Local drug delivery for treatment of coronary and peripheral artery disease.
Local drug delivery (LDD), the direct application of a therapeutic agent to a focal location, has been used in cardiovascular interventions to prophylactically reduce neointimal hyperplasia and relieve clot burden. LDD allows targeted use of drugs whose toxicities inhibit their systemic use while stent delivery allows for consistent and prolonged delivery. Stents eluting limus family drugs or paclitaxel inhibit vascular smooth muscle cell hyperplasia and migration and clinical use of such stents have reduced restenosis rates after percutaneous coronary procedures. However, associated with the increased efficacy is an increased rate of late stent thrombosis associated with death and myocardial infarction. Recent innovations, including bioabsorbable polymers and completely bioabsorbable stents may expand the use of drug-eluting stents. In this review, we discuss the development, the clinical use, and the effects of LDD from balloon and stent-based platforms in the treatment of restenosis and thrombus.
Gertz
Zachary M
ZM
Cardiovascular Division, Hospital of the University of Pennsylvania, and Cardiovascular Institute, University of Pennsylvania, Philadelphia, PA, USA.
Wilensky
Robert L
RL
D020341:Absorbable Implants; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation; D000818:Animals; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D057785:Catheters; D020099:Coated Materials, Biocompatible; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000628:therapy*; D016503:Drug Delivery Systems / Q000295:instrumentation; D054855:Drug-Eluting Stents; D004867:Equipment Design; D006801:Humans; D058729:Peripheral Arterial Disease / Q000188:drug therapy / Q000628:therapy*; D011474:Prosthesis Design; D016896:Treatment Outcome
D002317:Cardiovascular Agents; D020099:Coated Materials, Biocompatible