1
|
Shazly T, Eberth JF, Kostelnik CJ, Uline MJ, Chitalia VC, Spinale FG, Alshareef A, Kolachalama VB. Hydrophilic Coating Microstructure Mediates Acute Drug Transfer in Drug-Coated Balloon Therapy. ACS APPLIED BIO MATERIALS 2024; 7:3041-3049. [PMID: 38661721 DOI: 10.1021/acsabm.4c00080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Drug-coated balloon (DCB) therapy is a promising endovascular treatment for obstructive arterial disease. The goal of DCB therapy is restoration of lumen patency in a stenotic vessel, whereby balloon deployment both mechanically compresses the offending lesion and locally delivers an antiproliferative drug, most commonly paclitaxel (PTX) or derivative compounds, to the arterial wall. Favorable long-term outcomes of DCB therapy thus require predictable and adequate PTX delivery, a process facilitated by coating excipients that promotes rapid drug transfer during the inflation period. While a variety of excipients have been considered in DCB design, there is a lack of understanding about the coating-specific biophysical determinants of essential device function, namely, acute drug transfer. We consider two hydrophilic excipients for PTX delivery, urea (UR) and poly(ethylene glycol) (PEG), and examine how compositional and preparational variables in the balloon surface spray-coating process impact resultant coating microstructure and in turn acute PTX transfer to the arterial wall. Specifically, we use scanning electron image analyses to quantify how coating microstructure is altered by excipient solid content and balloon-to-nozzle spray distance during the coating procedure and correlate obtained microstructural descriptors of coating aggregation to the efficiency of acute PTX transfer in a one-dimensional ex vivo model of DCB deployment. Experimental results suggest that despite the qualitatively different coating surface microstructures and apparent PTX transfer mechanisms exhibited with these excipients, the drug delivery efficiency is generally enhanced by coating aggregation on the balloon surface. We illustrate this microstructure-function relation with a finite element-based computational model of DCB deployment, which along with our experimental findings suggests a general design principle to increase drug delivery efficiency across a broad range of DCB designs.
Collapse
Affiliation(s)
- Tarek Shazly
- Department of Biomedical Engineering Program, College of Engineering and Computing, University of South Carolina, Columbia, South Carolina 29208, United States
- Department of Mechanical Engineering, College of Engineering and Computing, University of South Carolina, Columbia, South Carolina 29208, United States
- Cardiovascular Translational Research Center, University of South Carolina, Columbia, South Carolina 29208, United States
| | - John F Eberth
- Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania 19104, United States
| | - Colton J Kostelnik
- Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania 19104, United States
- Aerospace Engineering and Engineering Mechanics, The University of Texas at Austin, Austin, Texas 78712, United States
| | - Mark J Uline
- Department of Biomedical Engineering Program, College of Engineering and Computing, University of South Carolina, Columbia, South Carolina 29208, United States
- Cardiovascular Translational Research Center, University of South Carolina, Columbia, South Carolina 29208, United States
- Department of Chemical Engineering, College of Engineering and Computing, University of South Carolina, Columbia, South Carolina 29208, United States
| | - Vipul C Chitalia
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts 02118, United States
- VA Coston Healthcare System, Boston, Massachusetts 02115, United States
| | - Francis G Spinale
- Department of Biomedical Engineering Program, College of Engineering and Computing, University of South Carolina, Columbia, South Carolina 29208, United States
- Cardiovascular Translational Research Center, University of South Carolina, Columbia, South Carolina 29208, United States
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, South Carolina 29208, United States
| | - Ahmed Alshareef
- Department of Biomedical Engineering Program, College of Engineering and Computing, University of South Carolina, Columbia, South Carolina 29208, United States
- Department of Mechanical Engineering, College of Engineering and Computing, University of South Carolina, Columbia, South Carolina 29208, United States
- Cardiovascular Translational Research Center, University of South Carolina, Columbia, South Carolina 29208, United States
| | - Vijaya B Kolachalama
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts 02118, United States
- Department of Computer Science and Faculty of Computing & Data Sciences, Boston University, Boston, Massachusetts 02115, United States
| |
Collapse
|
2
|
Shazly T, Uline M, Webb C, Pederson B, Eberth JF, Kolachalama VB. Novel Payloads to Mitigate Maladaptive Inward Arterial Remodeling in Drug-Coated Balloon Therapy. J Biomech Eng 2023; 145:121004. [PMID: 37542712 PMCID: PMC10578076 DOI: 10.1115/1.4063122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/03/2023] [Accepted: 08/03/2023] [Indexed: 08/07/2023]
Abstract
Drug-coated balloon therapy is a minimally invasive endovascular approach to treat obstructive arterial disease, with increasing utilization in the peripheral circulation due to improved outcomes as compared to alternative interventional modalities. Broader clinical use of drug-coated balloons is limited by an incomplete understanding of device- and patient-specific determinants of treatment efficacy, including late outcomes that are mediated by postinterventional maladaptive inward arterial remodeling. To address this knowledge gap, we propose a predictive mathematical model of pressure-mediated femoral artery remodeling following drug-coated balloon deployment, with account of drug-based modulation of resident vascular cell phenotype and common patient comorbidities, namely, hypertension and endothelial cell dysfunction. Our results elucidate how postinterventional arterial remodeling outcomes are altered by the delivery of a traditional anti-proliferative drug, as well as by codelivery with an anti-contractile drug. Our findings suggest that codelivery of anti-proliferative and anti-contractile drugs could improve patient outcomes following drug-coated balloon therapy, motivating further consideration of novel payloads in next-generation devices.
Collapse
Affiliation(s)
- Tarek Shazly
- College of Engineering and Computing, Biomedical Engineering Program, University of South Carolina, Columbia, SC 29208; College of Engineering and Computing, Department of Mechanical Engineering, University of South Carolina, Columbia, SC 29208; Cardiovascular Translational Research Center, University of South Carolina, Columbia, SC 29208
| | - Mark Uline
- College of Engineering and Computing, Biomedical Engineering Program, University of South Carolina, Columbia, SC 29208; Cardiovascular Translational Research Center, University of South Carolina, Columbia, SC 29208; College of Engineering and Computing, Department of Chemical Engineering, University of South Carolina, Columbia, SC 29208
| | - Clinton Webb
- College of Engineering and Computing, Biomedical Engineering Program, University of South Carolina, Columbia, SC 29208; Cardiovascular Translational Research Center, University of South Carolina, Columbia, SC 29208; School of Medicine, Department of Cell Biology and Anatomy, University of South Carolina, Columbia, SC 29208
| | - Breanna Pederson
- College of Engineering and Computing, Biomedical Engineering Program, University of South Carolina, Columbia, SC 29208
| | - John F. Eberth
- Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA 19104
| | - Vijaya B. Kolachalama
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118; Department of Computer Science and Faculty of Computing and Data Sciences, Boston University, Boston, MA 02115
| |
Collapse
|
3
|
Voll F, Wolf F, Ingwersen M, Kinstner CM, Kufner S, Ibrahim T, Ott I, Krankenberg H, Fusaro M, Cassese S. Diabetes mellitus and femoropopliteal in-stent restenosis. VASA 2022; 51:247-255. [DOI: 10.1024/0301-1526/a001006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Summary: Background: The influence of diabetes mellitus (DM) on recurrent in-stent restenosis (ISR) of femoropopliteal arteries remains understudied. We investigated whether DM has an impact on recurrent restenosis after femoropopliteal stenting in patients included in the dRug-coatEd balloon angioPlasty for femoropopliteAl In-stent Restenosis (REPAIR) cooperation. Patients and methods: The REPAIR cooperation pooled the patient-level data from 3 randomized trials in which patients with ISR of femoropopliteal arteries received either drug-coated balloon (DCB) or plain balloon angioplasty. For this analysis, patients were divided in two groups based on whether they had or had not a DM diagnosis at the time of enrollment. The primary outcome was target lesion revascularization (TLR). The main secondary outcome was recurrent ISR. Other outcomes of interest were death, Rutherford class improvement and ankle-brachial index at follow-up. Results: 256 patients (DM, n=99 vs. non-DM, n=157) with 12-month follow-up were included in the analysis. Compared to non-DM patients, DM patients displayed no difference in terms of TLR [adjusted hazard ratio (95% Confidence intervals): 0.96 (0.55, 1.69), p=0.89] and recurrent ISR [1.04 (0.61, 1.77), p=0.88], whilst mortality was higher [9.38 (1.06, 83.11), p=0.044]. There were no differences between groups with respect to other secondary outcomes. The percutaneous treatment with DCB as compared to plain balloon angioplasty significantly reduced the risk of TLR and recurrent ISR without an excess risk of death irrespective of DM (p for interaction ≥0.70). Conclusions: In patients with femoropopliteal ISR, diabetes has a neutral effect on the risk of recurrence, but increases mortality at 12-month follow-up. DCB as compared to plain balloon angioplasty is associated with superior efficacy without trade-off in safety, regardless of diabetes.
Collapse
Affiliation(s)
- Felix Voll
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Germany
| | - Florian Wolf
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Austria
| | - Maja Ingwersen
- Department of Radiology, Friedrich-Schiller-University, Jena University Hospital, Jena, Germany
| | - Christian M. Kinstner
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Austria
| | - Sebastian Kufner
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Germany
| | - Tareq Ibrahim
- I. Medical Department – Cardiology, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Ilka Ott
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Germany
- Cardiology Clinic, Helios Hospital Pforzheim, Germany
| | | | - Massimiliano Fusaro
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Germany
- Department of Interventional Cardiology, Klinik Vincentinum, Augsburg, Germany
- These authors contributed equally
| | - Salvatore Cassese
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Germany
- These authors contributed equally
| |
Collapse
|
4
|
Yazar O, Provoost A, Broughton A, Ghijselings L, Leclef Y, Van Calster K, Reginster F, Fourneau I. Paclitaxel drug-coated balloon angioplasty for the treatment of failing arteriovenous fistulas: a single-center experience. Acta Chir Belg 2020; 120:85-91. [PMID: 30633638 DOI: 10.1080/00015458.2018.1561796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objectives: To report our experience of angioplasty with Lutonix (Bard Peripheral Vascular, Inc., Tempe, AZ) drug-coated balloon (DCB) for the treatment of failing arteriovenous fistulas (AVF).Materials and methods: Retrospective, single-center analysis consisting of 14 patients treated with Lutonix paclitaxel DCBs in the period from July 2015 through April 2017. We analyzed technical success, clinical success, primary patency of the target lesion, primary patency of the dialysis circuit, and the rate of complications. Regular follow-up of AVF patency was realized by clinical examination and duplex ultrasonography. The Kaplan-Meier survival method was applied to determine the cumulative primary patency of the target lesion and the dialysis circuit.Results: Technical success was 100% and clinical success 92.9%. There were no major or minor complications. Cumulative target lesion primary patency after DCB was 69.2% at 6 months and 31.6% at 12 months. Cumulative vascular circuit primary patency was 61.5% at 6 months and 31.6% at 12 months.Conclusion: Compared to results reported in literature with plain old balloon angioplasty (POBA), Lutonix paclitaxel DCB angioplasty proved a short-term patency benefit in treatment of dialysis AVF stenosis.
Collapse
Affiliation(s)
- O. Yazar
- Department of Surgery, Europe Hospitals Brussels, Brussels, Belgium
| | - A. Provoost
- Department of Surgery, Europe Hospitals Brussels, Brussels, Belgium
| | - A. Broughton
- Department of Nephrology, Europe Hospitals Brussels, Brussels, Belgium
| | - L. Ghijselings
- Department of Radiology, Europe Hospitals Brussels, Brussels, Belgium
| | - Y. Leclef
- Department of Surgery, Europe Hospitals Brussels, Brussels, Belgium
| | - K. Van Calster
- Department of Surgery, Europe Hospitals Brussels, Brussels, Belgium
| | - F. Reginster
- Department of Nephrology, Europe Hospitals Brussels, Brussels, Belgium
| | - I. Fourneau
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
5
|
Cassese S, Byrne RA. Endovascular stenting in femoropopliteal arteries. Lancet 2018; 392:1491-1493. [PMID: 30262333 DOI: 10.1016/s0140-6736(18)32339-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 01/10/2023]
Affiliation(s)
- Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität München, Munich 80636, Germany
| | - Robert A Byrne
- Deutsches Herzzentrum München, Technische Universität München, Munich 80636, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
| |
Collapse
|
6
|
Colleran R, Harada Y, Kufner S, Giacoppo D, Joner M, Cassese S, Ibrahim T, Laugwitz KL, Kastrati A, Byrne R. Changes in high-sensitivity troponin after drug-coated balloon angioplasty for drug-eluting stent restenosis. EUROINTERVENTION 2017; 13:962-969. [DOI: 10.4244/eij-d-16-00939] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
7
|
Local arterial wall drug delivery using balloon catheter system. J Control Release 2016; 238:149-156. [PMID: 27473765 DOI: 10.1016/j.jconrel.2016.07.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 07/24/2016] [Accepted: 07/25/2016] [Indexed: 11/23/2022]
Abstract
Balloon-based drug delivery systems allow localized application of drugs to a vascular segment to reduce neointimal hyperplasia and restenosis. Drugs are coated onto balloons using excipients as drug carriers to facilitate adherence and release of drug during balloon inflation. Drug-coated balloon delivery system is characterized by a rapid drug transfer that achieves high drug concentration along the vessel wall surface, intended to correspond to the balloon dilation-induced vascular injury and healing processes. The balloon catheter system allows homogenous drug delivery to the vessel wall, such that the drug release per unit surface area is kept constant along balloons of different lengths. Optimization of the balloon coating matrix is essential for efficient drug transfer and tissue retention until the artery remodels to a normal set point. Challenges in the development of balloon-based drug delivery to the arterial wall include finding suitable excipients for drug formulation to enable drug release to a targeted lesion site effectively, maintain coating integrity during transit, prolong tissue retention and reduce particulate generation. This review highlights various factors involved in the successful design of balloon-based delivery systems, including drug release kinetics, matrix coating transfer, transmural drug partitioning, dissolution rate and release of unbound active drug.
Collapse
|