Physiological Transport Forces Govern Drug Distribution for Stent-Based Delivery

Abstract

Background-The first compounds considered for stent-based delivery, such as heparin, were chosen on the basis of promising tissue culture and animal experiments, and yet they have failed to stop restenosis clinically. More recent compounds, such as paclitaxel, are of a different sort, being hydrophobic in nature, and their effects after local release seem far more profound. This dichotomy raises the question of whether drugs that have an effect when released from a stent do so because of differences in biology or differences in physicochemical properties and targeting. Methods and Results-We applied continuum pharmacokinetics to examine the effects of transport forces and device geometry on the distribution of stent-delivered hydrophilic and hydrophobic drugs. We found that stent-based delivery invariably leads to large concentration gradients, with drug concentrations ranging from nil to several times the mean tissue concentration over a few micrometers. Concentration variations were a function of the Peclet number (Pe), the ratio of convective to diffusive forces. Although hydrophobic drugs exhibited greater variability than hydrophilic drugs, they achieved higher mean concentrations and remained closer to the intima. Inhomogeneous strut placement influenced hydrophilic drugs more negatively than hydrophobic drugs, dramatically affecting local concentrations without changing mean concentrations. Conclusions-Because local concentrations and gradients are inextricably linked to biological effect, our results provide a potential explanation for the variable success of stent-based delivery. We conclude that mere proximity of delivery devices to tissues does not ensure adequate targeting, because physiological transport forces cause local concentrations to deviate significantly from mean concentrations. (Circulation. 2001;104:600-605.)

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A New 3-D Automated Computational Method to Evaluate In-Stent Neointimal Hyperplasia in In-Vivo Intravascular Optical Coherence Tomography Pullbacks

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Specific binding to intracellular proteins determines arterial transport properties for rapamycin and paclitaxel

“…I t now appears that the success of drug-eluting stents is predicated to as great a degree upon the extent of drug deposition and distribution through the arterial wall as virtually any other factor (1)(2)(3)(4)(5). The biological effects of a candidate drug are essential, but, ultimately, tissue residence time will determine effect and toxicity (6,7).…”