A comparison of stent-induced stenosis in coronary and peripheral arteries

Krueger, Kristopher; Mitra, Amit; DelCore, Michael; Hunter, William J.; Agrawal, Devendra K.

doi:10.1136/jcp.2004.025643

Cited by 28 publications

(32 citation statements)

References 27 publications

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“…It has been shown that the iliac artery experiences more intimal hyperplasia than the coronary artery, but with less subsequent restenosis in porcine tests. The differences in restenosis rates between the two types of artery are not statistically significant (Krueger et al, 2006). Distal to the iliac arteries, the differences in restenosis rates between peripheral and coronary arteries is more evident.…”

Section: Introductionmentioning

confidence: 79%

Stresses in peripheral arteries following stent placement: a finite element analysis

Early

Lally

Prendergast

et al. 2009

Computer Methods in Biomechanics and Biomedical Engineering

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The success of stents to restore blood flow in atherosclerotic peripheral arteries is low relative to coronary arteries. It has been shown that joint flexion induces a mechanical environment that makes stent placement in these arteries highly incompatible, and damage and destruction of stents has been recorded. However, the effect of this environment on the stresses in the arteries is unknown. It is hypothesised that the stresses induced in arteries as a result of this mechanical environment could be sufficient to explain the relatively low success rates. To investigate this hypothesis, a finite element model of the stent-artery interaction was developed. Following stent expansion, bending was simulated by applying a displacement boundary condition to the artery. It is found that high stresses occur at the proximal/distal ends of the stent. As stress and vascular injury are hypothesised to cause restenosis, the results presented here suggest that the mechanical environment of peripheral arteries could be the predominant cause of high restenosis rates.

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Section: Introductionmentioning

confidence: 79%

Stresses in peripheral arteries following stent placement: a finite element analysis

Early

Lally

Prendergast

et al. 2009

Computer Methods in Biomechanics and Biomedical Engineering

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“…Also, D-1-phenyl-2-decanoylamino-3-morpholino-1-propanol (D-PDMP), attenuates the shear-induced activation of GalT-2, superoxide production and ICAM-1 expression (Yeh et al, 2001;Chatterjee, 1998). The triggering of an inflammatory reaction following activation of transcription factors NF-κB and AP-1 causes phenotypic modulation of medial vascular smooth muscle cells and their migration and subsequent proliferation in the intimal layer; increased extracellular matrix production by these vascular smooth muscle cells increases the volume of intimal tissue causing neointimal hyperplasia, ultimately leading to restenosis (Krueger et al, 2006;Mitra and Agrawal, 2006). The surface expression of Mac-1 or CD11/CD8 on human neutrophils is also stimulated by LacCer, ultimately leading to atherosclerosis.…”

Section: Ceramide and Cardiovascular Disordersmentioning

confidence: 99%

Recent advances in the immunobiology of ceramide

Pandey

Murphy

Agrawal

2007

Experimental and Molecular Pathology

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Ceramide, a sphingosine-based lipid molecule, has emerged as a key regulator of a wide spectrum of biological processes such as cellular differentiation, proliferation, apoptosis and senescence. Sphingomyelinase-dependent hydrolysis of sphingomyelin, and de novo synthesis involving the coordinated action of serinepalmitoyl transferase and ceramide synthase, are the two major pathways involved in ceramide synthesis. Clustering of plasma membrane rafts into ceramide enriched platforms serves as an important transmembrane signaling mechanism for cell surface receptors. Ceramides have been implicated in apoptosis, stress-signaling cascades as well as ion channels. There is accumulating evidence that targeted manipulation of ceramide metabolism pathway has immense therapeutic potential and may eventually prove to be a boon in the design of novel strategies and development of innovative treatments for diverse conditions including cardiovascular diseases, cancer and Alzheimer's disease. As yet uncharacterized natural ceramide analogs and novel inhibitors of ceramide metabolism might prove to be potent drugs. In this review, we discuss significant advances that continue to provide intriguing insights into the complex cellular and molecular mechanisms underlying ceramide-mediated signaling cascades.

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“…Although coronary and peripheral applications share several conceptual similarities in their preclinical evaluation, there are special considerations for peripheral devices with regard to model, anatomic location, and clinical application, for which supplementary references are provided. 41,98,161,208 Moreover, there is increasing complexity in the design of DES systems and the development of alternative endovascular treatments for ISR. Given that no set program or means for preclinical safety and efficacy evaluation can encompass all these endovascular technologies, this review seeks simplicity by focusing on DES systems commercially available or with published preclinical results.…”

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confidence: 99%

Preclinical Models of Restenosis and Their Application in the Evaluation of Drug-Eluting Stent Systems

Perkins

2010

Vet Pathol

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Coronary arterial disease (CAD) is the leading cause of death in the United States, the European Union, and Canada. Percutaneous coronary intervention (PCI) has revolutionized the treatment of CAD, and it is the advent of drug-eluting stent (DES) systems that has effectively allayed much of the challenge of restenosis that has plagued the success of PCI through its 30-year history. However, DES systems have not been a panacea: There yet remain the challenges associated with interventions involving bare metallic stents as well as newly arisen concerns related to the application of DES systems. To effectively address these novel and ongoing issues, animal models are relied on both to project the safety and efficacy of endovascular devices and to provide insight into the pathophysiology underlying the vascular response to injury and mechanisms of restenosis. In this review, preclinical models of restenosis are presented, and their application and limitation in the evaluation of device-based interventional technologies for the treatment of CAD are discussed.Keywords restenosis, stent, animal models, coronary artery disease Coronary artery disease (CAD) is the progressive accumulation of atherosclerotic plaque within the lumen of a coronary artery, with the typical result being luminal narrowing, reduced compliance of the vessel wall, and either a gradual reduction or a dramatic and sudden loss of blood supply to the myocardium. It is the leading cause of death in the United States, the European Union, and Canada, singly accounting for the death of 1 in 5 Americans. 117,185 In treatment options for symptomatic CAD, percutaneous coronary intervention (PCI) is the foremost modality, being based on the nonsurgical placement of a bare metallic scaffold, or stent, to prop open the artery to regain patency. However, there are drawbacks to coronary stenting, with restenosis being the Achilles' heel, accounting for a rate of failure up to 15 to 25%.18,124 Drug-eluting stents (DESs) have revolutionized PCI by effectively reducing restenosis rates to the single digits over standard bare metallic stents.DES systems combine mechanical and pharmacological approaches to assuage one or more events in the cascade that results in restenosis. These combination products consist of an intravascular scaffolding device that presents or releases single or multiple bioactive agents or pharmaceuticals into the bloodstream and arterial wall. Traditional DESs have consisted of a platform (stent), a carrier (usually a polymer), and an antirestenotic agent that is delivered locally to avert the need for high, systemically administered doses. The fundamental goal of the DES is to restore lumen patency while curtailing the diseased vessel's innate and often exuberant response to the implanted foreign material (stent) and to stent-induced injury. Despite the success of current DESs at achieving these goals, concerns have surfaced with their accruing clinical use. Such concerns pertain to vascular healing and late stent thrombosis, biocompat...

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A comparison of stent-induced stenosis in coronary and peripheral arteries

Cited by 28 publications

References 27 publications

Stresses in peripheral arteries following stent placement: a finite element analysis

Stresses in peripheral arteries following stent placement: a finite element analysis

Recent advances in the immunobiology of ceramide

Preclinical Models of Restenosis and Their Application in the Evaluation of Drug-Eluting Stent Systems

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