© 1997 by European Society of Cardiology
Copyright © 1997, European Society of Cardiology
Local drug delivery systems and prevention of restenosis
Department of Cardiology and the Joseph J. Jacobs Center for Vascular Biology, The Cleveland Clinic Foundation, 9500 Euclid Ave, Desk F-25, Cleveland, OH 44195, USA
* Corresponding author. Tel.: +1 216 4459490; Fax: +1 216 4459595; E-mail: topole@cesmtp.ccf.org
Received 11 February 1997; accepted 3 June 1997
KEYWORDS Restenosis; Percutaneous coronary revascularization
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1 Introduction |
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It is somewhat incongruous that the successful performance of percutaneous transluminal coronary revascularization, a technically challenging and somewhat delicate endeavour, is predicated on the delivery of a traumatic insult to the vascular wall. This injury incites a cascade of compensatory responses, involving thrombosis and inflammation, vascular smooth muscle proliferation and migration, and matrix production and deposition. Although this reparative process usually stabilizes the site of injury and ensures a successful long term result, in 30 to 50% of cases it is excessive [1], resulting in compromise of the lumen with the potential for recurrent ischemia.
Our understanding of the process of restenosis, although not yet complete, has evolved considerably in recent years. There is a complex interplay of vessel wall remodeling and neointimal proliferation. Remodeling refers to a contracture or ‘shrinkage’ of the vessel, primarily related to the inflammatory process in the vessel wall which involves the media and
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2 Validation of the concept of local drug delivery |
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3 Local delivery devices (Table 2) |
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3.1 Balloon catheter delivery systems
3.1.1 Double balloon (Fig. 2a)
3.1.2 Porous and microporous balloons (Fig. 2b,c).
3.1.3 Channel, transport and sheath balloons (Fig. 2d)
3.1.4 Hydrogel balloon
3.1.5 Dispatch catheter (Fig. 2e)
3.1.6 Mechanical delivery
3.1.7 Choice of balloon catheter delivery system
3.2 Limitations of balloon catheter delivery systems.
3.2.1 Delivery efficiency
3.2.2 Retention of infused drug
3.2.3 Efficiency of gene transfer
3.3 Stents
3.4 Local radiation
3.5 Future directions
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