Treatment Of Advanced Coronary Disease Research Articles

Stent-Based Gene Delivery for Coronary Disease.

Percutaneous coronary interventions (PCI) are the mainstay for treatment of advanced coronary disease. A majority of PCI involve deployment of a stent in the affected vascular segment. This chapter introduces the concept of using stents as a platform for delivering gene therapies to the vasculature with the overarching aim of mitigating in-stent restenosis (ISR), late stent thrombosis (LST), and neoatherosclerosis (NA), a triad of delayed complications that reduce the overall success rate of PCI. The chapter provides a detailed methodology for coatless reversible attachment of adenoviral (Ad) and adeno-associated viral (AAV) vectors to the metal stent struts along with representative in vitro and in vivo results.

Embolization of the internal thoracic arteries in refractory angina

Embolization of the internal thoracic arteries in refractory angina

Therapeutic Angiogenesis

Therapeutic angiogenesis is a rapidly evolving approach to the treatment of advanced coronary disease. The availability of growth factors such as basic fibroblast growth factor (bFGF or FGF2) has made possible the practical clinical application of this research. In this article, we summarise the basic biology of bFGF, a prototypical angiogenic growth factor, and the preclinical studies with this growth factor, and analyse recent clinical experience. While much remains to be learned, bFGF has been clearly shown to induce effective growth of new vasculature in a variety of animal models. The initial clinical data are promising, with patients demonstrating improvement in symptoms, quality of life and exercise tolerance. At the same time, the adverse effects profile has, to date, remained relatively benign.

Coronary Artery Insufficiency

We do not possess any specific curative agent for coronary insufficiency. The vast complex of factors involved in the etiology and pathogenesis of thrombosing coronary atherosclerosis remains an enigma. The determining of therapeutic efficacy is extremely difficult. It is not surprising, therefore, that there is disagreement as to the effectiveness of anticoagulant therapy. I do think, however, that the main reason for this is that the type of patients treated has differed greatly and secondly, the quality of therapy has been far from uniform. The use of anticoagulants represents a prophylactic measure. It has its main indications in the early stages of the disease when thrombotic occlusion is a relatively frequent cause of death. Preferably, it should be given before extensive occlusions and irreversible myocardial damage have been done. By appropriate selection of such patients and by guiding therapy in such a way that an adequate and stable level of hypocoagulability is maintained, there is, in my opinion, convincing evidence of beneficial effect. This therapy has certain indications which by experience can be better classified and characterized than they are today. Anticoagulants have little, if any, place in the treatment of advanced coronary disease in which disability and mortality is to a great extent determined by non-thrombotic causes.