Abstract
PurposeTo experimentally investigate a new homogenously paclitaxel/resveratrol-coated balloon catheter in terms of transport of the coating to the treated tissue and local effects including histology and functional tests.MethodsAdherence of the coating to the balloon was explored by in vitro simulation of its passage to the lesion. Paclitaxel and resveratrol transfer to the vessel wall was investigated in porcine coronary and peripheral arteries. Matrix-assisted laser desorption/ionization (MALDI) was used for direct microscopic visualization of paclitaxel in arterial tissue. Inhibition of neointimal proliferation and tolerance of complete coating and resveratrol-only coating was investigated in pigs 4 weeks after treatment, and the effect of resveratrol on inflammation and healing after 3 and 7 days.ResultsDrug loss on the way to the lesion was < 10% of dose, while 65 ± 13% was detected at the site of balloon inflation. After treatment similar proportions of drug were detected in coronary and peripheral arteries, i.e., 7.4 ± 4.6% of dose or 125 ± 74 ng/mg tissue. MALDI showed circumferential deposition. Inhibition of neointimal proliferation by paclitaxel/resveratrol coating was significant (p = 0.001) whereas resveratrol-only coating did not inhibit neointimal proliferation. During the first week after treatment of peripheral arteries with resveratrol-only balloons, we observed nominally less inflammation and fibrin deposition along with a significant macrophage reduction and more pronounced re-endothelialization. No safety issues emerged including left ventricular ejection fraction for detection of potential distal embolization after high-dose treatment of coronary arteries.ConclusionsPaclitaxel/resveratrol-coated balloons were effective and safe in animal studies. Beyond acting as excipient resveratrol may contribute to vascular healing.
Highlights
Angioplasty has become the preferred local treatment of stenosis and occlusions in many vascular territories, offering high and immediate success, low invasiveness, and moderate cost
Drug loss on the way to the lesion was \ 10% of dose, while 65 ± 13% was detected at the site of balloon inflation
In the preclinical studies presented here we investigated adherence of paclitaxel and resveratrol to the balloon on its in vitro simulated way to the lesion, drug and resveratrol transfer to coronary and peripheral vessels in pigs, inhibition of neointimal proliferation, and effects of high-dose paclitaxel/resveratrol on the vessel wall
Summary
Angioplasty has become the preferred local treatment of stenosis and occlusions in many vascular territories, offering high and immediate success, low invasiveness, and moderate cost. After successful initial restoration of patency, long-term benefit is hampered by high rates of restenosis—most frequently occurring 3–12 months after treatment. The main underlying mechanism is excessive neointimal proliferation in response to injury [1]. While additional stenting increases the initial lumen gain and prevents recoil, continuous irritation contributes to excessive scar formation beyond the initial healing process [2]. The efficacy of drug-eluting stents (DES) was the incentive for coating paclitaxel onto angioplasty balloons [3]. Release of paclitaxel from the balloons improves
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