Добавил:

Sekretar kiopkiopkiop18@yandex.ru t.me/Prokururor I Вовсе не секретарь, но почту проверяю Опубликованный материал нарушает ваши авторские права? Сообщите нам.

Вуз:

Ростовский Государственный Медицинский Университет

Предмет:

Медицина общая

Файл:

Книга_3919_Библиотеки_им_академика_М_И_Перельмана

.pdf

Скачиваний:

Добавлен:

10.10.2026

Размер:

8 Мб

Скачать

☆

<<< < Предыдущая 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2021 / 2121

Grube et al. have recently presented clinical

findings on 32 patients treated with either control

stents or paclitaxel-eluting stents; the restenosis

rates were respectively 54% and 0%.

2 9

Because of

the patient numbers, this study has the value of

only demonstrating the potential of this combina-

tion and the need for a proper clinical trial, but the

data are nevertheless intriguing.

There are two further studies underway or

about to start that address the issue of in-stent

restenosis using agents that have been shown in

vitro, ex vivo and in animal studies to influence

smooth muscle cell activity.

Paclitaxel has clinical use in ovarian cancer. It

was discovered as part of a National Cancer

Institute programme in which thousands of plants

were screened for anti-cancer activity. In 1963 an

extract from the bark of the Pacific yew (

T a x u s

b r e v i f o l i a

), a relatively rare plant, was found to

have cytotoxic activity against many tumours. It

186 LOCAL DRUG DELIVERY FROM COATED STENTS

Figure 15.7

Location of dipyridamole delivered into

human saphenous vein ex vivo and

detected by fluorescence microscopy.

Dipyridamole is naturally autofluores -

cent and may be detected by ultravio -

let microscopy. (a) Control saphenous

vein showing autofluorescence of

elastic material within the vessel wall.

(b) Central or stented segment of

saphenous vein showing areas of

fluorescent dipyridamole within the

media 24 hours after stent deployment

(arrows). Magnification

⫻

320

https://t.me/med1917

has specific properties against microtubules,

promoting polymerization of tubulin. It inhibits the

disassembly of microtubules, which thus become

very stable and dysfunctional, so inhibiting cell

division through inhibition of the mitotic spindle

and cell death through its prevention of normal

interphase functions.

3 0

Being a potent agent, with

systemic side-effects, it is ideally suited to be

considered for local, stent based delivery. As early

as 1995 Sollott and others

3 1

had demonstrated

inhibition of neointimal hyperplasia following

angioplasty in the rat carotid artery model. We

CLINICAL TRIALS 187

Figure 15.8

Location of [

125

I]angiopeptin delivered to human saphenous

vein ex vivo. After 1 hour, dense areas of black silver

grains representing [

125

I]angiopeptin can be seen in both

proximal and central regions of the vein (a and b, arrow -

heads). No [

125

I]angiopeptin can be seen in the distal region

(c). Magnification

⫻

200

Figure 15.9

Location of [

125

I]angiopeptin delivered to porcine coronary

arteries in vivo. (a,b) Microautoradiographs show the

presence of [

125

I]angiopeptin (arrowheads) along the

luminal surface, and extending a short distance into the

media of the vessel directly surrounding the stent at 7

days (b (magnification

⫻

320) = high power of a (magnifi -

cation

⫻

64)). [

125

I]Angiopeptin was seen at intermittent

points along the intima, probably corresponding to the

location of the stent struts prior to their removal

https://t.me/med1917

have now been able to coat stents with paclitaxel.

In the pig coronary stent model the inhibitory

effects on smooth muscle activity appear to be

dose related with an inhibitory, but not necessar-

ily linear, response (between 10 ␮g and 90 ␮g per

stent). This, together with the dose-related

inhibitory effects on post-traumatic endothelial

cell regeneration, have led at this stage to the initi-

ation of a European pilot safety study with the

Cook V-Flex stent (the Evaluation of Taxol

E l u t i n g

Stent trial [ELUTES]). A further trial using the

Boston Scientific stent and Taxol

is due to start

in the Autumn of 2000.

A large European based trial of a drug called

sirolimus has also started (the RAVEL study)

following intriguing data from early clinical trials

in South America. Sirolimus is a naturally occur-

ring macrocyclic lactone. It has been used as an

immunosupressive agent in renal and islet graft-

ing and for bone marrow transplantation. It binds

to a specific cytosolic protein (immunophilin)

found in target cells. This complex then binds to

a specific regulatory kinase called the

‘mammalian target of rapamycin’ (mTOR), inhibit-

ing its activation, which in turn through inhibition

of cell cycle progression suppresses cytokine-

stimulated T-cell proliferation. However it has

other effects, including inhibition of the transla-

tion of cdk4/cyclin d and cdk2/cyclin E complexes,

that are perhaps of greater potential for inhibiting

in-stent restenosis. Again the issues of local reten-

tion, safety and rate of re-endothelialization may

be important. The doses of the agents used are

minute compared to those administered systemi-

cally. Early results from the RAVEL study

presented to the investigators are promising.

Summary and future directions

In-stent restenosis remains a major limitation to

the long term success of coronary stenting. The

ability to inhibit its formation via drug eluting

stents is an attractive concept. Various polymers

have been investigated as stent coatings capable

of being loaded with therapeutic agents. Proof of

the concept with various stents and a number of

agents in vitro and in vivo have led to the initia-

tion of early clinical trials. Candidate agents for

inhibiting in-stent restenosis include not only

traditional pharmacological agents, but also

gene therapy approaches.

One of the problems

of such an approach is the delivery of genetic

material in high amounts at the required site.

Stent-based delivery may indeed provide the

solution. However, further work aimed at eluci-

dating the ideal therapeutic candidate is required

before the promise of drug-eluting stents for the

inhibition of in-stent restenosis may be deliv-

ered. Altering the drug, its concentration and the

stent is relatively easy and cheap. Current stent

user-friendliness appears to be unaffected.

Stent-based local drug delivery is the next

important phase of stent development and it is

likely that drug-eluting stents will become part of

routine clinical practice.

References

1. Gershlick AH, Baron J. Dealing with in-stent

restenosis. Heart 1998;79:319–323.

2. Serruys PW, de Jaegere P, Kiemeneij F, et al. for

the Benestent Study Group. A comparison of

balloon-expandable stent implantation with

balloon angioplasty in patients with coronary

disease. N Engl J Med 1994:331:489–495.

3. Van Belle E, Bauters C, Hubert E, et al. Restenosis

rates in diabetic patients: a comparison of stent-

ing and balloon angioplasty in native coronary

vessels. Circulation 1997;96:1454–1460.

4. Serruys PW, Unger F, van Hout BA, et al. The

ARTS study (Arterial Revascularization Therapies

Study). Semin Intervent Cardiol 1999;4:209–219.

5. Eccleston D, Horrigan M, Ellis S. Rationale for local

drug delivery. Semin Interven Cardiol 1996;8–16.

6. Van der Giessen WJ, Lincoff M, Schwartz R, et al.

Marked inflammatory sequelae to implantation of

biodegradable and non-biodegradable polymers

in porcine coronary arteries. Circulation

1996;94:1690–1697.

7. De Scheeder I, Wilkzek K, Van Dorpe J, et al Local

angiopeptin delive ry using coated stents reduces

neointimal prolife ration in overstretched porcine

coronary arteries. J Invasive Cardiol 1996;8:215–222.

8. Lincoff AM, Furst JG, Ellis SG, Tuch RJ, Topol EJ.

Sustained local delivery of dexamethasone by a

novel intravascular eluting stent to prevent

restenosis in the porcine coronary injury model. J

Am Coll Cardiol 1997;29:808–816.

9. Cumberland DC, Gunn J, Malik N, Holt CM.

Biomimicry 1: PC. Semin Intervent Cardiol

1998;3:149–150.

10. Malik N, Gunn J, Shepherd L, et al.

Phosphorylcholine-coated stents in porcine

188 LOCAL DRUG DELIVERY FROM COATED STENTS

https://t.me/med1917

coronary arteries: angiographic and morphometric

assessment. Eur Heart J 1997;18:152(abstract).

11. Whelan DM, van der Giessen WJ, Krabbendam

SC, van Vliet EA, et al. Biocompatibility of

phosphorylcholine coated stents in normal

porcine coronary arteries. Heart 2000;83:338–345.

12. Baron JH, Aggrawal R, de Bono DP, Gershlick AH.

Adsorption and elution of c7E3 Fab from polymer

coated stents in-vitro. ESC 1997 (abstract).

13. Foo RS, Hogrefe K, Baron JH, de Bono DP,

Gershlick AH. Activated protein C to prevent

thrombosis in percutaneous coronary interven-

tion. Clin Sci 1999;96(Suppl 40):4P(abstract).

14. Swanson N, Hogrefe K, Baron J, et al. VEGF-

eluting stents to reduce stent complications—

pharmacokinetics of adsorption and elution. 6th

International LDD&R Local Drug delivery meeting

and cardiovascular course on radiation and molec-

ular strategies 28/1/2000 (abstract).

15. Shargul L, Yu ABC. Applied Biopharmaceutics and

Pharmacokinetics, 3rd Edn. Prentice Hall

International, 1993.

16. Lambert T, Dev V, Rechavia E, Forrester J, et al.

Localised arterial wall drug delivery from a

polymer-coated removable metallic stent. Kinetics,

distribution and bioactivity of forskolin. Circulation

1994;90:1003–1011.

17. Azrin MA, Ling FS, Chen Q, et al. Preparation,

characterization, and evaluation of a monoclonal

antibody against the rabbit platelet glycoprotein

IIb/IIIa in an experimental angioplasty model. Circ

Res 1994;75:268–277.

18. Aggarwal RK, Ireland DC, Azrin MA, et al.

Antithrombotic potential of polymer-coated stents

eluting platelet glycoprotein IIb/IIIa receptor

antibody. Circulation. 1996;94:3311–3317.

1 9 . Baron JH, de Bono DP, Gershlick AH. Adsorption of

c7E3 Fab onto polymer-coated Cook GR II stents:

Reopro eluting stents inhibit platelet deposition in

vitro. Heart 1998;55:183(abstract).

20. Lincoff AM. Potent complementary clinical benefit

of abciximab and stenting during percutaneous

coronary revascularisation in patients with

diabetes mellitus. Results of the EPISTENT study.

Am Heart J 2000;139:S46–52(Review).

21. Baron JH, Aggrawal R, de Bono DP, Gershlick AH.

c7E3 Fab inhibits adhesion of smooth muscle cells

to vitronectin: a possible way of inhibiting in-stent

restenosis. ESC 1997 (abstract).

22. Foo RS, Gershlick AH, Hogrefe K, et al. Inhibition

of platelet thrombosis using an activated protein

C-loaded stent: in vitro and in vivo results. Thromb

Haemost 2000;83:496–502.

23. Van Belle E, Tio FO, Chen D, et al. Passivation of

metallic stents after arterial gene transfer of

phVEGF165 inhibits thrombus formation and

intimal thickening. J Am Coll Cardiol

1997;29:1371–1379.

24. Asahara T, Chen D, Tsurumi Y, et al. Accelerated

restitution of endothelial integrity and endothe-

lium-dependent function after phVEGF165 gene

transfer. Circulation 1996;94:3291–3302.

25. Swanson N, Baron J, Hogrefe K, et al. Novel deliv-

ery of vascular endothelial growth factor delivery

using polymer-coated stents: loading and elution

characteristics. Heart 2000; 83:P28(abstract).

26. Costa MA, Sabaté M, van der Giessen W, et al.

Late coronary occlusion after intracoronary

brachytherapy. Circulation 1999;100:789–792.

27. Armstrong J, Holt CM, Stratford P, Cumberland

DC. Phosphorylcholine stent coating as a method

of local drug delivery: preliminary data from an ex

vivo model. Heart 1997;77:P47(abstract).

28. Armstrong J, Gunn J, Holt CM, et al. Local

angiopeptin delivery from coronary stents in

porcine coronary arteries. Eur Heart J

1999;20:1929(abstract).

29. Grube E, Gerkens U, Oesterle E et al. Inhibition of

in-stent restenosis by the Quanam Drug Delivery

polymer stent, in humans followed for up to 8

months. JACC 2000:34A (abstract).

30. Jordan MA, Tosos RJ, Wilson L. Mechanism of

mitotic block and inhibition of cell proliferation by

taxol at low concentrations. Proc Natl Acad Sci

1993;90:9552–9556.

31. Sollott SJ, Cheng L, Pauly RR, et al. Taxol inhibits

neointimal smooth muscle cell accumulation after

angioplasty in the rat. J Clin Invest 1995;95:

1869–1876.

32. Keelan PC, Miyauchi K, Caplice NM, et al.

Modification of molecular events in coronary

restenosis using coated stents: the Mayo Clinic

approach. Semin Intervent Cardiol 1998;3:211–

215.

REFERENCES 189

https://t.me/med1917

abciximab

acute myocardial infarction 119, 120, 121, 122, 123,

124, 126, 128, 129, 130

complication cases 147

dissections 149, 151, 152, 156

delivery from coated stent 181, 182, 183–5

direct stenting 98, 101, 103

graft disease 80, 83

left main stem disease 67, 69

multivessel disease 20, 25

stent thrombosis 164, 165, 166

timing, complex lesions 17

total chronic occlusions 39

ACE inhibitors 167

ACE (Scimed) balloon 81

ACS MULTI-LINK

stent

acute myocardial infarction 125–6, 128, 130

bifurcation disease 45, 48, 53

complication cases

dissections 149, 151, 156

non-dissection 138, 144, 145, 147

discrete lesions 4

graft disease 78

left main stem disease 67

long lesions 10, 12

multivessel disease 19, 23

ostial disease 109, 111

restenosis cases 171, 172, 173, 175

total chronic occlusions 32, 36

acute coronary syndromes 117–32

see also

myocardial infarction, acute

adenosine 122, 129

Amplatz Left (AL) guide catheters

complication cases

dissections 154, 159

non-dissection 133, 144

graft disease 78, 83

long lesions 14

restenosis case 175

total chronic occlusion 30, 31, 32, 37

Amplatz Right guide catheter 86, 108

AngioGuard™ 93

Angiojet™ 85, 122, 132

angiopeptin, stent delivery 183

anti-platelet therapies 163

see also

graft disease

coronary artery spasm 144–6

Crossflex stent

see

Cordis CrossFlex™ stent

Crown stent

direct stenting 99

left main stem disease 65

cullottes technique

see

‘Y’ stent

cutting balloon 177–8

debulking

bifurcation lesions 45, 59, 64

complication cases 140

graft disease 92

left main lesions 64, 70–1

long lesions 7, 8, 9

restenosis 175–8

dexamethasone, stent delivery 183

diltiazem 145

dipyridamole, stent delivery 183

direct stenting 95–108

complications 96

indications and contraindications 95–6

potential risks/benefits 96

tips and tricks 96

vein grafts 96, 106–8

directional atherectomy, bifurcation disease 45, 59

discrete lesions 1–6

dissections 149–62

stent-edge 135, 138, 140, 147, 152

thrombosis and 164–7

drug delivery, coated stents 179–89

DUET stent

direct stenting 103

left main stem disease 65

see also

Guidant Duet; MULTI-LINK DUET

EBU4 guide catheter 103

ELUTES 188

EPILOG 39

EPISTENT trial 39, 120, 184

eptafibatide 151

glycoprotein IIb/IIIa inhibitors

acute myocardial infarction 122

dissection cases 151, 152, 153, 154, 156

long lesions 7, 15

stent delivery 184

stent thrombosis 165

graft disease 77–93

acute myocardial infarction 130–2

direct stenting 96, 106–8

ostial lesions 111–14

Guidant Duet

stent

bifurcation disease 44

graft disease 83

long lesion 15

total chronic occlusion 41

heparin, intravenous, discrete lesions 1, 3

‘hockey stick’ catheter 30, 78

192 INDEX

https://t.me/med1917

intra-aortic balloon pump (IABP)

direct stenting 101, 103

dissection cases 159

graft disease 91

left main stem disease 67

intravascular ultrasound (IVUS)

cine-IVUS positioning 10

left main stem disease 67, 69

lesion length measurement 9

long lesions 7, 9, 12, 17, 101

stent thrombosis 164–5

JL3.5 guiding catheter

acute myocardial infarction 128

bifurcation disease 45

complication cases 135

left main stem disease 72, 75

JL4 guide catheter

acute myocardial infarction 120, 121, 122

bifurcation disease 44, 47, 53, 54, 58

complication cases

dissections 152, 156

non-dissection 137, 139, 140, 145

direct stenting 101

left main stem disease 67, 68

multivessel disease 19, 21, 23, 25

restenosis cases 171, 172

stent thrombosis case 166

total chronic occlusions 34.39

Jomed stent, left main stem disease 68

Jomed stent graft, ostial disease 114, 115

Jostent

128

JR4 guide catheter

acute myocardial infarction 117, 119, 124, 126, 129

bifurcation disease 47

complication cases

dissections 149

non-dissection 142, 147

direct stenting 97, 98

discrete lesions 3, 4, 5

graft disease 82

left main stem disease 68

long lesions 8, 10, 12, 14, 15

multivessel disease 25

ostial disease 114

restenosis cases 169, 173

stent thrombosis case 163

total chronic occlusions 29, 30, 35, 36, 39, 41, 42

JR6 guide catheter, direct stenting 100

laser debulking 175, 176, 177

LCB guide catheter 108, 113

left anterior descending (LAD) artery

acute myocardial infarction 120, 122–3, 125–6, 128

after CABG 21–3

bifurcation disease 44–54, 58–61

complication cases

dissections 156–7, 159–61

non-dissection 133–4, 136–7, 139–40, 144–6

direct stenting 101–5

discrete lesions 4

graft disease 77–8, 81–4, 86–90, 108

left main stem disease and 64–5, 69–70

long lesions 8–9

in multivessel disease 119–27

muscle bridge 5–6

restenosis 171–2

stent thrombosis 166–7

total chronic occlusions 34, 37–40

cross-filling from RCA 39–40

Left graftseeker guide catheter 78, 79, 81, 83

left main stem disease 63–75

direct stenting 101–3

protected 64–5

unprotected 66–7, 72–5

left main stem dissections 156, 158

Left Voda 3.5 catheter guide

complication cases 136

left main stem disease 64

total chronic occlusion 38

long lesions 7–18

complications 135

IVUS measurement 9

restenosis 7, 8, 10, 12

MULTI-LINK DUET™ stent, bifurcation disease 45

multiple vessel disease 19–27

muscle bridge, stenting 5–6

myocardial infarction, acute 117–32

direct stenting 98–9, 101–7

NIR™ Royal stent 57

NIR™ stent

acute myocardial infarction 120

bifurcation disease 44

direct stenting 99, 100, 103, 106

graft disease 79

left main stem disease 65

multivessel disease 21

ostial disease 109

nitrates 122, 129, 145

nitroglycerine 8

obtuse marginal (OM) artery

acute myocardial infarction 121–2

bifurcation disease 54–5, 60

direct stenting 104

graft disease 79, 83

multivessel disease 21

restenosis 175

occlusions, total chronic

see

total chronic

occlusions

ostial disease 109–15

ostial dissections 154, 156

INDEX 193

https://t.me/med1917

paclitaxel, stent delivery 188

Palmaz ‘biliary’ stent 80

PAMI Stent Randomized Trials 121, 122

Percusurge balloon 80

Percusurge Guardwire 129, 130

phosphorylcholine 181

as stent coating 181, 185–6

poly-L-lactic acid (PLLA) 181

polymer coated stents 180–8

poly(organo)phosphazene polymers 181

posterior descending artery (PDA), total chronic

occlusion 41

protein C, activated, stent delivery 181, 185

R stent™ 128

radiation

intracoronary 175

see also

brachytherapy

RAVEL study 188

ReoPro

see

abciximab

RESOLVE trial 185

restenosis 169–78

graft disease 89

intimal hyperplasia and 179

long lesions 7, 8, 10, 12

stent-based drug delivery and 179–89

total chronic occlusions 30, 32

right coronary artery (RCA)

acute myocardial infarction 124, 126–7, 129

complication cases

dissections 149–51, 154–5

non-dissection 142–3, 147

direct stenting 97–101

discrete lesions 3

graft disease 80, 83–5, 89–90

left main stem disease and 68–9

long lesions 14–17, 163–4

tortuous artery 12–13

in multivessel disease 23, 25, 27

ostial disease 109–11, 114–15

restenosis 169–70, 173

stent thrombosis 163–5

total chronic occlusion 29–32, 36, 42

after CABG 35

Rotablation of ostial lesion 114–15

rotational atherectomy

complication cases 140

graft disease 92

left main lesions 64, 70–1

long lesions 9

restenosis 175

sirolimus, stent delivery 188

small vessel stenting 137, 138

‘snow-plough’ phenomenon 9, 47, 58

spasm, coronary artery 144–6

spot-stenting 7, 10, 12

stent graft

™ 88

stent-jail 9, 10, 17, 69

stents

coated 179–89

self-expandable 12

streptokinase 122, 123

‘T’ stenting 65

thrombectomy devices 85, 122, 129, 132

thrombosis, stent 147, 163–7, 179

ticlopidine 163

tirofiban 151

total chronic occlusions 29–42

restenosis 30, 32

transluminal extractional atherectomy catheter (TEC)

130

ultrasound, intravascular

see

intravascular ultrasound

vascular endothelial growth factor (VEGF), stent

delivery 181, 183, 185

vein grafts

see

graft disease

verapamil 122, 129, 145

Voda

see

Left Voda; XB/VODA

Wallstent

dissection cases 154

long lesions 12

restenosis cases 169, 170, 176

total chronic occlusion 29, 30, 32

Washington Radiation for In-stent Restenosis Trial

(WRIST) 175, 177

Wiktor

stents

bifurcation disease 44, 45

complication cases

dissections 152

non-dissection 139

discrete lesions 3

X-SIZER 122, 129

XB/VODA guide catheter 120, 122, 123

‘Y’ stent 25, 26

bifurcation disease 47, 53–6, 58–61

Zwolle Myocardial Infarction Trial 121

194 INDEX

https://t.me/med1917

<<< < Предыдущая 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2021 / 2121

Соседние файлы в папке Библиотека им академика М.И. Перельмана

#
10.10.20268 Мб0Книга_3914_Библиотеки_им_академика_М_И_Перельмана.pdf
#
10.10.20268 Мб0Книга_3915_Библиотеки_им_академика_М_И_Перельмана.pdf
#
10.10.20268 Мб0Книга_3916_Библиотеки_им_академика_М_И_Перельмана.pdf
#
10.10.20268 Мб0Книга_3917_Библиотеки_им_академика_М_И_Перельмана.pdf
#
10.10.20268 Мб0Книга_3918_Библиотеки_им_академика_М_И_Перельмана.pdf
#
10.10.20268 Мб0Книга_3919_Библиотеки_им_академика_М_И_Перельмана.pdf
#
10.10.20268 Мб0Книга_3921_Библиотеки_им_академика_М_И_Перельмана.pdf
#
10.10.20268 Мб0Книга_3922_Библиотеки_им_академика_М_И_Перельмана.pdf
#
10.10.20268 Мб1Книга_3924_Библиотеки_им_академика_М_И_Перельмана.pdf
#
10.10.20268 Мб0Книга_3925_Библиотеки_им_академика_М_И_Перельмана.pdf
#
10.10.20268 Мб0Книга_3926_Библиотеки_им_академика_М_И_Перельмана.pdf