Abstract
In recent years, we have witnessed a revolution in the treatment of coronary artery disease. The development and improvement of drug eluting stents (DES) have lowered the incidence of restenosis to one-digit figures. In the search for a superior efficacy, animal models have played a key role. The classical swine model of coronary stenting remains the preferred model to measure restenosis, although the rabbit iliac artery stenting has become an accepted alternative. After widespread clinical use of DES, an unforeseen complication arose: late stent thrombosis. In a back-to-bench step, some data from animal models helped to explain the phenomenon. A delayed and incomplete vascular healing was detected. Toxic and hypersensitivity reactions to polymers and/or drugs seem to be the underlying causes. So, translational research focused on the safety aspect of these devices: development of better drug carriers as absorbable polymers or fully bioresorbable scaffolds, selection of different drugs and assessment of the re-endothelialization process. We review and evaluate the efficacy and safety of coronary stents in different animal models. Further improvements in this field such as, the selection of better animal models (e.g. hyperlipidemic, diabetic, atherosclerotic) that closely mimic the clinical setting and longer follow-up periods to detect late complications are also discussed.
Keywords: Animal model, drug eluting stent, endothelium, inflammation, percutaneous coronary intervention, safety, stent thrombosis vascular healing
Current Vascular Pharmacology
Title:Preclinical Evaluation of Coronary Stents: Focus on Safety Issues
Volume: 11 Issue: 1
Author(s): Armando Perez de Prado, Claudia Perez-Martinez, Carlos Cuellas, Jose M. Gonzalo-Orden, Alejandro Diego, Marta Regueiro, Beatriz Martinez-Fernandez, Jose R. Altonaga, J. Francisco G. Marin and Felipe Fernandez-Vazquez
Affiliation:
Keywords: Animal model, drug eluting stent, endothelium, inflammation, percutaneous coronary intervention, safety, stent thrombosis vascular healing
Abstract: In recent years, we have witnessed a revolution in the treatment of coronary artery disease. The development and improvement of drug eluting stents (DES) have lowered the incidence of restenosis to one-digit figures. In the search for a superior efficacy, animal models have played a key role. The classical swine model of coronary stenting remains the preferred model to measure restenosis, although the rabbit iliac artery stenting has become an accepted alternative. After widespread clinical use of DES, an unforeseen complication arose: late stent thrombosis. In a back-to-bench step, some data from animal models helped to explain the phenomenon. A delayed and incomplete vascular healing was detected. Toxic and hypersensitivity reactions to polymers and/or drugs seem to be the underlying causes. So, translational research focused on the safety aspect of these devices: development of better drug carriers as absorbable polymers or fully bioresorbable scaffolds, selection of different drugs and assessment of the re-endothelialization process. We review and evaluate the efficacy and safety of coronary stents in different animal models. Further improvements in this field such as, the selection of better animal models (e.g. hyperlipidemic, diabetic, atherosclerotic) that closely mimic the clinical setting and longer follow-up periods to detect late complications are also discussed.
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Perez de Prado Armando, Perez-Martinez Claudia, Cuellas Carlos, M. Gonzalo-Orden Jose, Diego Alejandro, Regueiro Marta, Martinez-Fernandez Beatriz, R. Altonaga Jose, Francisco G. Marin J. and Fernandez-Vazquez Felipe, Preclinical Evaluation of Coronary Stents: Focus on Safety Issues, Current Vascular Pharmacology 2013; 11 (1) . https://dx.doi.org/10.2174/1570161111309010074
DOI https://dx.doi.org/10.2174/1570161111309010074 |
Print ISSN 1570-1611 |
Publisher Name Bentham Science Publisher |
Online ISSN 1875-6212 |
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