Cardiac catheterization: consequences for the endothelium and potential for nanomedicine

Abstract

Cardiac catheterization results in interactions between the catheter and surfaces and the artery lumen, which is lined by the endothelium. These interactions can range from minor rubbing to severe mechanical injury. Further, in the case of radial access, even atraumatic interactions have consequences ranging from clinical complications, such as radial spasm and radial occlusion, to lasting endothelial cell dysfunction. These consequences may be underappreciated; however, endothelial cells play a central role in maintaining vascular homeostasis via nitric oxide production. Existing treatment paradigms do not address endothelial dysfunction or damage and, thus, novel therapeutic approaches are needed. Nanomedicine, in particular, offers great potential in the form of targeted drug delivery, via functionalized coatings or nanocarriers, aimed at increased nitric oxide bioavailability or reduced inflammation.

Friction behaviour of hydrophilic lubricious coatings for medical device applications

“…In endovascular catheterisation procedures, friction against the luminal surface of a blood vessel along which the catheter passes is integral to the insertion, manipulation and removal of the catheter by the operator. A hydrophilic coating on the catheter can replace or supplement the lubricating action of the endothelial surface layer [6], facilitating catheterisation [7]. Existing hydrophilic coatings are formed by polymers with functional groups able to absorb water molecules, such as amino, hydroxyl or carboxyl groups.…”

Measurement of Friction-induced Changes in Pig Aorta Fibre Organization by Non-invasive Imaging as a Model for Detecting the Tissue Response to Endovascular Catheters

“…Since we were unable to obtain fresh samples with intact endothelia and ESL assessment has not proved useful in the determination of catheter-induced damage [8], we focused on studying the impact of force on the collagen and elastin fibres of the aorta.…”

“…This is because in almost all cases, patients undergoing catheterization as a result of cardiovascular disease may already have pre-existing damage to their glycocalyx. In addition, the endothelium of such patients is potentially more vulnerable to damage by the catheter [8].…”

Evaluation of catheter-induced tribological damage to porcine aorta using infra-red spectroscopy

“…A recent study by Sobolewski and El Fray may provide a useful starting point [24]. They point out that the use of a balloon catheter to denude an artery segment has long been utilized as a model of arterial injury and intimal thickening, and explain the mechanisms involved in the healing of the arterial wall after damage.…”

“…According to the Sobolewski and El Fray [24], the critical moment in mechanical damaging of the artery wall occurs when the thin intima layer is removed, either by scraping, friction (i.e., abrasion or rubbing), or exposing of the media layer. Based on this finding, in the current study "acceptable" damage is defined as mechanical injury to the arterial wall which does not result in a change in the porcine aortic spectrum from one typical for that of the intima to one typical for that of the media.…”