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Neointimal thickening after stent delivery of paclitaxel: change in composition and arrest of growth over six months.

Abstract：

OBJECTIVES:The purpose of this study was to determine long-term effects of stent-based paclitaxel delivery on amount, rate and composition of neointimal thickening after stent implantation. BACKGROUND:Paclitaxel prevents vascular smooth muscle cell proliferation and migration in vitro and in vivo. These actions, coupled with low solubility, make it a viable candidate for modulating vascular responses to injury and prolonged effects after local delivery. We asked whether local delivery of paclitaxel for a period of weeks from a stent coated with a bioerodible polymer could produce a sustained reduction in neointimal hyperplasia for up to six months after stenting. METHODS:Stainless steel stents were implanted in the iliac arteries of rabbits after endothelial denudation. Stents were uncoated or coated with a thin layer of poly(lactide-co-sigma-caprolactone) copolymer alone or containing paclitaxel, 200 microg. RESULTS:Paclitaxel release in vitro followed first-order kinetics for two months. Tissue responses were examined 7, 28, 56 or 180 days after implantation. Paclitaxel reduced intimal and medial cell proliferation three-fold seven days after stenting and virtually eliminated later intimal thickening. Six months after stenting, long after drug release and polymer degradation were likely complete, neointimal area was two-fold lower in paclitaxel-releasing stents. Tissue responses in paclitaxel-treated vessels included incomplete healing, few smooth muscle cells, late persistence of macrophages and dense fibrin with little collagen. CONCLUSIONS:Poly(lactide-co-sigma-caprolactone) copolymer-coated stents permit sustained paclitaxel delivery in a manner that virtually abolishes neointimal hyperplasia for months after stent implantation, long after likely completion of drug delivery and polymer degradation.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Drachman DE,Edelman ER,Seifert P,Groothuis AR,Bornstein DA,Kamath KR,Palasis M,Yang D,Nott SH,Rogers C

doi

10.1016/s0735-1097(00)01020-2

subject

Has Abstract

pub_date

2000-12-01 00:00:00

pages

2325-32

issue

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(00)01020-2

journal_volume

pub_type

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Neointimal thickening after stent delivery of paclitaxel: change in composition and arrest of growth over six months.