Systems of local drug delivery to arterial wall for prevention of in-stent restenosis

New generation, drug-eluting stents used in the treatment of coronary and peripheral atherosclerotic disease (CPAD) significantly reduced restenosis and revascularization rates as well as frequency of thrombosis as compared to bare metal stents and first-generation drug eluting stents. However, despite fast development of this technology several reports have been published recently that describe cases of late and very late stent thrombosis, restenosis and neoatheroslerosis within arterial segments with previously implanted stents. For this reason many research are being conducted with the aim to design alternative methods for intra-arterial drugs delivery in order to reduce restenosis and revascularization rates, yet eliminating adverse effects mentioned above. One of possibilities is lipophilic and antiproliferative drug coated balloon technology, which offers high drug concentration in arterial tissue and restenotic effect in selected clinical situations despite the short balloon inflation time. A particularly interesting option is intra-arterial delivery of drugs with different mechanisms of action, regardless of their lipophilicity by loading them into biodegradable nanospheres. In this paper, currently used systems for local drug delivery have been described including their limitations and opportunities. In addition, we provided a brief description of the project sponsored by Polpharma Scientific Foundation, which aimed to evaluate potentials of local delivery of biodegradable nanospheres loaded with everolimus, which could be used to reduce restenosis rate after stent implantation.

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Very late stent thrombosis with second generation drug eluting stents compared to bare metal stents: Network meta-analysis of randomized primary percutaneous coronary intervention trials

Catheterization and Cardiovascular Interventions ◽

10.1002/ccd.26458 ◽

2016 ◽

Vol 88 (1) ◽

pp. 38-48 ◽

Cited By ~ 24

Author(s):

Femi Philip ◽

Susan Stewart ◽

Jeffrey A. Southard

Keyword(s):

Meta Analysis ◽

Bare Metal Stents ◽

Coronary Intervention ◽

Drug Eluting Stents ◽

Metal Stents ◽

Late Stent Thrombosis ◽

Very Late Stent Thrombosis ◽

Percutaneous Coronary ◽

Drug Eluting ◽

Intervention Trials

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AS-052 Virtual Histology Intravasucular Ultrasound Comparison of Neointimal Morphology of In-Stent Restenosis with Drug Eluting Stents Versus Bare Metal Stents

The American Journal of Cardiology ◽

10.1016/j.amjcard.2012.01.057 ◽

2012 ◽

Vol 109 (7) ◽

pp. S27

Author(s):

Shimpei Fujita ◽

Satoru Sakuragi

Keyword(s):

Bare Metal Stents ◽

Drug Eluting Stents ◽

Metal Stents ◽

Bare Metal ◽

Virtual Histology ◽

Stent Restenosis ◽

Drug Eluting ◽

In Stent Restenosis

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Outcome Differences With the Use of Drug-Eluting Stents for the Treatment of In-Stent Restenosis of Bare-Metal Stents Versus Drug-Eluting Stents

The American Journal of Cardiology ◽

10.1016/j.amjcard.2008.09.107 ◽

2009 ◽

Vol 103 (4) ◽

pp. 491-495 ◽

Cited By ~ 72

Author(s):

Daniel H. Steinberg ◽

Michael A. Gaglia ◽

Tina L. Pinto Slottow ◽

Probal Roy ◽

Laurent Bonello ◽

...

Keyword(s):

Bare Metal Stents ◽

Drug Eluting Stents ◽

Metal Stents ◽

Bare Metal ◽

Stent Restenosis ◽

Drug Eluting ◽

Outcome Differences ◽

In Stent Restenosis

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Meeting the Unmet – The Cre8 Polymer-free Drug-eluting Stents Technology

Interventional Cardiology Review ◽

10.15420/icr.2014.9.3.184 ◽

2014 ◽

Vol 9 (3) ◽

pp. 184

Author(s):

Katrina Mountfort ◽

Didier Carrié ◽

Marco Valgimigli ◽

Gennaro Sardella ◽

Shmuel Banai ◽

...

Keyword(s):

De Novo ◽

Randomised Trial ◽

Bare Metal Stents ◽

Significant Advance ◽

Drug Eluting Stents ◽

Metal Stents ◽

Diabetic Patients ◽

Bare Metal ◽

Very Late Stent Thrombosis ◽

Drug Eluting

The use of first-generation drug-eluting stents (DES) has been associated with safety concerns such as very late stent thrombosis. Today, with the release of newer DES, there is a need for comparative studies of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) to demonstrate their value in patients with high risk of restenosis such as diabetic patients. In a satellite symposium presented at EuroPCR 2014, the Cre8™ DES was discussed. The Cre8 device has a number of unique clinical features, including polymer-free technology, abluminal reservoir technology and bio-inducer surface that ensure effective neointima suppression and rapid endothelialisation. The efficacy of the Cre8 DES has been demonstrated in the International randomised comparison between DES Limus Carbostent and Taxus drug-eluting stents in the treatment of de novo coronary lesions (NEXT) randomised clinical study, with equivalent efficacy in the diabetic and general populations, a unique finding. Ongoing clinical studies such as Investig8 and the Tel Aviv Medical Center (TLVMC) Cre8 study have confirmed the efficacy of the device in patient populations with a high proportion of diabetic patients. The Demonstr8 randomised trial has shown almost complete Cre8 strut coverage at three months with a numerical advantage versus bare metal stent (bare metal stents [BMS] – comparator device) at one month. In addition, use of the Cre8 DES may enable a shorter duration of dual antiplatelet therapy (DAPT) following PCI. The Cre8 DES therefore represents a significant advance in stent technology and may be particularly useful in challenging clinical settings

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Second- versus First-generation Drug-eluting Stents

Interventional Cardiology Review ◽

10.15420/icr.2010.5.1.23 ◽

2010 ◽

Vol 5 (1) ◽

pp. 23 ◽

Cited By ~ 3

Author(s):

Kamal Chitkara ◽

Anthony Gershlick ◽

◽

Keyword(s):

First Generation ◽

Second Generation ◽

Bare Metal Stents ◽

Coronary Intervention ◽

Drug Eluting Stents ◽

Metal Stents ◽

Stent Restenosis ◽

Early Results ◽

Number Of Patients ◽

Drug Eluting

Drug-eluting stents (DES) have demonstrated their superiority over bare-metal stents (BMS) with respect to in-stent restenosis and the need for repeat revascularisation. BMS and first-generation DES, such as sirolimus-eluting (Cypher®) and paclitaxel-eluting stents (Taxus®), have further improved the results of percutaneous coronary intervention (PCI) by improving early results and reducing the risk of restenosis. However, there is currently a debate as to the safety of these first-generation DES given the potential for late stent thrombosis, especially after discontinuation of dual-antiplatelet therapy. Second-generation DES, such as zotarolimus-eluting (Endeavor®) and everolimus-eluting stents (Xience V®), have recently become available in the US and Europe. The available data already suggest the superiority of the Xience V stent in comparison with the Taxus stent in terms of prevention of restenosis, without significant untoward events. Nonetheless, the number of patients studied and the follow-up duration are still too limited to enable definitive conclusions. This systematic review aims to provide a concise and critical appraisal of the available data to compare first- and second-generation stents.

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