title: Local delivery of paclitaxel in the treatment of peripheral arterial disease.
abstract: BACKGROUND
  Despite advancements from balloon angioplasty to drug-eluting stents, primary patency rates after endovascular revascularization of peripheral artery disease have remained inferior compared to surgery. Endovascular revascularization has been limited by restenosis and mechanical stent failure. Thus, there is increased research into other nonstent-based local drug delivery modalities, which can provide an active drug to inhibit restenosis focally and avoid the risk of systemic adverse effects.
  
  
  METHODS
  This review will summarize the unique properties of paclitaxel and studies on paclitaxel local delivery for the treatment of peripheral artery disease. A MEDLINE search for relevant peer-reviewed scientific literature published in English was conducted. Search terms included but were not limited to paclitaxel pharmacodynamics, paclitaxel local drug delivery, and drug eluting balloons, with a focus on the use of paclitaxel in the context of coronary and peripheral vascular disease.
  
  
  RESULTS
  The primary search produced 182 results of which 51 papers were relevant. Of the 51 relevant papers, 27 were original research papers and 24 were either review papers, commentary or opinion papers.
  
  
  CONCLUSIONS
  Paclitaxel has several chemical properties, which make it ideal for local drug delivery including its hydrophobicity, ability to concentrate into the arterial intima layer and prolonged effect on cells even after brief exposure periods. Local delivery of paclitaxel via injection catheters, balloon catheters and coated balloons has shown encouraging results in terms of efficacy and safety in small-scale animal and clinical studies. Additional preclinical and clinical studies are needed to determine the long-term efficacy and safety of these treatments in humans.
authors.affiliation: Yale Cardiovascular Research Group, Yale University Medical Center, New Haven, CT, USA.
authors.forename: Vivian G
authors.initials: VG
authors.lastname: Ng
authors.forename: Carlos
authors.initials: C
authors.lastname: Mena
authors.forename: Cody
authors.initials: C
authors.lastname: Pietras
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Lansky
mesh_terms: D000800:Angioplasty, Balloon / Q000379:methods; D002986:Clinical Trials as Topic; D004353:Drug Evaluation, Preclinical; D054855:Drug-Eluting Stents; D005990:Glycerol / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D007262:Infusions, Intravenous; D007472:Iohexol / Q000008:administration & dosage / Q000031:analogs & derivatives; D053758:Nanoparticles / Q000008:administration & dosage; D017239:Paclitaxel / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000494:pharmacology; D058729:Peripheral Arterial Disease / Q000188:drug therapy*; D014677:Pharmaceutical Vehicles / Q000008:administration & dosage; D050257:Tubulin Modulators / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000494:pharmacology
chemical_list: D014677:Pharmaceutical Vehicles; D050257:Tubulin Modulators; D007472:Iohexol; C000515:cremophor EL; C038192:iopromide; D017239:Paclitaxel; D005990:Glycerol
keywords: Angioplasty; drug eluting stent; peripheral artery disease