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Gross D. Thromboembolic Phenomena and the use of the Pig as an Appropriate Animal Model for Research on Cardiovascular Devices. Int J Artif Organs 2018. [DOI: 10.1177/039139889702000402] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- D.R. Gross
- Department of Veterinary Biosciences, College of Veterinary Medicine, University of Illinois, Urbana-Champaign - USA
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[Sinus thrombosis in a 15-year-old girl : An interdisciplinary case]. DER NERVENARZT 2016; 86:743-7. [PMID: 25367231 DOI: 10.1007/s00115-014-4191-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Ding Y, Yang M, Yang Z, Luo R, Lu X, Huang N, Huang P, Leng Y. Cooperative control of blood compatibility and re-endothelialization by immobilized heparin and substrate topography. Acta Biomater 2015; 15:150-63. [PMID: 25541345 DOI: 10.1016/j.actbio.2014.12.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 12/04/2014] [Accepted: 12/16/2014] [Indexed: 11/17/2022]
Abstract
A wide variety of environmental cues provided by the extracellular matrix, including biophysical and biochemical cues, are responsible for vascular cell behavior and function. In particular, substrate topography and surface chemistry have been shown to regulate blood and vascular compatibility individually. The combined impact of chemical and topographic cues on blood and vascular compatibility, and the interplay between these two types of cues, are subjects that are currently being explored. In the present study, a facile polydopamine-mediated approach is introduced for immobilization of heparin on topographically patterned substrates, and the combined effects of these cues on blood compatibility and re-endothelialization are systematically investigated. The results show that immobilized heparin and substrate topography cooperatively modulate anti-coagulation activity, endothelial cell (EC) attachment, proliferation, focal adhesion formation and endothelial marker expression. Meanwhile, the substrate topography is the primary determinant of cell alignment and elongation, driving in vivo-like endothelial organization. Importantly, combining immobilized heparin with substrate topography empowers substantially greater competitive ability of ECs over smooth muscle cells than each cue individually. Moreover, a model is proposed to elucidate the cooperative interplay between immobilized heparin and substrate topography in regulating cell behavior.
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Affiliation(s)
- Yonghui Ding
- Department of Mechanical and Aerospace Engineering, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong
| | - Meng Yang
- Department of Mechanical and Aerospace Engineering, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong
| | - Zhilu Yang
- Key Laboratory of Advanced Technology of Materials, School of Material Science and Engineering, Southwest Jiaotong University, Chengdu 610031, Sichuan, China
| | - Rifang Luo
- Key Laboratory of Advanced Technology of Materials, School of Material Science and Engineering, Southwest Jiaotong University, Chengdu 610031, Sichuan, China
| | - Xiong Lu
- Key Laboratory of Advanced Technology of Materials, School of Material Science and Engineering, Southwest Jiaotong University, Chengdu 610031, Sichuan, China
| | - Nan Huang
- Key Laboratory of Advanced Technology of Materials, School of Material Science and Engineering, Southwest Jiaotong University, Chengdu 610031, Sichuan, China
| | - Pingbo Huang
- Division of Life Science, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong; Division of Biomedical Engineering, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong; State Key Laboratory of Molecular Neuroscience, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong
| | - Yang Leng
- Department of Mechanical and Aerospace Engineering, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong.
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Yang Y, Qi P, Wen F, Li X, Xia Q, Maitz MF, Yang Z, Shen R, Tu Q, Huang N. Mussel-inspired one-step adherent coating rich in amine groups for covalent immobilization of heparin: hemocompatibility, growth behaviors of vascular cells, and tissue response. ACS APPLIED MATERIALS & INTERFACES 2014; 6:14608-20. [PMID: 25105346 DOI: 10.1021/am503925r] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Heparin, an important polysaccharide, has been widely used for coatings of cardiovascular devices because of its multiple biological functions including anticoagulation and inhibition of intimal hyperplasia. In this study, surface heparinization of a commonly used 316L stainless steel (SS) was explored for preparation of a multifunctional vascular stent. Dip-coating of the stents in an aqueous solution of dopamine and hexamethylendiamine (HD) (PDAM/HD) was presented as a facile method to form an adhesive coating rich in primary amine groups, which was used for covalent heparin immobilization via active ester chemistry. A heparin grafting density of about 900 ng/cm(2) was achieved with this method. The retained bioactivity of the immobilized heparin was confirmed by a remarkable prolongation of the activated partial thromboplastin time (APTT) for about 15 s, suppression of platelet adhesion, and prevention of the denaturation of adsorbed fibrinogen. The Hep-PDAM/HD also presented a favorable microenvironment for selectively enhancing endothelial cell (EC) adhesion, proliferation, migration and release of nitric oxide (NO), and at the same time inhibiting smooth muscle cell (SMC) adhesion and proliferation. Upon subcutaneous implantation, the Hep-PDAM/HD exhibited mitigated tissue response, with thinner fibrous capsule and less granulation formation compared to the control 316L SS. This number of unique functions qualifies the heparinized coating as an attractive alternative for the design of a new generation of stents.
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Affiliation(s)
- Ying Yang
- Key Laboratory of Advanced Technology for Materials of Education Ministry, ‡The Institute of Biomaterials and Surface Engineering, School of Materials Science and Engineering, and #Laboratory of Biosensing and MicroMechatronics, Southwest Jiaotong University , Chengdu 610031, China
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Scott RA, Park K, Panitch A. Water soluble polymer films for intravascular drug delivery of antithrombotic biomolecules. Eur J Pharm Biopharm 2013; 84:125-31. [PMID: 23262161 PMCID: PMC3619018 DOI: 10.1016/j.ejpb.2012.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 10/02/2012] [Accepted: 12/05/2012] [Indexed: 02/02/2023]
Abstract
Over the past 10 years, the number of percutaneous coronary intervention (PCI) procedures performed in the United States has increased by 33%; however, restenosis, which inhibits complete functional recovery of the vessel wall, remains a complication of this procedure. To traverse the complications associated with PCI, the investigation of therapeutic delivery has become an integral topic in modern research. One such therapeutic, a mimic of the proteoglycan decorin, termed DS-SILY, can mask exposed collagen and thereby effectively decrease platelet activation, has recently been developed by our lab. Drawing inspiration from coating technologies developed by the pharmaceutical industry, a fast-dissolving polymer film has been developed to deliver active therapeutic agents from a balloon catheter during PCI. This research investigates the release of DS-SILY from fast-dissolving polymer films composed of poly(vinyl alcohol) (PVA) and poly(ethylene glycol) (PEG). Thin, uniform polymer films were produced via spin coating technique. The dissolution speed of the polymer films was found to be dependent on the concentration of polymer solution, where at least 65% of the films were shown to dissolve into nanometer sized polymer fragments within 2 min. DS-SILY, up to 6.26 μg/cm(2), was loaded into the films and functional release of the mimic was demonstrated by its successful binding to collagen upon release. Furthermore, DS-SILY released from films resulted in increased platelet inhibition. These results indicate that use of fast-dissolving polymer films allow for the successful release of biomolecules and further investigation of their use for localized drug delivery during PCI procedures is warranted.
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Affiliation(s)
- Rebecca A. Scott
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907
| | - Kinam Park
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907
- School of Industrial and Physical Pharmacy, Purdue University, West Lafayette, IN 47907
| | - Alyssa Panitch
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907
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Yang ZL, Zhou S, Lu L, Wang X, Wang J, Huang N. Construction and hemocompatibility study of highly bioactive heparin-functionalized surface. J Biomed Mater Res A 2012; 100:3124-33. [DOI: 10.1002/jbm.a.34247] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 04/27/2012] [Accepted: 05/03/2012] [Indexed: 01/15/2023]
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Bae IH, Park IK, Park DS, Lee H, Jeong MH. Thromboresistant and endothelialization effects of dopamine-mediated heparin coating on a stent material surface. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2012; 23:1259-1269. [PMID: 22389099 DOI: 10.1007/s10856-012-4587-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 02/13/2012] [Indexed: 05/31/2023]
Abstract
Heparinization of surfaces has proven a successful strategy to prevent thrombus formation. Inspired by the composition of adhesive proteins in mussels, the authors used dopamine to immobilize heparin on a stent surface. This study aimed to assess the thromboresistant and endothelialization effects of dopamine-mediated heparin (HPM) coating on a stent material surface. The HPM was synthesized by bonding dopamine and heparin chemically. Cobalt-chromium (Co-Cr) alloy disks were first placed in the HPM solution and applied to surface stability then underwent thromboresistant tests and human umbilical vein endothelial cells (HUVEC) cytotoxicity assays. The results showed not only thromboresistant activity and a stable state of heparin on the surfaces after investigation with toluidine blue and thrombin activation assay but also proliferation of HUVEC in vitro. Studies on animals showed that the HPM-coated stent has no obvious inflammation response and increasing of restenosis rate compared to the bare metal stent (BMS) indicating good biocompatibility as well as safety in its in vivo application. Moreover, improving the endothelial cell (EC) proliferation resulted in a higher strut-covering rate (i.e., endothelialization) with shuttle-shaped EC in the HPM-coated stent group compared to that of the BMS group. These results suggest that this facile coating approach could significantly promote endothelialization and offer greater safety than the BMS for its much improved thromboresistant property. Moreover, it may offer a platform for conjugating secondary drugs such as anti-proliferative drugs.
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Affiliation(s)
- In-Ho Bae
- The Heart Research Center of Chonnam National University Hospital Designated by Korea Ministry of Health and Welfare, Gwangju 501-757, Republic of Korea
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La Barge DV, Bishop FS, Stevens EA, Eskandari R, Schmidt RH, Skalabrin EJ, Ng PP. Intrasinus catheter-directed heparin infusion in the treatment of dural venous sinus thrombosis. AJNR Am J Neuroradiol 2009; 30:1672-8. [PMID: 19617450 DOI: 10.3174/ajnr.a1677] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE In this small series, local intrasinus catheter-directed heparin infusion with or without balloon thrombectomy was safe in the treatment of dural venous sinus thrombosis (DVST). Although systemic anticoagulation (SAC) is the treatment of choice, there is a lack of consensus regarding the best treatment should SAC fail or be contraindicated. We present our institutional experience with 16 patients in whom failure of, or contraindication to, SAC occurred and who subsequently underwent intrasinus catheter-directed heparin infusion with or without balloon thrombectomy. MATERIALS AND METHODS A retrospective review of 16 patients ranging in age from 14 days to 77 years who had intrasinus catheter-directed heparin infusion was undertaken with 9 male and 7 female patients identified. Of these 16 patients, 4 (25%) had a contraindication to SAC and SAC failed in 12 (75%). Technically successful intrasinus infusion catheter placement was achieved in all 16 patients (100%). Mean duration of infusion was 3.3 days (range, 1-6 days). Adjunctive balloon thrombectomy was performed in 9 (56.3%) of 16 patients. No procedure-related mortality occurred. RESULTS Partial and complete sinus recanalization occurred in 10 (62.5%) of 16 patients and 1 (6.3%) of 16 patients, respectively. There were 3 deaths (18.8%) attributed to disease progression. At most recent clinical follow-up (mean, 9.3 months), 11 (84.6%) of 13 surviving patients were independent, with a modified Rankin Scale (mRS) score of 1 or less. CONCLUSIONS Local intrasinus catheter-directed heparin infusion with or without adjunctive balloon thrombectomy seems to be a safe and effective treatment of DVST in patients in whom SAC failed or in whom there was a contraindication to SAC. In addition, the risk for symptomatic intracranial hemorrhage may be significantly lower than intrasinus infusion of thrombolytics.
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Affiliation(s)
- D V La Barge
- Department of Radiology, Division of Neuroradiology, University of Utah, University Health Care, Salt Lake City, Utah 84132, USA.
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Rathi S, Latif F, Emilio Exaire J, Hennebry TA. Use of simultaneous angioplasty and in situ thrombolysis with a specialized balloon catheter for peripheral interventions. J Thromb Thrombolysis 2008; 28:77-82. [DOI: 10.1007/s11239-008-0286-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2008] [Accepted: 10/06/2008] [Indexed: 10/21/2022]
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Kavanagh CA, Rochev YA, Gallagher WM, Dawson KA, Keenan AK. Local drug delivery in restenosis injury: thermoresponsive co-polymers as potential drug delivery systems. Pharmacol Ther 2004; 102:1-15. [PMID: 15056495 DOI: 10.1016/j.pharmthera.2003.01.001] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The success of percutaneous transluminal coronary angioplasty in treatment of acute coronary syndromes has been compromised by the incidence of restenosis. The physical insult of balloon insertion can damage or remove the endothelial monolayer, thereby generating a prothrombotic surface. The resulting inappropriate response to injury can also lead to penetration of inflammatory cells, conversion of the underlying media to a synthetic phenotype, deposition of extracellular matrix, constrictive remodeling, and neointimal hyperplasia. While stent implantation at the time of balloon insertion has offset some of these events, inflammatory responses to the implanted biomaterial (stent) and intimal hyperplasia are still prominent features of the procedure, leading in 20-30% of cases to in-stent restenosis within a year. Systemic delivery of drugs designed to offset in-stent restenosis injury has been largely unsuccessful, which has led to the development of strategies for coating stents with drugs for local delivery. Drug-eluting stents constitute an innovative means of further reducing the incidence of restenosis injury and clinical trials have shown encouraging results. This review focuses on properties of a class of environment-sensitive hydrogels, the N-isopropylacrylamide-based thermoresponsive co-polymers, on their potential roles as stent coatings, on their demonstrated ability to incorporate and release drugs that modify vascular endothelial and smooth muscle cell functions, and on issues that still await clarification, prior to their adoption in a clinical setting.
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Affiliation(s)
- Caroline A Kavanagh
- Department of Pharmacology, Conway Institute for Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland
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Preul MC, Bichard WD, Spetzler RF. Toward optimal tissue sealants for neurosurgery: use of a novel hydrogel sealant in a canine durotomy repair model. Neurosurgery 2004; 53:1189-98; discussion 1198-9. [PMID: 14580287 DOI: 10.1227/01.neu.0000089481.87226.f7] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2003] [Accepted: 06/09/2003] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Watertight dural repairs are difficult to achieve, and cerebrospinal fluid leakage causes complications and extends hospital stays. Therefore, a novel synthetic hydrogel film was evaluated as an adjunct to dural closure in a canine model. METHODS The self-polymerizing, absorbable, and biocompatible hydrogel was sprayed onto tissue and formed a flexible, adherent sealant. A 2-cm incision of cranial dura and arachnoid was created in 26 adult dogs and loosely repaired. Hydrogel was applied over the 2-mm dural gap in 13 dogs; 13 control dogs received no hydrogel application. RESULTS All dogs remained neurologically intact. Valsalva tests conducted at 1, 4, 7, and 56 days were associated with mean leakage pressures (+/- standard error of the mean) of 5 +/- 0, 5 +/- 0, 7 +/- 2, and 13 +/- 8 cm H(2)O in the controls and of 53 +/- 2, 37 +/- 11, 42 +/- 6, and 48 +/- 4 in the treated animals (P = 0.001, 0.053, 0.010, 0.035, respectively, at each time point; one-tailed t test). Histopathological analysis revealed minimal changes. CONCLUSION The hydrogel-treated animals exhibited normal progression of dural healing, no dural adhesions, and no underlying effects on the brain. Although dural healing progressed normally, the control animals displayed marked peridural adhesions. The results of this in vivo study suggest that hydrogels, such as that used here, may significantly decrease cerebrospinal fluid leakage, thereby increasing the safety and effectiveness of dural closure in patients and facilitating surgical reexploration.
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Affiliation(s)
- Mark C Preul
- Division of Neurological Surgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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Kalinowski M, Alfke H, Hamann C, Viehofer K, Klose KJ, Barry JJ, Wagner HJ. Effects of altering infusion parameters on intimal hyperplasia following local catheter-based delivery into the rabbit iliac artery. Atherosclerosis 2004; 172:71-8. [PMID: 14709359 DOI: 10.1016/j.atherosclerosis.2003.09.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Efficient local gene or drug therapy requires optimized application modalities to avoid vessel damage, which might lead to increased neointimal hyperplasia. Aim of the study was to evaluate different application parameters for local delivery using the channeled balloon catheter in order to minimize vessel trauma induced by local application. METHODS AND RESULTS Sixty cholesterol fed rabbits were randomly enrolled into twelve groups of different local application parameters: group I, application pressure 2atm/application volume 1ml physiologic saline; group II, 2atm/2ml; group III, 2atm/5ml; group IV, 4atm/1ml; group V, 4atm/2ml; group VI, 4atm/5ml. The other six groups received Ringer's solution instead of saline. Administration of the solution was randomly performed in one iliac artery using the channeled balloon catheter with simultaneous balloon angioplasty (8atm). The contralateral iliac artery served as a control and was treated with balloon angioplasty only. Four weeks after local therapy, calibrated angiography was performed; the animals were sacrificed, vessel segments were excised and quantitative morphometric measurements were obtained. In none of the animals acute complications, e.g. dissection, thrombosis or perforation of the vessel, was noted. Up to an application pressure of 4atm and an application volume of 5ml, no significant neointima formation was seen compared to arteries which underwent angioplasty only. Additionally, no significant differences between saline and Ringer's solution were detected. In a multivariate analysis, neither application pressure nor volume were found to have a statistically significant influence on the amount of neointimal hyperplasia. CONCLUSIONS Local application of "drugs" using the channeled balloon catheter is safe and feasible without significant induction of neointimal hyperplasia compared to angioplasty, if an application volume of 5ml and a pressure of 4atm is not exceeded.
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Affiliation(s)
- Marc Kalinowski
- Department of Diagnostic Radiology, Philipps-University Hospital, Baldingerstrasse, 35033, Marburg, Germany.
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Kalinowski M, Alfke H, Bergen S, Klose KJ, Barry JJ, Wagner HJ. Comparative Trial of Local Pharmacotherapy withl-Arginine, r-Hirudin, and Molsidomine to Reduce Restenosis after Balloon Angioplasty of Stenotic Rabbit Iliac Arteries. Radiology 2001; 219:716-23. [PMID: 11376260 DOI: 10.1148/radiology.219.3.r01jn27716] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine if local application of L-arginine, r-hirudin, or molsidomine significantly reduces restenosis after balloon angioplasty in stenotic rabbit iliac arteries. MATERIALS AND METHODS Thirty-one male cholesterol-fed New Zealand white rabbits underwent balloon dilation of both common iliac arteries to induce arterial stenosis. Four weeks later, one stenotic iliac artery was simultaneously dilated and received local application of L-arginine (210 mg/mL, n = 7), r-hirudin (0.5 mg/mL, n = 8), or molsidomine (0.2 mg/mL, n = 8) with a channeled balloon catheter. On the contralateral side, 0.9% saline was injected as a control. In eight sham animals, saline was applied to one iliac artery and balloon dilation to only the contralateral artery. Six weeks after local treatment, vessels were harvested, and computerized morphometric and immunohistologic analyses were performed. RESULTS Application of drugs resulted in a significant reduction of neointimal area as follows: 53% with L-arginine (1.01 mm(2) vs. 2.17 mm(2), P <.05), 43% with molsidomine (1.04 mm(2) vs. 1.89 mm(2), P <.05), and 20% with r-hirudin (1.79 mm(2) vs. 2.24 mm(2), P <.05). Infusion of saline led to a significant increase (50%, 1.21 mm(2) vs. 1.93 mm(2), P <.05) in neointimal area compared with balloon dilation alone. Immunohistologic findings showed a significant reduction of macrophages (5.0% vs. 10.2%, P <.05) and proliferating cells (6.2% vs. 10.6%, P <.05) in the neointima after local application of L-arginine. CONCLUSION Reduction of neointimal area was significant for L-arginine and molsidomine but not for r-hirudin. Saline infusion caused significant arterial trauma, resulting in additional neointimal proliferation.
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Affiliation(s)
- M Kalinowski
- Department of Diagnostic Radiology, Philipps-University Hospital, Marburg, Germany
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Söderström T, Hedner U, Arnljots B. Active site-inactivated factor VIIa prevents thrombosis without increased surgical bleeding: topical and intravenous administration in a rat model of deep arterial injury. J Vasc Surg 2001; 33:1072-9. [PMID: 11331851 DOI: 10.1067/mva.2001.112808] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE The primary event in the procoagulant response after vascular interventions is the tissue factor (TF)-factor VIIa complex formation, which occurs when TF is exposed to the circulating blood by the inflicted trauma. Human recombinant active site-inhibited coagulation factor VIIa (FFR-rFVIIa) binds well to TF but cannot initiate blood coagulation, and should thereby block thrombus formation. This hypothesis was tested with a rat model of arterial thrombosis. METHODS In a blinded randomized study, the antithrombotic and antihemostatic effects of FFR-rFVIIa and heparin were evaluated in a rat model of mechanical deep arterial injury. In one arm of the study, FFR-rFVIIa (0.2 mg in 150 microL) or vehicle alone was applied topically at the site of vascular injury. In the other arm, FFR-rFVIIa (4 mg/kg), heparin (1 mg/kg), or vehicle alone was injected intravenously. RESULTS FFR-rFVIIa produced a powerful antithrombotic effect after both topical and intravenous administrations (P =.02 and P =.005, respectively) without increasing the surgical bleeding. Heparin prevented thrombosis equally well as FFR-rFVIIa (P =.0007), but doubled the surgical bleeding compared with FFR-rFVIIa (P =.03) and controls (P =.008). In the topical study, the antithrombotic effect was achieved without altering parameters of plasma anticoagulation (prothrombin time and activated partial thromboplastin time) or producing detectable levels of FFR-rFVIIa in plasma. CONCLUSION In this model FFR-rFVIIa effectively inhibits thrombus formation without the expense of increased surgical bleeding, which indicates the potential of FFR-rFVIIa as an effective and safe strategy for prevention of thrombosis in reconstructive vascular surgery and various forms of percutaneous revascularization.
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Affiliation(s)
- T Söderström
- Department of Plastic and Reconstructive Surgery, University Hospital, Malmö, Sweden
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Park S, Bearinger JP, Lautenschlager EP, Castner DG, Healy KE. Surface modification of poly(ethylene terephthalate) angioplasty balloons with a hydrophilic poly(acrylamide-co-ethylene glycol) interpenetrating polymer network coating. JOURNAL OF BIOMEDICAL MATERIALS RESEARCH 2000; 53:568-76. [PMID: 10984706 DOI: 10.1002/1097-4636(200009)53:5<568::aid-jbm17>3.0.co;2-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
An interpenetrating polymer network (IPN) of poly(acrylamide-co-ethylene glycol) (p(AAm-co-EG)) hydrogel was covalently grafted to polyethylene terephthalate (PET) angioplasty balloons to increase surface hydrophilicity and improve lubricity. A 2-step graft polymerization protocol was followed to first polymerize and cross-link acrylamide onto the substrate with a photosensitizer and/or oxygen plasma pretreatment. The effects of varying photo-initiation and plasma exposure times were investigated separately and conjunctively using water contact angles to obtain optimal coating deposition parameters. A poly(ethylene glycol) network was then grafted by swelling the preexisting polyacrylamide network to allow inter-diffusion of the monomer and cross-linker, which were then polymerized by photo-initiation. When the photo-initiation time was long enough to reach near gelation, pretreatment of PET with oxygen plasma did not offer significant benefit. X-ray photoelectron spectroscopy confirmed the presence of both polymer layers, and composition depth profiles supported the assessment that an interpenetrating network was formed. Tensile testing and application of Weibull statistics on unmodified and modified films indicated that the surface modification approach did not significantly alter the mechanical integrity of the material. These findings indicate that a p(AAm-co-EG) coating can be effectively deposited on PET surfaces without compromising the structural integrity of the substrate.
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Affiliation(s)
- S Park
- Division of Biological Materials, Northwestern University Medical School, 311 E. Chicago Ave., Ward 10-019, Chicago, IL 60611-3008, USA
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Tanguay JF, Cantor WJ, Krucoff MW, Muhlestein B, Barsness GW, Zidar JP, Sketch MH, Tcheng JE, Phillips HR, Stack RS, Kaplan AV, Ohman EM. Local delivery of heparin post-PTCA: a multicenter randomized pilot study. Catheter Cardiovasc Interv 2000; 49:461-7. [PMID: 10751780 DOI: 10.1002/(sici)1522-726x(200004)49:4<461::aid-ccd26>3.0.co;2-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Bailout stenting for major dissection and threatened closure has high rates of ischemic complications. We performed a randomized trial of local heparin delivery using the infusion sleeve before bailout stenting for suboptimal angioplasty results. In phase I, 20 patients were randomized to local delivery with either 40- or 100-psi infusion pressure. In phase II, 37 patients were randomized to local delivery at 100 psi or standard therapy. Local delivery succeeded in all but one patient; overall there was no significant worsening of intimal dissection. One patient treated with 100-psi drug infusion suffered a perforation after stent placement. There were no significant differences in the composite endpoint of death, MI, CABG, urgent repeat angioplasty, and stent thrombosis at 30 days (21% vs. 0%; P = 0.18). At 6 months, the rates of myocardial infarction in phase II were 27% with local delivery vs. 10% with standard treatment (P = 0.4). Local heparin delivery in dissected vessels may be associated with increased complications and should be approached with caution.
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Affiliation(s)
- J F Tanguay
- Montreal Heart Institute, Montreal, Quebec, Canada
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Lehmann KG, Popma JJ, Werner JA, Lansky AJ, Wilensky RL. Vascular remodeling and the local delivery of cytochalasin B after coronary angioplasty in humans. J Am Coll Cardiol 2000; 35:583-91. [PMID: 10716458 DOI: 10.1016/s0735-1097(99)00603-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study sought to determine the safety, feasibility and outcome of local delivery of cytochalasin B at the site of coronary angioplasty. BACKGROUND Previous failures in the pharmacologic prevention of restenosis may have been related to inadequate dosing at the angioplasty site as a result of systemic drug administration. Alternatively, although previous experimental protocols have typically targeted control of excess tissue growth (intimal hyperplasia), it now appears that overall arterial constriction (vascular remodeling) is the major contributor to late lumen loss. Cytochalasin B inhibits the polymerization of actin and has proved to be a potent inhibitor of vascular remodeling in animal models. METHODS In this phase I, multicenter, randomized, controlled trial, cytochalasin B (or matching placebo) was administered to the site of a successful balloon angioplasty using a microporous local delivery infusion balloon. RESULTS The rate of drug delivery at a constant infusion pressure varied significantly from patient to patient (range 1.7 to 20.2 ml/min), perhaps related to a variable constricting effect of the atherosclerotic plaque on the infusion balloon. The minimal stenosis diameter after the procedure was slightly better in the active drug group (1.86 +/- 0.44 vs. 1.49 +/- 0.63 mm, p < 0.03), but this difference was not seen at four to six weeks. Although the study was not powered for clinical outcomes (n = 43), the combined end point (death, nonfatal infarction or repeat revascularization) was encountered in 20% of the patients receiving cytochalasin B and in 38% of the patients receiving placebo. Clinical restenosis occurred in 18% of the treatment group and 22% of the placebo group. There were no significant differences between groups in biochemical or electrocardiographic variables. CONCLUSIONS Cytochalasin B can be safely administered by local delivery after successful coronary angioplasty and warrants further study of its efficacy in reducing restenosis.
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Affiliation(s)
- K G Lehmann
- Division of Cardiology, University of Washington School of Medicine, Seattle, USA
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18
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19
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Kidane A, Lantz GC, Jo S, Park K. Surface modification with PEO-containing triblock copolymer for improved biocompatibility: in vitro and ex vivo studies. JOURNAL OF BIOMATERIALS SCIENCE. POLYMER EDITION 1999; 10:1089-105. [PMID: 10591134 DOI: 10.1163/156856299x00702] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Poly(ethylene oxide) (PEO) has been frequently used to modify biomaterial surfaces for improved biocompatibility. We have used PEO-polybutadiene-PEO triblock copolymer to graft PEO to biomaterials by gamma-irradiation for a total radiation dose of 1 Mrad. The molecular weight of PEO in the block copolymer was 5000. In vitro study showed that fibrinogen adsorption to Silastic, polyethylene, and glass was reduced by 70 to approximately 95% by PEO grafting. On the other hand, the reduction of fibrinogen adsorption was only 30% on expanded polytetrafluoroethylene (e-PTFE). In vitro platelet adhesion study showed that almost no platelets could adhere to PEO-coated Silastic, polyethylene, and glass, while numerous platelet aggregates were found on the ePTFE. The platelet adhesion in vitro corresponded to the fibrinogen adsorption. When the PEO-grafted surfaces were tested ex vivo using a series shunt in a canine model, the effect of the grafted PEO was not noticeable. Platelet deposition on ePTFE was reduced by PEO grafting from 8170 +/- 1030 to 5100 +/- 460 platelets 10(-3) microm2, but numerous thrombi were still present on the PEO-grafted surface. The numbers of platelets cumulated on Silastic, polyethylene, and glass were 100 +/- 80, 169 +/- 35, and 24 +/- 22 platelets 10(-3) microm2, respectively. This is about 35% reduction in platelet deposition by PEO grafting. While the numbers of deposited platelets were small, the decreases were not as large as those expected from the in vitro study. This may be due to a number of reasons which have to be clarified in future studies, but it appears that in vitro platelet adhesion and fibrinogen adsorption studies may not be a valuable predictor for the in vivo or ex vivo behavior of the PEO-grafted surfaces.
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Affiliation(s)
- A Kidane
- Purdue University, School of Pharmacy, West Lafayette, IN 47907, USA
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20
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Kalinowski M, Tepe G, Schieber A, Brehme U, Bruck B, Erley CM, Claussen CD, Duda SH. Local administration of ramiprilat is less effective than oral ramipril in preventing restenosis after balloon angioplasty in an animal model. J Vasc Interv Radiol 1999; 10:1397-404. [PMID: 10584658 DOI: 10.1016/s1051-0443(99)70251-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To test the hypothesis that local administration of angiotensin converting enzyme (ACE) inhibitor via a microporous balloon catheter would be more effective than oral administration of ACE inhibitor in preventing neointima formation after balloon angioplasty. MATERIALS AND METHODS Neointima formation was induced by balloon denudation followed by 0.5% cholesterol diet in 29 New Zealand White rabbits. Directly after denudation, local administration of 1.8 mg of ramiprilat (n = 7) or saline (n = 7) with a microporous balloon catheter at a pressure of 3 atm was performed. Both groups additionally received ramipril orally (1 mg/d). Seven animals were treated exclusively with oral ramipril. The control group was fed a 0.5% cholesterol diet and given no medication (n = 8). Six weeks after intervention, the animals were killed and morphometric and immunohistologic analyses were performed. RESULTS Oral administration of ramipril resulted in a significant reduction of placque area (-66%, P < .05). Oral and local administration of the ACE inhibitor was followed by a nonsignificant reduction of the neointimal area (-17%). Local administration of saline combined with oral ramipril failed to prevent neointimal formation (reduction of 6%, NS). CONCLUSION Oral administration of ramipril resulted in a significant reduction of neointimal proliferation in New Zealand White rabbits. The possible benefit of an additional administration of local ramiprilat was diminished by an excessive neointimal hyperplasia, which was most likely caused by the inherent vessel trauma with use of the microporous balloon catheter.
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MESH Headings
- Administration, Oral
- Angioplasty, Balloon/adverse effects
- Angiotensin-Converting Enzyme Inhibitors/administration & dosage
- Animals
- Aorta, Abdominal/pathology
- Graft Occlusion, Vascular/etiology
- Graft Occlusion, Vascular/pathology
- Graft Occlusion, Vascular/prevention & control
- Injections, Intra-Arterial
- Male
- Neovascularization, Pathologic/complications
- Neovascularization, Pathologic/pathology
- Neovascularization, Pathologic/prevention & control
- Rabbits
- Ramipril/administration & dosage
- Ramipril/analogs & derivatives
- Secondary Prevention
- Treatment Outcome
- Tunica Intima/pathology
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Affiliation(s)
- M Kalinowski
- Department of Diagnostic Radiology, Eberhard-Karls-University, Tübingen, Germany
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21
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Komiyama N, Chronos NA, Uren NG, Moore MP, Kelly AB, Harker LA, Hanson SR, Metz JA, Yock PG, Fitzgerald PJ. The progression of thrombus in an ex-vivo shunt model evaluated by intravascular ultrasound radiofrequency analysis. ULTRASOUND IN MEDICINE & BIOLOGY 1999; 25:561-566. [PMID: 10386731 DOI: 10.1016/s0301-5629(99)00006-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
We tested the ability of ultrasound radiofrequency (RF) signal analysis to characterize thrombus accumulation in a Dacron graft incorporated into the exteriorized arteriovenous shunt in 3 baboons with constant blood flow for 60 min. Thrombus formation was quantified by sequential measurements of 111Indium-labeled platelet deposition. RF signals were acquired every 15 min at 2 sites in the graft, using a 2.9 Fr intravascular ultrasound catheter-based transducer (30 MHz) and digitized at 250 MHz in 8-bit resolution. Regions of interest were placed within a 0.5-mm perimeter adjacent to the graft wall. Integrated backscatter increased significantly (p < 0.001) with increasing platelet deposition. However, mean-to-standard deviation ratio of the RF envelope showed no significant change and the distribution pattern of the RF probability function remained constant and consistent with a Rayleigh scattering process. These results provide a basis for using RF analysis to monitor the time-course of thrombus formation.
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Affiliation(s)
- N Komiyama
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA, USA.
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22
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Indolfi C, Avvedimento EV, Rapacciuolo A, Esposito G, Di Lorenzo E, Leccia A, Pisani A, Chieffo A, Coppola A, Chiariello M. In vivo gene transfer: prevention of neointima formation by inhibition of mitogen-activated protein kinase kinase. Basic Res Cardiol 1997; 92:378-84. [PMID: 9464861 DOI: 10.1007/bf00796211] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The mitogen-activated protein kinase kinase (MAPKK) is a protein downstream ras which is rapidly activated in cells stimulated with various extracellular signals. These proteins are believed to play a pivotal role in integrating and transmitting transmembrane signals required for cell growth. METHODS AND RESULTS To study the effect of inhibition of MAPKK on smooth muscle cell (SMC) proliferation in vivo after vascular injury, we performed experimental balloon angioplasty using the standard Clowes technique in male Wistar rats 14-weeks old. The animals did not receive any treatment after vascular injury (N = 6) or were randomly assigned to receive, after balloon injury, a 30% (w/v) pluronic gel solution applied to the injured carotid artery, containing respectively: 1) no plasmid DNA (n = 10); 2) RSV-lacZ (encoding the beta-galactosidase gene) as control gene without effects on SMC proliferation (n = 10); 3) Tg-CAT (encoding cloramphenicol acetyl-transferase gene under the control of thyreoglobulin promoter) as an additional control gene without effects on SMC proliferation (n = 7): 4) a negative mutant of Mitogen-Activated Protein Kinase Kinase (MAPKK-) (n = 13). Fourteen days after vascular injury, carotid arteries were removed and cross sections were cut and stained with hematoxylin/eosin. Morphometric analysis demonstrated, in the MAPKK- treated rats, a significant reduction of both neointima (0.096+/-.018 mm2 vs. 0.184+/-0.019 mm2, p < 0.01) and neointima/media ratio (0.603+/-0.103 vs. 1.471+/-0.161, p < 0.01) compared to control DNA. CONCLUSIONS The inhibition of MAPKK, by a dominant inhibitor mutant gene, prevents the SMC proliferation after vascular injury in vivo.
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Affiliation(s)
- C Indolfi
- Division of Cardiology, Federico II University, Napoli, Italy.
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23
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Kandarpa K, Nakatsuka S, Bravo SM, Harapanhalli RS, Barry JJ. Mural delivery of iloprost with use of hydrogel-coated balloon catheters suppresses local platelet aggregation. J Vasc Interv Radiol 1997; 8:997-1004. [PMID: 9399469 DOI: 10.1016/s1051-0443(97)70701-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To develop reproducible and quantifiable methods for mural delivery of iloprost, a potent agent against platelet aggregation, with use of hydrogel-coated angioplasty balloons, and to determine the in vivo effect of direct iloprost delivery on platelet aggregation at the angioplasty site. MATERIALS AND METHODS Drug loading of tritiated iloprost from an immersion solution onto hydrogel-coated balloons was evaluated as a function of balloon size (3 mm x 2 cm, 6 mm x 2 cm, 8 mm x 3 cm; n = 4 each), drug concentration (0.0715 mg/mL, 0.1072 mg/mL, 0.1430 mg/mL; n = 3 each), and duration of immersion (40 seconds, 60 seconds, 120 seconds; n = 3 each). In another set of experiments, optimal drying methods were tested to minimize drug loss within a protective delivery sheath (n = 3 each). Ex vivo angioplasty was performed on excised swine arteries to estimate how much of the drug present on the balloon could be delivered to the wall (n = 3 iliac segments). Finally, in vivo angioplasty was performed in three Yorkshire pigs (n = 6 iloprost-treated and 6 control arteries) and indium-111-labeled platelet aggregation was measured at these sites, which were harvested 1 hour after the procedure. RESULTS In the initial set of experiments, the authors found that the volume of drug loaded is determined by the wet-volume of the hydrogel coating, that the majority of volume loading occurs within the first 2 minutes, and that the volume uptake is independent of the drug concentration. The optimal drying method resulting in the least loss of iloprost within the sheath (only 4%) was prolonged drying (5 hours) under ambient conditions. Ex vivo angioplasty experiments showed that approximately 33% of the drug present on the balloon can be delivered to the wall. Finally, in vivo experiments showed that platelet aggregation is significantly suppressed at treated sites (by approximately 33% compared to control sites; P = .03) by minuscule mural doses of iloprost (roughly estimated at under 1 microg). CONCLUSION Quantifiable and reproducible methods for loading iloprost onto hydrogel-coated angioplasty balloons were developed. The best of these methods was able to deliver enough iloprost into the wall to significantly reduce local platelet aggregation.
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Affiliation(s)
- K Kandarpa
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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24
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Viel K, Cui J, Thomas CN, Nunes GC, King SB, Cipolla GD, Scott NA. Inhibition of platelet deposition with local delivery of heparin using a double balloon catheter. Thromb Res 1997; 88:147-57. [PMID: 9361368 DOI: 10.1016/s0049-3848(97)00226-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Heparin is an effective agent in the treatment of unstable angina and myocardial infarction. The clinical utility of heparin is limited by bleeding complications. This study was performed to determine whether static delivery of heparin could effectively inhibit further platelet deposition. Thrombogenic graft segments were incorporated into chronic arteriovenous shunts in pigs. Autologous platelets were labeled with 111Indium. Platelet deposition was quantitated with gamma camera imaging. The grafts were exposed to blood flow for 15 min in order to induce platelet deposition on the thrombogenic surface. Heparin was delivered locally either by direct exposure or with a double balloon catheter. After a 15 minute exposure period, the heparin solution was removed and subsequent platelet deposition was monitored for 90 minutes. Heparin, administered with the double balloon catheter in doses as low as 12.5 U, effectively inhibited further platelet deposition. An intravenous injection of 100 U of heparin, the highest dose use for local delivery, did not perturb bleeding time or the activated partial thromboplastin time. In conclusion, platelet deposition can be inhibited with static local delivery of heparin at doses that are not associated with systemic bleeding.
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Affiliation(s)
- K Viel
- Andreas R. Gruentzig Cardiovascular Center, Emory University Hospital, Atlanta, GA 30322, USA
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25
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Indolfi C, Avvedimento EV, Di Lorenzo E, Esposito G, Rapacciuolo A, Giuliano P, Grieco D, Cavuto L, Stingone AM, Ciullo I, Condorelli G, Chiariello M. Activation of cAMP-PKA signaling in vivo inhibits smooth muscle cell proliferation induced by vascular injury. Nat Med 1997; 3:775-9. [PMID: 9212106 DOI: 10.1038/nm0797-775] [Citation(s) in RCA: 151] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Injury of the arterial wall induces the formation of the neointima. This structure is generated by the growth of mitogenically activated smooth muscle cells of the arterial wall. The molecular mechanism underlying the formation of the neointima involves deregulated cell growth, primarily triggered by the injury of the arterial wall. The activated gene products transmitting the injury-induced mitogenic stimuli have been identified and inhibited by several means: transdominant negative expression vectors, antisense oligodeoxynucleotides, adenovirus-mediated gene transfer, antibodies and inactivating drugs. Results of our study show that local administration of 3',5'-cyclic AMP and phosphodiesterase-inhibitor drugs (aminophylline and amrinone) to rats markedly inhibits neointima formation after balloon injury in vivo and in smooth muscle cells in vitro. The growth inhibitory effect of aminophylline was completely reversed by the inhibition of cAMP-dependent protein kinase A (PKA). These findings indicate an alternative approach to the treatment of diseases associated with injury-induced cell growth of the arterial wall, as stimulation of cAMP signaling is pharmacologically feasible in the clinical setting.
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MESH Headings
- 8-Bromo Cyclic Adenosine Monophosphate/pharmacology
- Aminophylline/pharmacology
- Amrinone/pharmacology
- Animals
- Carotid Arteries
- Cell Division/drug effects
- Cell Division/physiology
- Cells, Cultured
- Cyclic AMP-Dependent Protein Kinases/antagonists & inhibitors
- Cyclic AMP-Dependent Protein Kinases/metabolism
- Cyclic AMP-Dependent Protein Kinases/physiology
- Dose-Response Relationship, Drug
- Enzyme Activation
- Growth Inhibitors/pharmacology
- Muscle, Smooth, Vascular/cytology
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/injuries
- Muscle, Smooth, Vascular/metabolism
- Phosphodiesterase Inhibitors/pharmacology
- Rats
- Signal Transduction/drug effects
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Affiliation(s)
- C Indolfi
- Cattedra di Cardiologia, Universita degli Studi di Napoli Federico II, Naples, Italy
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26
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Camenzind E, Bakker WH, Reijs A, van Geijlswijk IM, Foley D, Krenning EP, Roelandt JR, Serruys PW. Site-specific intravascular administration of drugs: history of a method applicable in humans. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1997; 41:342-7. [PMID: 9213034 DOI: 10.1002/(sici)1097-0304(199707)41:3<342::aid-ccd16>3.0.co;2-p] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Demonstration and quantification of site-specific intracoronary administration of pharmacological compounds has been limited thus far to animal experimental models. Recently, a method applicable in humans has been developed. The aim of this study is to give an overview on the available methods to visualize and quantify intravascularly administered "labeled" drugs in animals and to describe the historical development of a method now applied in the clinical arena. The potential of this approach is briefly summarized.
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Affiliation(s)
- E Camenzind
- Thoraxcenter, University Hospital Dijkzigt, Rotterdam, The Netherlands
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27
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29
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Sheley RC, Schuman ES, Standage BA, Ragsdale JW, Feliciano PD, Quinn SF. Local delivery of heparin with balloon angioplasty: results of a prospective randomized trial. J Vasc Interv Radiol 1996; 7:853-8. [PMID: 8951752 DOI: 10.1016/s1051-0443(96)70860-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To evaluate the effectiveness of local delivery of heparin via hydrogel-coated balloons in the treatment of vascular stenoses associated with hemodialysis access. MATERIALS AND METHODS This was a randomized, prospective trial comparing treatment with hydrogel-coated balloon catheters delivered with heparin coating (n = 33) and without (n = 26). All patients were undergoing hemodialysis, and all stenoses involved the venous anastomosis of a dialysis graft or a native vein. The heparin-treated balloons were soaked in concentrated heparin and delivered in a protected manner to help prevent washout of heparin. RESULTS The mean primary patencies were 143 days with heparin treatment and 214 days without heparin (P = .174). The mean assisted primary patencies were 165 days with heparin and 194 days without (P = .315). The mean secondary patencies were 351 days with heparin and 384 without (P = .81). CONCLUSION In this population with this technique, the treatment outcome of venous outflow stenosis in patients with dialysis grafts is not improved with local delivery of heparin.
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Affiliation(s)
- R C Sheley
- Department of Radiology, Legacy Good Samaritan Hospital and Medical Center, Portland, OR 97210, USA
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30
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Thomas CN, Robinson KA, Cipolla GD, King SB, Scott NA. Local intracoronary heparin delivery with a microporous balloon catheter. Am Heart J 1996; 132:969-72. [PMID: 8892769 DOI: 10.1016/s0002-8703(96)90007-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Arterial thrombosis plays a major role in the pathogenesis of acute coronary syndromes such as unstable angina and acute myocardial infarction. Heparin is efficacious in treating both disorders; however, systemically administered heparin is associated with bleeding complications. Local intracoronary delivery of heparin may be a safer, more effective method of administration. This study was performed to determine the fate of heparin infused with a specially designed catheter for local intracoronary delivery. To quantitate heparin delivery, tritiated-labeled heparin was dissolved in a solution of unlabeled heparin (1,000 U/ml). A microporous balloon catheter was placed in the left anterior descending (LAD) and left circumflex arteries of anesthetized pigs (n = 15), and 1 ml of the heparin solution was infused. The animals were euthanized within 1 hour, and the treated arteries and controls were harvested, processed, and the tritiated activity was measured. To assess the distribution of the heparin in the arterial wall, 1 ml of fluorescein-isothiocyanate (FITC)-labeled heparin was locally delivered into the walls of the LAD and left circumflex arteries with the microporous balloon catheter. To visualize the dynamic fluid transfer of the device, a microporous balloon catheter was inflated in the LAD, and 1 ml of diluted contrast medium was infused under cinefluoroscopy. The arteries treated with tritiated-labeled heparin contained 0.6% +/- 0.2% of the infused heparin dose. Control arteries contained 0.01% of the administered heparin. Animals that were infused with FITC-labeled heparin displayed fluorescence throughout all layers of the artery, especially in the adventitia. In animals that were injected with 1 ml of diluted contrast medium through the microporous balloon, a relatively large amount of the infusate appeared in the arterial lumen proximal to the balloon. In conclusion, these results suggest that heparin can be delivered to coronary arteries with a microporous balloon catheter. However, <1% of the infused dose can be found in the artery 1 hour after delivery. Infused heparin is distributed throughout the arterial wall, but most of the infused solution appears in the arterial lumen proximal to the inflated balloon and is probably washed downstream after balloon deflation.
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Affiliation(s)
- C N Thomas
- Andreas R. Gruentzig Cardiovascular Center, Emory University Hospital, Atlanta, GA 30322, USA
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