)
| | - Stephen G. Worthley
- From Stanford University, Stanford, CA (K.W., J.A., M.Y., T.K., R.S., Y. Hongo, B.-K.K., P.J.F., Y. Honda); Auckland City Hospital, Auckland, New Zealand (J.O.); Royal Adelaide Hospital, Adelaide, Australia (S.G.W.); St Vincent's Hospital, Melbourne, Australia (R.J.W.); Prince Charles Hospital, Brisbane, Australia (D.L.W.); and Monash Heart and Medical Centre, Clayton, Australia (I.T.M.)
| | - Robert J. Whitbourn
- From Stanford University, Stanford, CA (K.W., J.A., M.Y., T.K., R.S., Y. Hongo, B.-K.K., P.J.F., Y. Honda); Auckland City Hospital, Auckland, New Zealand (J.O.); Royal Adelaide Hospital, Adelaide, Australia (S.G.W.); St Vincent's Hospital, Melbourne, Australia (R.J.W.); Prince Charles Hospital, Brisbane, Australia (D.L.W.); and Monash Heart and Medical Centre, Clayton, Australia (I.T.M.)
| | - Darren L. Walters
- From Stanford University, Stanford, CA (K.W., J.A., M.Y., T.K., R.S., Y. Hongo, B.-K.K., P.J.F., Y. Honda); Auckland City Hospital, Auckland, New Zealand (J.O.); Royal Adelaide Hospital, Adelaide, Australia (S.G.W.); St Vincent's Hospital, Melbourne, Australia (R.J.W.); Prince Charles Hospital, Brisbane, Australia (D.L.W.); and Monash Heart and Medical Centre, Clayton, Australia (I.T.M.)
| | - Ian T. Meredith
- From Stanford University, Stanford, CA (K.W., J.A., M.Y., T.K., R.S., Y. Hongo, B.-K.K., P.J.F., Y. Honda); Auckland City Hospital, Auckland, New Zealand (J.O.); Royal Adelaide Hospital, Adelaide, Australia (S.G.W.); St Vincent's Hospital, Melbourne, Australia (R.J.W.); Prince Charles Hospital, Brisbane, Australia (D.L.W.); and Monash Heart and Medical Centre, Clayton, Australia (I.T.M.)
| | - Peter J. Fitzgerald
- From Stanford University, Stanford, CA (K.W., J.A., M.Y., T.K., R.S., Y. Hongo, B.-K.K., P.J.F., Y. Honda); Auckland City Hospital, Auckland, New Zealand (J.O.); Royal Adelaide Hospital, Adelaide, Australia (S.G.W.); St Vincent's Hospital, Melbourne, Australia (R.J.W.); Prince Charles Hospital, Brisbane, Australia (D.L.W.); and Monash Heart and Medical Centre, Clayton, Australia (I.T.M.)
| | - Yasuhiro Honda
- From Stanford University, Stanford, CA (K.W., J.A., M.Y., T.K., R.S., Y. Hongo, B.-K.K., P.J.F., Y. Honda); Auckland City Hospital, Auckland, New Zealand (J.O.); Royal Adelaide Hospital, Adelaide, Australia (S.G.W.); St Vincent's Hospital, Melbourne, Australia (R.J.W.); Prince Charles Hospital, Brisbane, Australia (D.L.W.); and Monash Heart and Medical Centre, Clayton, Australia (I.T.M.)
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64
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Speck U, Scheller B, Rutsch W, Laule M, Stangl V. Local drug delivery – the early Berlin experience: single drug administration versus sustained release. EUROINTERVENTION 2011; 7 Suppl K:K17-22. [DOI: 10.4244/eijv7ska4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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65
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66
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Capodanno D, Dipasqua F, Tamburino C. Novel drug-eluting stents in the treatment of de novo coronary lesions. Vasc Health Risk Manag 2011; 7:103-18. [PMID: 21415924 PMCID: PMC3049546 DOI: 10.2147/vhrm.s11444] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Indexed: 11/01/2022] Open
Abstract
Due to safety concerns in recent years, much effort has been devoted to improving the outcomes associated with drug-eluting stents (DESs). This review summarizes the current status of methodological and technical achievements reported in second-generation DES. Novel stents are described based on the component (the platform, the polymer, and the drug) that has undergone the most significant changes compared to earlier generation DES. An overview of the currently available evidence on the use of novel coronary devices in patients undergoing coronary revascularization is also reviewed.
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Affiliation(s)
- Davide Capodanno
- Department of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
- ETNA Foundation, Catania, Italy
| | - Fabio Dipasqua
- Department of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Corrado Tamburino
- Department of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
- ETNA Foundation, Catania, Italy
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67
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Novel Coating Technologies of Drug Eluting Stents. ACTIVE IMPLANTS AND SCAFFOLDS FOR TISSUE REGENERATION 2011. [DOI: 10.1007/8415_2010_54] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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68
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Seidlitz A, Nagel S, Semmling B, Grabow N, Martin H, Senz V, Harder C, Sternberg K, Schmitz KP, Kroemer HK, Weitschies W. Examination of drug release and distribution from drug-eluting stents with a vessel-simulating flow-through cell. Eur J Pharm Biopharm 2010; 78:36-48. [PMID: 21182943 DOI: 10.1016/j.ejpb.2010.12.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 12/08/2010] [Accepted: 12/09/2010] [Indexed: 10/18/2022]
Abstract
The recently introduced vessel-simulating flow-through cell offers new possibilities to examine the release from drug-eluting stents in vitro. In comparison with standard dissolution methods, the additional compartment allows for the examination of distribution processes and creates dissolution conditions which simulate the physiological situation at the site of implantation. It was shown previously that these conditions have a distinct influence on the release rate from the stent coating. In this work, different preparation techniques were developed to examine the spatial distribution within the compartment simulating the vessel wall. These methods allowed for the examination of diffusion depth and the distribution resulting in the innermost layer of the compartment simulating the vessel wall. Furthermore, the in vitro release and distribution examined experimentally were modelled mathematically using finite element (FE) methods to gain further insight into the release and distribution behaviour. The FE modelling employing the experimentally determined diffusion coefficients yielded a good general description of the experimental data. The results of the modelling also provided important indications that inhomogeneous coating layer thicknesses around the strut may result from the coating process which influence release and distribution behaviour. Taken together, the vessel-simulating flow-through cell in combination with FE modelling represents a unique method to analyse drug release and distribution from drug-eluting stents in vitro with particular opportunities regarding the examination of spatial distributions within the vessel-simulating compartment.
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Affiliation(s)
- Anne Seidlitz
- Institute of Pharmacy, Biopharmaceutics and Pharmaceutical Technology, EMA University of Greifswald, Greifswald, Germany.
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Yang J, Liu F, Tu S, Chen Y, Luo X, Lu Z, Wei J, Li S. Haemo- and cytocompatibility of bioresorbable homo- and copolymers prepared from 1,3-trimethylene carbonate, lactides, and epsilon-caprolactone. J Biomed Mater Res A 2010; 94:396-407. [PMID: 20186738 DOI: 10.1002/jbm.a.32677] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A series of bioresorbable polymers were prepared by ring-opening polymerization of L-lactide (LLA), DL-lactide (DLLA), epsilon-caprolactone (CL) and 1,3-trimethylene carbonate (TMC), using low toxic zinc lactate as catalyst. The various PLLA, PTMC, PCL homopolymers, and PLLA-TMC, PDLLA-TMC, PCL-TMC copolymers with 50/50 molar ratios were characterized by using analytical techniques such as proton nuclear magnetic resonance, gel permeation chromatography, tensiometer, and differential scanning calorimetry. The haemo- and cyto-compatibility were investigated in order to evaluate the potential of the polymers as coating material in drug eluting stents. Haemolysis tests show that all the homo- and copolymers present very low haemolytic ratios, indicating good haemolytic properties. Adhesion and activation of platelets were observed on the surface of PLLA, PCL, PLLA-TMC, and PDLLA-TMC films, while less platelets and lower activation were found on PTMC. The most interesting results were obtained with PCL-TMC which exhibited the lowest degree of activation with few adhered platelets, in agreement with its outstanding anticoagulant properties. Both indirect and direct cytocompatibility studies were performed on the polymers. The relative growth ratio data obtained from the liquid extracts during the 6-day cell culture period indicate that all the polymers present very low cytotoxicity. Microscopic observations demonstrate adhesion, spreading and proliferation of human umbilical vein endothelial cells ECV304. Therefore, it is concluded that these bioresorbable polymers, in particular PCL-TMC, are promising candidate materials as drug loading coating material in drug eluting stents.
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Affiliation(s)
- Jian Yang
- Department of Materials Science, Fudan University, Shanghai 200433, China
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70
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Garg S, Serruys PW. Coronary stents: looking forward. J Am Coll Cardiol 2010; 56:S43-78. [PMID: 20797503 DOI: 10.1016/j.jacc.2010.06.008] [Citation(s) in RCA: 205] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 06/01/2010] [Accepted: 06/15/2010] [Indexed: 11/24/2022]
Abstract
Despite all the benefits of drug-eluting stents (DES), concerns have been raised over their long-term safety, with particular reference to stent thrombosis. In an effort to address these concerns, newer stents have been developed that include: DES with biodegradable polymers, DES that are polymer free, stents with novel coatings, and completely biodegradable stents. Many of these stents are currently undergoing pre-clinical and clinical trials; however, early results seem promising. This paper reviews the current status of this new technology, together with other new coronary devices such as bifurcation stents and drug-eluting balloons, as efforts continue to design the ideal coronary stent.
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Affiliation(s)
- Scot Garg
- Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
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71
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Guagliumi G, Sirbu V, Musumeci G, Bezerra HG, Aprile A, Kyono H, Fiocca L, Matiashvili A, Lortkipanidze N, Vassileva A, Popma JJ, Allocco DJ, Dawkins KD, Valsecchi O, Costa MA. Strut Coverage and Vessel Wall Response to a New-Generation Paclitaxel-Eluting Stent With an Ultrathin Biodegradable Abluminal Polymer. Circ Cardiovasc Interv 2010; 3:367-75. [DOI: 10.1161/circinterventions.110.950154] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background—
Polymer-coated drug-eluting stents are effective in preventing restenosis but have been associated with delayed healing and incomplete strut coverage. It is unknown whether paclitaxel-eluting stents (PES) with minimal biodegradable abluminal coating enhances strut coverage while preventing neointimal hyperplasia. Using optical coherence tomography (OCT) as a primary imaging modality, we assessed the proportion of uncovered struts at 6-month follow-up in PES coated with durable versus ultrathin (<1 μm) biodegradable abluminal polymers.
Methods and Results—
In this pilot trial, 60 patients with de novo lesions (≤25 mm) in native coronary vessels were randomly assigned to receive either TAXUS Liberté PES or JACTAX PES, a Liberté stent with polymer deposited abluminally as microdots (JACTAX HD: 9.2 μg each of polymer and paclitaxel per 16-mm stent; JACTAX LD: 5 μg each). OCT follow-up occurred at 6 months with clinical follow-up through 1 year. The primary end point was percent uncovered struts by OCT. An independent core laboratory blinded to stent assignment analyzed images. The 6-month rate of uncovered struts per patient was 5.3±14.7% for TAXUS Liberté, 7.0±12.2% for JACTAX HD, and 4.6±7.3% for JACTAX LD (
P
=0.81); percent malapposed struts was 1.4±4.4%, 0.8±1.9%, and 1.1±2.8%, respectively (
P
=0.86). Strut-level intimal thickness was 0.20±0.10, 0.22±0.15, and 0.24±0.15 mm (
P
=0.64); percent volume obstruction by OCT was 22.2±12.8, 22.5±16.2, and 25.8±15.2 (
P
=0.69). There were no deaths, Q-wave myocardial infarctions, or stent thromboses through 1 year.
Conclusions—
JACTAX PES with an ultrathin microdot biodegradable abluminal polymer did not result in improved strut coverage at 6 months compared with TAXUS Liberté.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00776204.
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Affiliation(s)
- Giulio Guagliumi
- From the Division of Cardiology (G.G., V.S., G.M., A.A., L.F., A.M., N.L., A.V., O.V.), Cardiovascular Department, Ospedali Riuniti di Bergamo, Italy; University Hospitals Case Medical Center (H.G.B., H.K., M.A.C.), Case Western Reserve University Medical School, Cleveland, Ohio; Beth Israel Deaconess Medical Center (J.J.P.), Boston, Mass; and Boston Scientific Corporation (D.J.A., K.D.D.), Natick, Mass
| | - Vasile Sirbu
- From the Division of Cardiology (G.G., V.S., G.M., A.A., L.F., A.M., N.L., A.V., O.V.), Cardiovascular Department, Ospedali Riuniti di Bergamo, Italy; University Hospitals Case Medical Center (H.G.B., H.K., M.A.C.), Case Western Reserve University Medical School, Cleveland, Ohio; Beth Israel Deaconess Medical Center (J.J.P.), Boston, Mass; and Boston Scientific Corporation (D.J.A., K.D.D.), Natick, Mass
| | - Giuseppe Musumeci
- From the Division of Cardiology (G.G., V.S., G.M., A.A., L.F., A.M., N.L., A.V., O.V.), Cardiovascular Department, Ospedali Riuniti di Bergamo, Italy; University Hospitals Case Medical Center (H.G.B., H.K., M.A.C.), Case Western Reserve University Medical School, Cleveland, Ohio; Beth Israel Deaconess Medical Center (J.J.P.), Boston, Mass; and Boston Scientific Corporation (D.J.A., K.D.D.), Natick, Mass
| | - Hiram G. Bezerra
- From the Division of Cardiology (G.G., V.S., G.M., A.A., L.F., A.M., N.L., A.V., O.V.), Cardiovascular Department, Ospedali Riuniti di Bergamo, Italy; University Hospitals Case Medical Center (H.G.B., H.K., M.A.C.), Case Western Reserve University Medical School, Cleveland, Ohio; Beth Israel Deaconess Medical Center (J.J.P.), Boston, Mass; and Boston Scientific Corporation (D.J.A., K.D.D.), Natick, Mass
| | - Alessandro Aprile
- From the Division of Cardiology (G.G., V.S., G.M., A.A., L.F., A.M., N.L., A.V., O.V.), Cardiovascular Department, Ospedali Riuniti di Bergamo, Italy; University Hospitals Case Medical Center (H.G.B., H.K., M.A.C.), Case Western Reserve University Medical School, Cleveland, Ohio; Beth Israel Deaconess Medical Center (J.J.P.), Boston, Mass; and Boston Scientific Corporation (D.J.A., K.D.D.), Natick, Mass
| | - Hiroyuki Kyono
- From the Division of Cardiology (G.G., V.S., G.M., A.A., L.F., A.M., N.L., A.V., O.V.), Cardiovascular Department, Ospedali Riuniti di Bergamo, Italy; University Hospitals Case Medical Center (H.G.B., H.K., M.A.C.), Case Western Reserve University Medical School, Cleveland, Ohio; Beth Israel Deaconess Medical Center (J.J.P.), Boston, Mass; and Boston Scientific Corporation (D.J.A., K.D.D.), Natick, Mass
| | - Luigi Fiocca
- From the Division of Cardiology (G.G., V.S., G.M., A.A., L.F., A.M., N.L., A.V., O.V.), Cardiovascular Department, Ospedali Riuniti di Bergamo, Italy; University Hospitals Case Medical Center (H.G.B., H.K., M.A.C.), Case Western Reserve University Medical School, Cleveland, Ohio; Beth Israel Deaconess Medical Center (J.J.P.), Boston, Mass; and Boston Scientific Corporation (D.J.A., K.D.D.), Natick, Mass
| | - Aleksandre Matiashvili
- From the Division of Cardiology (G.G., V.S., G.M., A.A., L.F., A.M., N.L., A.V., O.V.), Cardiovascular Department, Ospedali Riuniti di Bergamo, Italy; University Hospitals Case Medical Center (H.G.B., H.K., M.A.C.), Case Western Reserve University Medical School, Cleveland, Ohio; Beth Israel Deaconess Medical Center (J.J.P.), Boston, Mass; and Boston Scientific Corporation (D.J.A., K.D.D.), Natick, Mass
| | - Nikoloz Lortkipanidze
- From the Division of Cardiology (G.G., V.S., G.M., A.A., L.F., A.M., N.L., A.V., O.V.), Cardiovascular Department, Ospedali Riuniti di Bergamo, Italy; University Hospitals Case Medical Center (H.G.B., H.K., M.A.C.), Case Western Reserve University Medical School, Cleveland, Ohio; Beth Israel Deaconess Medical Center (J.J.P.), Boston, Mass; and Boston Scientific Corporation (D.J.A., K.D.D.), Natick, Mass
| | - Angelina Vassileva
- From the Division of Cardiology (G.G., V.S., G.M., A.A., L.F., A.M., N.L., A.V., O.V.), Cardiovascular Department, Ospedali Riuniti di Bergamo, Italy; University Hospitals Case Medical Center (H.G.B., H.K., M.A.C.), Case Western Reserve University Medical School, Cleveland, Ohio; Beth Israel Deaconess Medical Center (J.J.P.), Boston, Mass; and Boston Scientific Corporation (D.J.A., K.D.D.), Natick, Mass
| | - Jeffrey J. Popma
- From the Division of Cardiology (G.G., V.S., G.M., A.A., L.F., A.M., N.L., A.V., O.V.), Cardiovascular Department, Ospedali Riuniti di Bergamo, Italy; University Hospitals Case Medical Center (H.G.B., H.K., M.A.C.), Case Western Reserve University Medical School, Cleveland, Ohio; Beth Israel Deaconess Medical Center (J.J.P.), Boston, Mass; and Boston Scientific Corporation (D.J.A., K.D.D.), Natick, Mass
| | - Dominic J. Allocco
- From the Division of Cardiology (G.G., V.S., G.M., A.A., L.F., A.M., N.L., A.V., O.V.), Cardiovascular Department, Ospedali Riuniti di Bergamo, Italy; University Hospitals Case Medical Center (H.G.B., H.K., M.A.C.), Case Western Reserve University Medical School, Cleveland, Ohio; Beth Israel Deaconess Medical Center (J.J.P.), Boston, Mass; and Boston Scientific Corporation (D.J.A., K.D.D.), Natick, Mass
| | - Keith D. Dawkins
- From the Division of Cardiology (G.G., V.S., G.M., A.A., L.F., A.M., N.L., A.V., O.V.), Cardiovascular Department, Ospedali Riuniti di Bergamo, Italy; University Hospitals Case Medical Center (H.G.B., H.K., M.A.C.), Case Western Reserve University Medical School, Cleveland, Ohio; Beth Israel Deaconess Medical Center (J.J.P.), Boston, Mass; and Boston Scientific Corporation (D.J.A., K.D.D.), Natick, Mass
| | - Orazio Valsecchi
- From the Division of Cardiology (G.G., V.S., G.M., A.A., L.F., A.M., N.L., A.V., O.V.), Cardiovascular Department, Ospedali Riuniti di Bergamo, Italy; University Hospitals Case Medical Center (H.G.B., H.K., M.A.C.), Case Western Reserve University Medical School, Cleveland, Ohio; Beth Israel Deaconess Medical Center (J.J.P.), Boston, Mass; and Boston Scientific Corporation (D.J.A., K.D.D.), Natick, Mass
| | - Marco A. Costa
- From the Division of Cardiology (G.G., V.S., G.M., A.A., L.F., A.M., N.L., A.V., O.V.), Cardiovascular Department, Ospedali Riuniti di Bergamo, Italy; University Hospitals Case Medical Center (H.G.B., H.K., M.A.C.), Case Western Reserve University Medical School, Cleveland, Ohio; Beth Israel Deaconess Medical Center (J.J.P.), Boston, Mass; and Boston Scientific Corporation (D.J.A., K.D.D.), Natick, Mass
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72
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Grube E, Schofer J, Hauptmann KE, Nickenig G, Curzen N, Allocco DJ, Dawkins KD. A Novel Paclitaxel-Eluting Stent With an Ultrathin Abluminal Biodegradable Polymer. JACC Cardiovasc Interv 2010; 3:431-8. [PMID: 20398872 DOI: 10.1016/j.jcin.2009.12.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Revised: 11/30/2009] [Accepted: 12/13/2009] [Indexed: 12/24/2022]
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Waseda K, Ako J, Yamasaki M, Koizumi T, Ormiston J, Worthley SG, Whitbourn RJ, Walters DL, Honda Y, Meredith IT, Fitzgerald PJ, The RESOLUTE Trial Investigators. Short- and Mid-Term Intravascular Ultrasound Analysis of the New Zotarolimus-Eluting Stent With Durable Polymer - Results From the RESOLUTE Trial -. Circ J 2010; 74:2097-102. [DOI: 10.1253/circj.cj-10-0063] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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75
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Magro M, Onuma Y, Silber S, Serruys P. Transferability of data between different drug-eluting stents. EUROINTERVENTION 2009; 5:527-31. [DOI: 10.4244/eijv5i5a85] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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76
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Noordeloos AM, Soullié T, Duckers HJ, Serruys PWJC. Promoting Vascular Regeneration as an Alternative to Conventional Angioplasty-Based Intervention. ACTA ACUST UNITED AC 2009; 13:431-9. [PMID: 17169775 DOI: 10.1080/10623320601066812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Technologies in interventional Cardiology have evolved from balloon to mechanical ablation, atherectomy, stenting, and brachytherapy to current drug eluting interventional strategies. New challenges are to develop techniques that not only prevent restenosis, but also promote vascular and endothelial healing after (balloon) injury. Endothelial healing approaches range from preventing endothelial injury to restoring endothelial function and reendothelialization by pharmacotherapy and cell therapy. These novel healing strategies warrant further exploration as they may represent an alternative to drug-eluting stent approaches.
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Affiliation(s)
- Annemarie M Noordeloos
- Molecular Cardiology Laboratory, Erasmus University Medical Center, Rotterdam, The Netherlands
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77
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Kraitzer A, Kloog Y, Zilberman M. Novel farnesylthiosalicylate (FTS)-eluting composite structures. Eur J Pharm Sci 2009; 37:351-62. [DOI: 10.1016/j.ejps.2009.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Revised: 02/19/2009] [Accepted: 03/09/2009] [Indexed: 10/21/2022]
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Chevalier B, Silber S, Park SJ, Garcia E, Schuler G, Suryapranata H, Koolen J, Hauptmann KE, Wijns W, Morice MC, Carrie D, van Es GA, Nagai H, Detiege D, Paunovic D, Serruys PW. Randomized Comparison of the Nobori Biolimus A9-Eluting Coronary Stent With the Taxus Liberté Paclitaxel-Eluting Coronary Stent in Patients With Stenosis in Native Coronary Arteries. Circ Cardiovasc Interv 2009; 2:188-95. [DOI: 10.1161/circinterventions.108.823443] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
The newly developed Nobori coronary stent coated with a bioresorbable polymer, polylactic acid, and the antiproliferative agent Biolimus A9 has the potential to reduce restenosis by suppressing neointima formation.
Methods and Results—
We conducted a randomized (2:1), controlled trial comparing the Biolimus A9-eluting stent Nobori and the paclitaxel-eluting stent Taxus Liberté, in 243 patients (153 Nobori and 90 Taxus) at 29 centers in Europe, Asia, and Australia. Patients with previously untreated lesions in up to 2 native coronary arteries were considered for enrollment. The primary end point was in-stent late loss at 9 months, whereas secondary end points included other quantitative coronary angiography parameters, such as in-segment late loss and the rate of restenosis as well as key intravascular ultrasound parameters. Clinical secondary end points were stent thrombosis and composite of major adverse cardiac events comprising death, myocardial infarction, and target vessel revascularization. At 9 months, the in-stent late loss was significantly lower in the Nobori group compared with the Taxus group (0.11�0.30 mm versus 0.32�0.50 mm) reaching both the primary hypothesis of noninferiority of Nobori stent versus Taxus Liberté stent (
P
<0.001) and the secondary hypothesis of superiority (
P
=0.001). This finding was confirmed by a significant reduction in binary restenosis from 6.2% in Taxus to 0.7% in Nobori (
P
=0.02) and neointimal volume obstruction, detected by intravascular ultrasound, from 5.5�7.2% in Taxus to 1.8�5.2% in Nobori (
P
=0.01). The major adverse cardiac events rate was 4.6% in the Nobori and 5.6% in the Taxus cohort of patients. The stent thrombosis rate was 0% in the Nobori arm and 4.4% in the Taxus arm.
Conclusions—
The NOBORI 1 clinical trial confirmed its primary hypothesis—noninferiority of the Nobori Biolimus A9-eluting stent versus the Taxus Liberté stent in reducing neointimal proliferation. Both stents showed a low major adverse cardiac events rate in the studied population.
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Affiliation(s)
- Bernard Chevalier
- From the Institut Cardiovasculaire Paris Sud (B.C.), Massy/Quincy, France; Kardiologische Gemeinschaftspraxis und Praxisklinik (S.S.), München, Germany; Department of Medicine (S.J.P.), Asan Medical Centre, Seoul, Republic of Korea; Gregorio Marañón (E.G.), Madrid, Spain; Heart Centre (G.S.), University of Leipzig, Leipzig, Germany; Isala Clinic (H.S.), Zwolle, The Netherlands; Department of Cardiology (J.K.), Catharina Ziekenhuis, Eindhoven, The Netherlands; Krankenhaus der Barmherzigen Brüder
| | - Sigmund Silber
- From the Institut Cardiovasculaire Paris Sud (B.C.), Massy/Quincy, France; Kardiologische Gemeinschaftspraxis und Praxisklinik (S.S.), München, Germany; Department of Medicine (S.J.P.), Asan Medical Centre, Seoul, Republic of Korea; Gregorio Marañón (E.G.), Madrid, Spain; Heart Centre (G.S.), University of Leipzig, Leipzig, Germany; Isala Clinic (H.S.), Zwolle, The Netherlands; Department of Cardiology (J.K.), Catharina Ziekenhuis, Eindhoven, The Netherlands; Krankenhaus der Barmherzigen Brüder
| | - Seung-Jung Park
- From the Institut Cardiovasculaire Paris Sud (B.C.), Massy/Quincy, France; Kardiologische Gemeinschaftspraxis und Praxisklinik (S.S.), München, Germany; Department of Medicine (S.J.P.), Asan Medical Centre, Seoul, Republic of Korea; Gregorio Marañón (E.G.), Madrid, Spain; Heart Centre (G.S.), University of Leipzig, Leipzig, Germany; Isala Clinic (H.S.), Zwolle, The Netherlands; Department of Cardiology (J.K.), Catharina Ziekenhuis, Eindhoven, The Netherlands; Krankenhaus der Barmherzigen Brüder
| | - Eulogio Garcia
- From the Institut Cardiovasculaire Paris Sud (B.C.), Massy/Quincy, France; Kardiologische Gemeinschaftspraxis und Praxisklinik (S.S.), München, Germany; Department of Medicine (S.J.P.), Asan Medical Centre, Seoul, Republic of Korea; Gregorio Marañón (E.G.), Madrid, Spain; Heart Centre (G.S.), University of Leipzig, Leipzig, Germany; Isala Clinic (H.S.), Zwolle, The Netherlands; Department of Cardiology (J.K.), Catharina Ziekenhuis, Eindhoven, The Netherlands; Krankenhaus der Barmherzigen Brüder
| | - Gerhard Schuler
- From the Institut Cardiovasculaire Paris Sud (B.C.), Massy/Quincy, France; Kardiologische Gemeinschaftspraxis und Praxisklinik (S.S.), München, Germany; Department of Medicine (S.J.P.), Asan Medical Centre, Seoul, Republic of Korea; Gregorio Marañón (E.G.), Madrid, Spain; Heart Centre (G.S.), University of Leipzig, Leipzig, Germany; Isala Clinic (H.S.), Zwolle, The Netherlands; Department of Cardiology (J.K.), Catharina Ziekenhuis, Eindhoven, The Netherlands; Krankenhaus der Barmherzigen Brüder
| | - Harry Suryapranata
- From the Institut Cardiovasculaire Paris Sud (B.C.), Massy/Quincy, France; Kardiologische Gemeinschaftspraxis und Praxisklinik (S.S.), München, Germany; Department of Medicine (S.J.P.), Asan Medical Centre, Seoul, Republic of Korea; Gregorio Marañón (E.G.), Madrid, Spain; Heart Centre (G.S.), University of Leipzig, Leipzig, Germany; Isala Clinic (H.S.), Zwolle, The Netherlands; Department of Cardiology (J.K.), Catharina Ziekenhuis, Eindhoven, The Netherlands; Krankenhaus der Barmherzigen Brüder
| | - Jacques Koolen
- From the Institut Cardiovasculaire Paris Sud (B.C.), Massy/Quincy, France; Kardiologische Gemeinschaftspraxis und Praxisklinik (S.S.), München, Germany; Department of Medicine (S.J.P.), Asan Medical Centre, Seoul, Republic of Korea; Gregorio Marañón (E.G.), Madrid, Spain; Heart Centre (G.S.), University of Leipzig, Leipzig, Germany; Isala Clinic (H.S.), Zwolle, The Netherlands; Department of Cardiology (J.K.), Catharina Ziekenhuis, Eindhoven, The Netherlands; Krankenhaus der Barmherzigen Brüder
| | - Karl E. Hauptmann
- From the Institut Cardiovasculaire Paris Sud (B.C.), Massy/Quincy, France; Kardiologische Gemeinschaftspraxis und Praxisklinik (S.S.), München, Germany; Department of Medicine (S.J.P.), Asan Medical Centre, Seoul, Republic of Korea; Gregorio Marañón (E.G.), Madrid, Spain; Heart Centre (G.S.), University of Leipzig, Leipzig, Germany; Isala Clinic (H.S.), Zwolle, The Netherlands; Department of Cardiology (J.K.), Catharina Ziekenhuis, Eindhoven, The Netherlands; Krankenhaus der Barmherzigen Brüder
| | - William Wijns
- From the Institut Cardiovasculaire Paris Sud (B.C.), Massy/Quincy, France; Kardiologische Gemeinschaftspraxis und Praxisklinik (S.S.), München, Germany; Department of Medicine (S.J.P.), Asan Medical Centre, Seoul, Republic of Korea; Gregorio Marañón (E.G.), Madrid, Spain; Heart Centre (G.S.), University of Leipzig, Leipzig, Germany; Isala Clinic (H.S.), Zwolle, The Netherlands; Department of Cardiology (J.K.), Catharina Ziekenhuis, Eindhoven, The Netherlands; Krankenhaus der Barmherzigen Brüder
| | - Marie-Claude Morice
- From the Institut Cardiovasculaire Paris Sud (B.C.), Massy/Quincy, France; Kardiologische Gemeinschaftspraxis und Praxisklinik (S.S.), München, Germany; Department of Medicine (S.J.P.), Asan Medical Centre, Seoul, Republic of Korea; Gregorio Marañón (E.G.), Madrid, Spain; Heart Centre (G.S.), University of Leipzig, Leipzig, Germany; Isala Clinic (H.S.), Zwolle, The Netherlands; Department of Cardiology (J.K.), Catharina Ziekenhuis, Eindhoven, The Netherlands; Krankenhaus der Barmherzigen Brüder
| | - Didier Carrie
- From the Institut Cardiovasculaire Paris Sud (B.C.), Massy/Quincy, France; Kardiologische Gemeinschaftspraxis und Praxisklinik (S.S.), München, Germany; Department of Medicine (S.J.P.), Asan Medical Centre, Seoul, Republic of Korea; Gregorio Marañón (E.G.), Madrid, Spain; Heart Centre (G.S.), University of Leipzig, Leipzig, Germany; Isala Clinic (H.S.), Zwolle, The Netherlands; Department of Cardiology (J.K.), Catharina Ziekenhuis, Eindhoven, The Netherlands; Krankenhaus der Barmherzigen Brüder
| | - Gerrit-Anne van Es
- From the Institut Cardiovasculaire Paris Sud (B.C.), Massy/Quincy, France; Kardiologische Gemeinschaftspraxis und Praxisklinik (S.S.), München, Germany; Department of Medicine (S.J.P.), Asan Medical Centre, Seoul, Republic of Korea; Gregorio Marañón (E.G.), Madrid, Spain; Heart Centre (G.S.), University of Leipzig, Leipzig, Germany; Isala Clinic (H.S.), Zwolle, The Netherlands; Department of Cardiology (J.K.), Catharina Ziekenhuis, Eindhoven, The Netherlands; Krankenhaus der Barmherzigen Brüder
| | - Hirofumi Nagai
- From the Institut Cardiovasculaire Paris Sud (B.C.), Massy/Quincy, France; Kardiologische Gemeinschaftspraxis und Praxisklinik (S.S.), München, Germany; Department of Medicine (S.J.P.), Asan Medical Centre, Seoul, Republic of Korea; Gregorio Marañón (E.G.), Madrid, Spain; Heart Centre (G.S.), University of Leipzig, Leipzig, Germany; Isala Clinic (H.S.), Zwolle, The Netherlands; Department of Cardiology (J.K.), Catharina Ziekenhuis, Eindhoven, The Netherlands; Krankenhaus der Barmherzigen Brüder
| | - Danny Detiege
- From the Institut Cardiovasculaire Paris Sud (B.C.), Massy/Quincy, France; Kardiologische Gemeinschaftspraxis und Praxisklinik (S.S.), München, Germany; Department of Medicine (S.J.P.), Asan Medical Centre, Seoul, Republic of Korea; Gregorio Marañón (E.G.), Madrid, Spain; Heart Centre (G.S.), University of Leipzig, Leipzig, Germany; Isala Clinic (H.S.), Zwolle, The Netherlands; Department of Cardiology (J.K.), Catharina Ziekenhuis, Eindhoven, The Netherlands; Krankenhaus der Barmherzigen Brüder
| | - Dragica Paunovic
- From the Institut Cardiovasculaire Paris Sud (B.C.), Massy/Quincy, France; Kardiologische Gemeinschaftspraxis und Praxisklinik (S.S.), München, Germany; Department of Medicine (S.J.P.), Asan Medical Centre, Seoul, Republic of Korea; Gregorio Marañón (E.G.), Madrid, Spain; Heart Centre (G.S.), University of Leipzig, Leipzig, Germany; Isala Clinic (H.S.), Zwolle, The Netherlands; Department of Cardiology (J.K.), Catharina Ziekenhuis, Eindhoven, The Netherlands; Krankenhaus der Barmherzigen Brüder
| | - Patrick W. Serruys
- From the Institut Cardiovasculaire Paris Sud (B.C.), Massy/Quincy, France; Kardiologische Gemeinschaftspraxis und Praxisklinik (S.S.), München, Germany; Department of Medicine (S.J.P.), Asan Medical Centre, Seoul, Republic of Korea; Gregorio Marañón (E.G.), Madrid, Spain; Heart Centre (G.S.), University of Leipzig, Leipzig, Germany; Isala Clinic (H.S.), Zwolle, The Netherlands; Department of Cardiology (J.K.), Catharina Ziekenhuis, Eindhoven, The Netherlands; Krankenhaus der Barmherzigen Brüder
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Grube E, Dawkins K, Guagliumi G, Banning A, Zmudka K, Colombo A, Thuesen L, Hauptman K, Marco J, Wijns W, Joshi A, Mascioli S. TAXUS VI final 5-year results: a multicentre, randomised trial comparing polymer-based moderate-release paclitaxel-eluting stent with a bare metal stent for treatment of long, complex coronary artery lesions. EUROINTERVENTION 2009; 4:572-7. [PMID: 19378676 DOI: 10.4244/eijv4i5a97] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIMS To assess the long-term safety and efficacy of the paclitaxel-eluting TAXUS moderate-release (MR) investigation-only stent for the treatment of long, complex coronary artery lesions. METHODS AND RESULTS TAXUS VI was a prospective, double-blind, multicentre trial wherein 446 patients were randomised between a TAXUS Express MR stent and an uncoated Express Control stent. At 5-years, the overall rate of major adverse cardiac events (MACE) was similar in the two groups at 27.8% in control and 31.3% in TAXUS (P = 0.61), including similar rates for stent thrombosis. The target vessel revascularisation (TVR) rate was 23.7% in control and 22.2% in TAXUS (P = 0.45) with a non-target lesion revascularisation (non-TLR) rate of 5.1% in control and 10.9% in TAXUS (P = 0.0274) and a TLR rate of 21.4% in control and 14.6% in TAXUS (relative reduction, 32%; P = 0.0325). Furthermore, subgroup analysis revealed that the TLR benefit of TAXUS was preserved among study groups including small vessels, long lesions and patients receiving multiple overlapping stents. CONCLUSIONS Treatment of complex coronary lesions with the TAXUS MR stent demonstrated similar MACE, similar TVR, and reduced TLR rates compared with control through five years. Based on these positive results, the aetiology of increased non-TLR TVR rate in TAXUS remains unclear.
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Affiliation(s)
- Eberhard Grube
- HELIOS Heart Center, Department of Cardiology/Angiology, Ringstrasse 49, 53721, Siegburg, Germany.
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80
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Onuma Y, Serruys P, den Heijer P, Joesoef KS, Duckers H, Regar E, Kukreja N, Tanimoto S, Garcia-Garcia HM, van Beusekom H, van der Giessen W, Nishide T. MAHOROBA, first-in-man study: 6-month results of a biodegradable polymer sustained release tacrolimus-eluting stent in de novo coronary stenoses. Eur Heart J 2009; 30:1477-85. [PMID: 19406868 DOI: 10.1093/eurheartj/ehp127] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS To report the 4-month angiographic and 6-month clinical follow-up in first-in-man study using the tacrolimus-eluting bioabsorbable polymer-coated cobalt-chromium MAHOROBA stent. METHODS AND RESULTS A total of 47 patients with either stable angina or unstable angina, or silent myocardial ischaemia, based on a de novo coronary stenosis that could be covered by a single 18 mm stent in a native coronary artery with a diameter between 3.0 and 3.5 mm were enrolled at three sites. The primary endpoint was in-stent late loss at 4 months. The secondary endpoints include %volume obstruction of the stents assessed by intravascular ultrasound (IVUS) at 4 months and major adverse cardiac events (MACE) at 6 months. Forty-seven patients were enrolled. Procedural success was achieved in 97.9%. At 4-month follow-up, in-stent late loss was 0.99 +/- 0.46 mm, whereas in-stent %volume obstruction in IVUS was 34.8 +/- 15.8%. At 6 months, there were no deaths, but 2 patients suffered from a myocardial infarction and 11 patients required ischaemia-driven repeat revascularization. The composite MACE rate was 23.4%. CONCLUSION This tacrolimus-eluting stent failed to prevent neointimal hyperplasia, despite the theoretical advantages of the tacrolimus, which has less inhibitory effects on endothelial cells than smooth muscle cells.
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Affiliation(s)
- Yoshinobu Onuma
- Thoraxcenter, Erasmus Medical Center, Ba-583, s-Gravendijkwal 230, Rotterdam, The Netherlands
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81
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Tzafriri AR, Levin AD, Edelman ER. Diffusion-limited binding explains binary dose response for local arterial and tumour drug delivery. Cell Prolif 2009; 42:348-63. [PMID: 19438899 DOI: 10.1111/j.1365-2184.2009.00602.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Local drug delivery has transformed medicine, yet it remains unclear how drug efficacy depends on physicochemical properties and delivery kinetics. Most therapies seek to prolong release, yet recent studies demonstrate sustained clinical benefit following local bolus endovascular delivery. OBJECTIVES The purpose of the current study was to examine interplay between drug dose, diffusion and binding in determining tissue penetration and effect. METHODS We introduce a quantitative framework that balances dose, saturable binding and diffusion, and measured the specific binding parameters of drugs to target tissues. RESULTS Model reduction techniques augmented by numerical simulations revealed that impact of saturable binding on drug transport and retention is determined by the magnitude of a binding potential, B(p), ratio of binding capacity to product of equilibrium dissociation constant and accessible tissue volume fraction. At low B(p) (< 1), drugs are predominantly free and transport scales linearly with concentration. At high B(p) (> 40), drug transport exhibits threshold dependence on applied surface concentration. CONCLUSIONS In this paradigm, drugs and antibodies with large B(p) penetrate faster and deeper into tissues when presented at high concentrations. Threshold dependence of tissue transport on applied surface concentration of paclitaxel and rapamycin may explain threshold dose dependence of in vivo biological efficacy of these drugs.
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Affiliation(s)
- A R Tzafriri
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA.
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82
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Verheye S, Agostoni P, Dawkins KD, Dens J, Rutsch W, Carrie D, Schofer J, Lotan C, Dubois CL, Cohen SA, Fitzgerald PJ, Lansky AJ. The GENESIS (Randomized, Multicenter Study of the Pimecrolimus-Eluting and Pimecrolimus/Paclitaxel-Eluting Coronary Stent System in Patients with De Novo Lesions of the Native Coronary Arteries) Trial. JACC Cardiovasc Interv 2009; 2:205-14. [DOI: 10.1016/j.jcin.2008.12.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Accepted: 12/21/2008] [Indexed: 10/21/2022]
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Peters B, Ewert P, Berger F. The role of stents in the treatment of congenital heart disease: Current status and future perspectives. Ann Pediatr Cardiol 2009; 2:3-23. [PMID: 20300265 PMCID: PMC2840765 DOI: 10.4103/0974-2069.52802] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Intravascular or intracardiac stenoses occur in many forms of congenital heart disease (CHD). Therefore, the implantation of stents has become an accepted interventional procedure for stenotic lesions in pediatric cardiology. Furthermore, stents are know to be used to exclude vessel aneurysm or to ensure patency of existing or newly created intracardiac communications. With the further refinement of the first generation of devices, a variety of "modern" stents with different design characteristics have evolved. Despite the tremendous technical improvement over the last 20 years, the "ideal stent" has not yet been developed. Therefore, the pediatric interventionalist has to decide which stent is suitable for each lesion. On this basis, currently available stents are discussed in regard to their advantages and disadvantages for common application in CHD. New concepts and designs developed to overcome some of the existing problems, like the failure of adaptation to somatic growth, are presented. Thus, in the future, biodegradable or growth stents might replace the currently used generation of stents. This might truly lead to widening indications for the use of stents in the treatment of CHD.
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Affiliation(s)
- Bjoern Peters
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Germany
| | - Peter Ewert
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Germany
| | - Felix Berger
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Germany
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84
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Tin Hay E, Hou XM, Lim J, Low A, Teo SG, Tan HC, Lee CH. A novel drug-eluting stent using bioabsorbable polymer technology: Two-year follow-up of the CURAMI registry. Int J Cardiol 2009; 131:272-4. [DOI: 10.1016/j.ijcard.2007.07.074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Accepted: 07/01/2007] [Indexed: 11/25/2022]
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85
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Deconinck E, Sohier J, De Scheerder I, Van den Mooter G. Pharmaceutical aspects of drug eluting stents. J Pharm Sci 2008; 97:5047-60. [DOI: 10.1002/jps.21356] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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86
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Implantation of drug-eluting stents for relief of obstructed infra-cardiac totally anomalous pulmonary venous connection in isomerism of the right atrial appendages. Cardiol Young 2008; 18:628-30. [PMID: 18828956 DOI: 10.1017/s1047951108003120] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We describe an infant with severe obstruction of infra-cardiac totally anomalous pulmonary venous connection associated with right isomerism, atrioventricular septal defect, pulmonary atresia, and multiple aortopulmonary collateral arteries. Implantation of a stent into the obstructed descending vertical vein provided effective palliation, with a dramatic increase in saturations of oxygen obviating the need for urgent high-risk surgery.
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87
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Park CB, Hong MK, Lee CW, Park SW, Park SJ. Understanding the different pattern of in-stent restenosis between sirolimus-and paclitaxel-eluting stents; still long way to go. Int J Cardiol 2008. [DOI: 10.1016/j.ijcard.2007.08.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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88
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Borghi A, Foa E, Balossino R, Migliavacca F, Dubini G. Modelling drug elution from stents: effects of reversible binding in the vascular wall and degradable polymeric matrix. Comput Methods Biomech Biomed Engin 2008; 11:367-77. [DOI: 10.1080/10255840801887555] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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89
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Abstract
In an effort to overcome the limitations of balloon-expandible intravascular metal stent-induced neointimal formation, drug-coated stent devices have been developed. The stent platform allows the local delivery of drugs to an injury site, thereby reducing the amount of drug exposure to the systemic circulation and other organs. The drug carrier matrix allows the release of the drug in a diffusion-controlled manner over an extended time period after the stent implant. The drugs are chosen such that the complex cascade of events that occurs after stent implantation that leads to smooth muscle cell proliferation and migration towards the intima are inhibited. The success of an antirestenotic drug therapy from a drug-coated stent is dependent, at least partially, on the extent of drug elution from the stent, the duration and rate of release, and accumulation of drug in the arterial wall in such a way that it covers the initiation and progression of vessel wall remodeling. The local vascular drug concentrations achieved are directly correlated with the biological effects and local vascular toxicity, and there is therefore a challenge in finding an optimum dose of drug to be delivered to tissues (ie, one that has the desired therapeutic effect without local adverse effects). There is increased focus on optimization of various factors that affect drug release from the stent system, including the physicochemical properties of the drugs, carrier vehicle formulation, and profile of elution kinetics. This review highlights the various factors involved in drug release kinetics, local vascular toxicity, carrier vehicle matrix, tissue deposition, and distribution through the arterial wall from stent-based drug delivery systems.
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90
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Lao LL, Venkatraman SS. Adjustable paclitaxel release kinetics and its efficacy to inhibit smooth muscle cells proliferation. J Control Release 2008; 130:9-14. [PMID: 18599145 DOI: 10.1016/j.jconrel.2008.05.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Revised: 04/29/2008] [Accepted: 05/11/2008] [Indexed: 10/22/2022]
Abstract
Despite the success of drug-eluting stents in the field of interventional cardiology, very little work has been reported on the role of drug (paclitaxel) release kinetics on smooth muscle cell proliferation. This paper demonstrates how paclitaxel release from degradable polymers was successfully tailored from fast release rate to moderate and slow by changing the matrix composition. Cell counting and proliferation assays were employed to investigate the efficacy of each type of release kinetics in preventing human coronary artery smooth muscle cells proliferation. The fast release kinetics presented excellent inhibition immediately but may affect the re-endothelialization process. In this study, the moderate release kinetics appeared to be the best choice to prevent cell proliferation with consequently less effect on re-endothelialization. The slow release kinetics showed little inhibition in the early days but may be beneficial in the long term as a result of its sustained release.
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Affiliation(s)
- Luciana Lisa Lao
- School of Materials Science and Engineering, Nanyang Technological University, N4.1-02-06 Nanyang Avenue, Singapore 639798, Singapore
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91
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A novel bioresorbable polymer paclitaxel-eluting stent for the treatment of single and multivessel coronary disease: primary results of the COSTAR (Cobalt Chromium Stent With Antiproliferative for Restenosis) II study. J Am Coll Cardiol 2008; 51:1543-52. [PMID: 18420096 DOI: 10.1016/j.jacc.2008.01.020] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2007] [Revised: 01/10/2008] [Accepted: 01/15/2008] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The aim was to compare safety and effectiveness of the CoStar drug-eluting stent (DES) (Conor MedSystems, Menlo Park, California) with those of the Taxus DES (Boston Scientific, Maple Grove, Minnesota) in de novo single- and multivessel percutaneous coronary intervention (PCI). BACKGROUND Paclitaxel elution from a stent coated with biostable polymer (Taxus) reduces restenosis after PCI. The CoStar DES is a novel stent with laser-cut reservoirs containing bioresorbable polymer loaded to elute 10 microg paclitaxel/30 days. METHODS Patients undergoing PCI for a single target lesion per vessel in up to 3 native epicardial vessels were randomly assigned 3:2 to CoStar or Taxus. Primary end point was 8-month major adverse cardiac events (MACE), defined as adjudicated death, myocardial infarction (MI), or clinically driven target vessel revascularization (TVR). Protocol-specified 9-month angiographic follow-up included 457 vessels in 286 patients. RESULTS Of the 1,700 patients enrolled, 1,675 (98.5%) were evaluable (CoStar = 989; Taxus = 686), including 1,330 (79%) single-vessel and 345 (21%) multivessel PCI. The MACE rate at 8 months was 11.0% for CoStar versus 6.9% for Taxus (p < 0.005), including adjudicated death (0.5% vs. 0.7%, respectively), MI (3.4% vs. 2.4%, respectively), and TVR (8.1% vs. 4.3%, respectively). Per-vessel 9-month in-segment late loss was 0.49 mm with CoStar and 0.18 mm with Taxus (p < 0.0001). Findings were consistent across pre-specified subgroups. CONCLUSIONS The CoStar DES is not noninferior to the Taxus DES based on per-patient clinical and per-vessel angiographic analyses. The relative benefit of Taxus is primarily attributable to reduction in TVR. Follow-up to 9 months showed no apparent difference in death, MI, or stent thrombosis rates.
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92
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Wu W, Yang DZ, Huang YY, Qi M, Wang WQ. Topology optimization of a novel stent platform with drug reservoirs. Med Eng Phys 2008; 30:1177-85. [PMID: 18407779 DOI: 10.1016/j.medengphy.2008.02.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 02/28/2008] [Accepted: 02/29/2008] [Indexed: 11/24/2022]
Abstract
The new generation of drug-eluting stents (DES) is required to control drug release kinetics. A novel DES (the Conor stent) with drug reservoirs on struts has been engineered. Topology optimization of one Conor stent strut was based on the commercial finite element analysis code OptiStruct, with the aim of increasing the strut stiffness while retaining its drug holding capacity. Results show that the element density distribution of the strut model was optimized with manufacturing constraints of extrusion constraint and minimum member size control. The optimal result was directly transformed to a clear, manufacturable design concept using the OptiStruct utility OSSmooth. The final manufacturing design increased the strut stiffness and yielded better stress distribution, as compared to the original strut design under the same loading. Topology optimization may help designers devise novel stent platforms for future DES with drug reservoirs and adequate scaffolding.
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Affiliation(s)
- Wei Wu
- Department of Materials Engineering, Dalian University of Technology, No. 2 LingGong Road, Dalian, LiaoNing 116024, China.
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93
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Ducrocq G, Serebruany V, Tanguay JF. Antiplatelet therapy in the era of drug-eluting stents: current and future perspectives. Expert Rev Cardiovasc Ther 2008; 5:939-53. [PMID: 17867923 DOI: 10.1586/14779072.5.5.939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The use of drug-eluting stents (DESs) dramatically reduced in-stent restenosis. However, the increasing use of these stents has raised concern about their potential thrombogenicity. Indeed, the particularity of DES thrombosis compared with bare metal stent thrombosis is a high rate of late thrombosis. Antiplatelet therapy is efficient in preventing DES thrombosis. However, this therapy could be optimized and may be improved in the future. This article will review the mechanisms and the epidemiology of stent thrombosis. Then, we will summarize the antiplatelet therapeutic strategies used to prevent stent thrombosis and especially DES-associated thrombosis. Finally, we will present some data with regard to potential advantages and pitfalls in DES thrombosis prevention using novel antiplatelet agents currently under development, as well as future stent designs with improved healing properties.
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Affiliation(s)
- Gregory Ducrocq
- Université de Montréal, Institut de Cardiologie de Montréal, Research Centre, Department of Medicine, 5000, rue Bélanger, Montréal, Qc H1T 1C8, Canada
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94
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Deuse T, Erben RG, Ikeno F, Behnisch B, Boeger R, Connolly AJ, Reichenspurner H, Bergow C, Pelletier MP, Robbins RC, Schrepfer S. Introducing the first polymer-free leflunomide eluting stent. Atherosclerosis 2008; 200:126-34. [PMID: 18295768 DOI: 10.1016/j.atherosclerosis.2007.12.055] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2007] [Accepted: 12/27/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND We here describe the pharmacological characteristic, in vivo efficacy, and in vitro mechanisms of a polymer-free leflunomide eluting stent in comparison to its rapamycin-coated equivalent. METHODS Stents were coated with 40 mM solutions of leflunomide (L) or rapamycin (R) or were left uncoated (BM). Neointima formation was assessed 6 weeks after implantation into Sprague Dawley rats by optical coherence tomographies (OCT) and histopathology. In vitro proliferation assays were performed using isolated endothelial and smooth-muscle-cells from Sprague Dawley rats to investigate the cell-specific pharmacokinetic effect of leflunomide and rapamycin. RESULTS HPLC-based drug release kinetics revealed a similar profile with 90% of the drug being released after 12.1+/-0.2 (L) and 13.0+/-0.2 days (R). After 6 weeks, OCTs showed that in-stent luminal obliteration was less for the coated stents (L:12.0+/-9.4%, R:13.3+/-13.1%) when compared to identical bare metal stents (BM:26.4+/-4.7%; p<or=0.046). Histology with computer-assisted morphometry was performed and demonstrated reduced in-stent I/M thickness ratios (L:2.5+/-1.2, R:3.7+/-3.3, BM:6.7+/-2.3, p<or=0.049 for L and R vs. BM) and neointimal areas (L:0.6+/-0.3, R:0.7+/-0.2, BM:1.3+/-0.4, p<or=0.039 for L and R vs. BM) with stent coating. No differences were found for injury and inflammation scores (L and R vs. BM; p=NS). In vitro SMC proliferation was dose-dependently and similarly inhibited by L and R at 1-100 nM (p=NS L vs. R). Interestingly, human EC proliferation at 10-100 nM was significantly inhibited only by R (p<0.001), but not by L (p=NS). CONCLUSIONS The diminished inhibition of EC proliferation may improve arterial healing and contribute to the safety profile of the leflunomide stent.
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Affiliation(s)
- Tobias Deuse
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Dr., CVRB MC 5407, Stanford, CA, USA
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95
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Abstract
This review aims to provide a glimpse into the future of drug-eluting stents (DES). Since their arrival in 2002, DES have transformed the practice of interventional cardiology by drastically reducing restenosis and the need for repeat revascularization. However, data about the potentially fatal long-term risk of stent thrombosis have spurred on research and development to improve upon the first generation of devices. The initial commercially available DES used a stainless steel platform coated with a permanent polymer to provide controlled release of the anti-restenotic drug. The platform, polymer and drug are all targets for improvement. More advanced metallic and fully biodegradable stent platforms are currently under investigation. The permanent polymer coating, a likely contributor adverse events, is being superseded by biocompatible and bioabsorbable alternatives. New drugs and drug combinations are also a research goal, as interventional cardiologists and the industry strive towards safer anti-restenotic DES.
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96
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Duckers H, Soullié T, den Heijer P, Rensing B, de Winter R, Rau M, Mudra H, Silber S, Benit E, Verheye S, Wijns W, Serruys P. Accelerated vascular repair following percutaneous coronary intervention by capture of endothelial progenitor cells promotes regression of neointimal growth at long term follow-up: final results of the Healing II trial using an endothelial progenitor cell capturing stent (Genous R stent)™. EUROINTERVENTION 2007; 3:350-8. [DOI: 10.4244/eijv3i3a64] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Affiliation(s)
- Stephan Windecker
- From the Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Bernhard Meier
- From the Department of Cardiology, University Hospital Bern, Bern, Switzerland
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98
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Abstract
The deployment of drug-eluting stents (DESs) is an integral treatment option for patients with coronary artery disease. Although the development and testing of the first-generation DESs focused to a considerable degree on efficacy parameters, including restenosis, recent concerns over late clinical events have prompted a refinement of the design criteria for succeeding generations of these devices. This review assesses design criteria for the ideal DES from 3 complementary perspectives: deliverability, efficacy, and safety. Most new investigational balloon-expandable DES systems have lowered crossing profiles by thinning stent struts using a cobalt chromium alloy, while investigational self-expanding DESs often use nitinol as the platform material. Stents designed to be fully biodegradable are also being developed, with deliverability and performance to be determined in future clinical trials. Refinements in bifurcation-dedicated stents will secure branch accessibility to offer better deliverability in complex lesion morphologies. Experimentation in stent design is already realizing multiple-lesion stenting and the in situ customization of stent length. Rather than simply targeting further reductions in restenosis rates, efforts to improve efficacy are shifting toward a lesion-specific approach, including the design of stents dedicated to bifurcation lesions. Another future direction is a disease-specific approach, or an approach using DESs as local drug-delivery devices. The identification of long-term safety issues with the first-generation DESs has reignited clinical interest in the development of stents that are more biologically based, including fully biodegradable stents and stents using biomimetic and biodegradable polymers. Important performance criteria for future DES agents include more cell-type specificity, broader safety margins, and greater facility at promoting endothelialization and healing.
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Affiliation(s)
- Junya Ako
- Center for Cardiovascular Technology, Stanford University Medical Center, Stanford, California 94305-5637, USA
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99
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Abstract
Drug-eluting stents have radically changed the way we treat coronary artery disease. They offer lower restenotic rates compared with the bare metal stents and this enables more challenging and complex lesions to be treated. However, there are still limitations as restenosis has not been completely abolished and there are concerns about stent thrombosis. The next generation stents offer the technology to address these pertinent issues. This review examines the new analogs of the sirolimus family and their use in novel stent platforms, including the use of biodegradable and bioabsorbable materials employed in both stents and on the polymer. "Reservoir stents" that are specially designed to contain layers of drugs in pockets with different release profiles are discussed and an insight into the emerging field of bioengineered stents is highlighted.
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Affiliation(s)
- Steve Ramcharitar
- Department of Interventional Cardiology, Thorax Center, Erasmus Medical Center, Dr Molewaterplein 40, GD 3015 Rotterdam, The Netherlands
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100
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Tsujino I, Ako J, Honda Y, Fitzgerald PJ. Drug delivery via nano-, micro and macroporous coronary stent surfaces. Expert Opin Drug Deliv 2007; 4:287-95. [PMID: 17489655 DOI: 10.1517/17425247.4.3.287] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Drug-eluting stents (DESs) have revolutionized the treatment of occlusive coronary artery disease via marked reduction of in-stent restenosis. One critical feature for successful DESs is the sustained release of drugs, which is achieved using a polymer coating in the present generation of DESs. However, recent studies have raised a concern that polymers may trigger allergic reactions and/or prolonged inflammation in some patients. These untoward reactions may eventually lead to undesirable clinical events, including stent thrombosis and sudden cardiac death. A new drug delivery technology, using a porous stent surface, may offer desirable drug elution properties without the use of polymers, and may translate into an improved safety profile for the next-generation DESs.
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Affiliation(s)
- Ichizo Tsujino
- Stanford University Medical Center, Division of Cardiovascular Medicine, Stanford, CA 94305, USA
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