Local urokinase delivery with the Channel balloon: device safety, pharmacokinetics of intracoronary drug delivery, and efficacy of thrombolysis.
The Channel balloon is a new local drug-delivery catheter that has the dual capability of high-pressure lesion dilation and low-pressure drug infusion. The purpose of this study was to assess the safety and efficacy of this device in the local delivery of urokinase in the porcine model. Three in vivo protocols were performed in 57 anesthetized swine to assess the safety of Channel balloon use in the coronary vasculature, the pharmacokinetics of local urokinase delivery, and the ability of the catheter to lyse intraluminal thrombus. First, safety studies were performed in 18 coronary vessels in 13 pigs to compare angiographic and histologic changes following use of the Channel balloon with conventional balloon angioplasty. Second, intramural deposition of 123I-labeled urokinase was measured in 24 coronary arteries in 20 pigs to assess the efficiency and technical determinants of urokinase delivery and the time course of intramural drug retention. Finally, an in vivo thrombus model was used in 24 pigs to compare the thrombolytic capacity of local urokinase delivery with the Channel balloon in comparison with conventional urokinase infusion techniques. All balloon inflations and drug infusions with the Channel balloon were well tolerated in all animals without adverse angiographic, hemodynamic, or electrical sequelae. Comparative histologic studies with the Channel balloon demonstrated no additional vessel trauma beyond that seen with conventional balloon angioplasty. Between 0.09 and 0.35% of infused urokinase was intramurally deposited, with intracoronary persistence for at least 5 h. Drug infusion pressure did not significantly affect drug deposition, although larger amounts of urokinase were deposited with larger balloon:artery ratios and higher urokinase concentrations. In comparison to conventional systemic and guiding catheter infusions, local delivery of urokinase with the Channel balloon resulted in higher levels of clot dissolution. These studies have demonstrated safe intracoronary use of the Channel balloon in the porcine model. Local infusion of urokinase with this device results in significant intramural drug deposition that persists for at least 5 h. In comparison with conventional thrombolytic techniques, local urokinase delivery with the Channel balloon may result in enhanced intravascular thrombolysis.
Mitchel
J F
JF
Department of Internal Medicine, Hartford Hospital, University of Connecticut 06102, USA.
Barry
J J
JJ
Bow
L
L
Alberghini
T A
TA
Abbas
S A
SA
McKay
R G
RG
D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D000818:Animals; D002455:Cell Division / Q000187:drug effects*; D016503:Drug Delivery Systems / Q000295:instrumentation*; D004867:Equipment Design; D004869:Equipment Safety; D005240:Feasibility Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D007083:Iliac Artery / Q000187:drug effects / Q000293:injuries / Q000473:pathology; D008297:Male; D009131:Muscle, Smooth, Vascular / Q000187:drug effects* / Q000293:injuries / Q000473:pathology; D018809:Proliferating Cell Nuclear Antigen / Q000378:metabolism; D013552:Swine; D015912:Thrombolytic Therapy / Q000295:instrumentation*; D016896:Treatment Outcome; D017540:Tunica Media / Q000187:drug effects / Q000293:injuries / Q000473:pathology; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage* / Q000493:pharmacokinetics
D005343:Fibrinolytic Agents; D018809:Proliferating Cell Nuclear Antigen; D014568:Urokinase-Type Plasminogen Activator