Drug-eluting stent: the "magic bullet" for prevention of restenosis?

Abstract

The need for repeat interventions after initially successful PTCA due to restenosis has been called the "Archilles heel" of a percutaneous revascularization procedure. The incidence of restenosis varies between 20-50 % depending on the stent material, the presence of risk factors, and the location of vascular disease. Some risk factors such as diabetes have been clearly identified, others are currently debated. After years of failures trying to reduces restenosis rates, locally administered antiproliferative means have been shown to successfully inhibit excessive cell growth in response to PTCA. Local radiotherapy of in-stent restenosis results in a reduction of recurrent stenosis versus a conventional PTCA procedure. However, long-term evaluation indicated that restenosis may only be delayed with radiation therapy. Moreover, the restenosis rates were reduced, but the restenotic process was not eliminated. Coronary stents eluting the anti-proliferative agent rapamycin have demonstrated for the first time, that restenosis rates of zero percent are achievable after percutaneous revascularization procedures. Thus, it is intriguing to believe that the elimination of restenosis may have become reality. The purpose of this review is to discuss, whether a stent eluting drugs should be considered as the "magic bullet" for prevention of restenosis after PTCA.

Catheter-based prostacyclin synthase gene transfer prevents in-stent restenosis in rabbit atheromatous arteries

“…However, there might be potential problems such as, (1) little selectivity for the target of VSMCs with damage on endothelial cells, which might cause delay of re-endothelialization and following late stent thrombosis, (2) arterial wall necrosis due to chronic exposure of toxic substances, and (3) unfavorable effects on vulnerable plaques downstream of a stent by elution of drug [7][8][9][10]. As an alternative of drug elution, gene therapy would be a potential strategy to overcome those disadvantages.…”

Polyurethane Organosilicate Nanocomposites as Blood Compatible Coatings

“…In the case of coronary stents, warfarin, aspirin and clopidogrel are commonly used peri-operatively and for at least 1 year post-operatively [1]. Using anti-thrombotics for long periods of time may introduce bleeding and surgical complications as well as longer hospital stays and higher costs [2].…”

Short-Time Tuning of the Biological Activity of Functionalized Polyelectrolyte Multilayers

“…For example, coronary stents coated with heparin present antithrombotic properties, [1] or, coated with an anti-proliferative agent, such as rapamycin, reduce restenosis. [2] Different methods have been developed to achieve this aim: active molecules were incorporated directly into the material, [3±5] or were fixed on the surface of the material merely by adsorption [6,7,8] or chemical grafting. [9±11] Bioactive molecules, such as insulin [12] or epidermal growth factor, [13] have, for example, been chemically grafted and immobilized on surfaces.…”