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      Factors that affect mass transport from drug eluting stents into the artery wall

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      BioMedical Engineering OnLine
      BioMed Central

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          Abstract

          Coronary artery disease can be treated by implanting a stent into the blocked region of an artery, thus enabling blood perfusion to distal vessels. Minimally invasive procedures of this nature often result in damage to the arterial tissue culminating in the re-blocking of the vessel. In an effort to alleviate this phenomenon, known as restenosis, drug eluting stents were developed. They are similar in composition to a bare metal stent but encompass a coating with therapeutic agents designed to reduce the overly aggressive healing response that contributes to restenosis. There are many variables that can influence the effectiveness of these therapeutic drugs being transported from the stent coating to and within the artery wall, many of which have been analysed and documented by researchers. However, the physical deformation of the artery substructure due to stent expansion, and its influence on a drugs ability to diffuse evenly within the artery wall have been lacking in published work to date. The paper highlights previous approaches adopted by researchers and proposes the addition of porous artery wall deformation to increase model accuracy.

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          Most cited references61

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          Molecular basis of restenosis and drug-eluting stents.

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            Comparison of an everolimus-eluting stent and a paclitaxel-eluting stent in patients with coronary artery disease: a randomized trial.

            A thin, cobalt-chromium stent eluting the antiproliferative agent everolimus from a nonadhesive, durable fluoropolymer has shown promise in preliminary studies in improving clinical and angiographic outcomes in patients with coronary artery disease. To evaluate the safety and efficacy of an everolimus-eluting stent compared with a widely used paclitaxel-eluting stent. The SPIRIT III trial, a prospective, randomized, single-blind, controlled trial enrolling patients at 65 academic and community-based US institutions between June 22, 2005, and March 15, 2006. Patients were 1002 men and women undergoing percutaneous coronary intervention in lesions 28 mm or less in length and with reference vessel diameter between 2.5 and 3.75 mm. Angiographic follow-up was prespecified at 8 months in 564 patients and completed in 436 patients. Clinical follow-up was performed at 1, 6, 9, and 12 months. Patients were randomized 2:1 to receive the everolimus-eluting stent (n = 669) or the paclitaxel-eluting stent (n = 333). The primary end point was noninferiority or superiority of angiographic in-segment late loss. The major secondary end point was noninferiority assessment of target vessel failure events (cardiac death, myocardial infarction, or target vessel revascularization) at 9 months. An additional secondary end point was evaluation of major adverse cardiac events (cardiac death, myocardial infarction, or target lesion revascularization) at 9 and 12 months. Angiographic in-segment late loss was significantly less in the everolimus-eluting stent group compared with the paclitaxel group (mean, 0.14 [SD, 0.41] mm vs 0.28 [SD, 0.48] mm; difference, -0.14 [95% CI, -0.23 to -0.05]; P < or = .004). The everolimus stent was noninferior to the paclitaxel stent for target vessel failure at 9 months (7.2% vs 9.0%, respectively; difference, -1.9% [95% CI, -5.6% to 1.8%]; relative risk, 0.79 [95% CI, 0.51 to 1.23]; P < .001). The everolimus stent compared with the paclitaxel stent resulted in significant reductions in composite major adverse cardiac events both at 9 months (4.6% vs 8.1%; relative risk, 0.56 [95% CI, 0.34 to 0.94]; P = .03) and at 1 year (6.0% vs 10.3%; relative risk, 0.58 [95% CI, 0.37 to 0.90]; P = .02), due to fewer myocardial infarctions and target lesion revascularization procedures. In this large-scale, prospective randomized trial, an everolimus-eluting stent compared with a paclitaxel-eluting stent resulted in reduced angiographic late loss, noninferior rates of target vessel failure, and fewer major adverse cardiac events during 1 year of follow-up. clinicaltrials.gov Identifier: NCT00180479.
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              Mechanisms of controlled drug release from drug-eluting stents.

              The clinical importance of drug-eluting stents (DESs) has been demonstrated by their unparalleled success in preventing restenosis after stenting procedures. The magnitude of success is historic despite their short history. The current DESs deliver a single drug aiming to prevent or minimize proliferation of smooth muscle cells. Since the restenosis process involves several different biological responses, the ability to deliver the right drugs at the right times is critical for further development of the second generation of DESs. As the type of drugs that can be delivered from DESs varies, it is imperative to understand the drug delivery mechanisms and the approaches available for drug coating on the stents. The drug delivery mechanisms of current DESs that have been used clinically and under clinical trials are explained.
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                Author and article information

                Journal
                Biomed Eng Online
                BioMedical Engineering OnLine
                BioMed Central
                1475-925X
                2010
                9 March 2010
                : 9
                : 15
                Affiliations
                [1 ]Centre for Applied Biomedical Engineering Research (CABER), Department of Mechanical and Aeronautical Engineering and the Materials and Surface Science Institute, University of Limerick, Limerick, Ireland
                Article
                1475-925X-9-15
                10.1186/1475-925X-9-15
                2854105
                20214774
                4a1c35ae-1e3c-49ff-a313-b5ebe3ea92bf
                Copyright ©2010 O'Connell et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 17 September 2009
                : 9 March 2010
                Categories
                Review

                Biomedical engineering
                Biomedical engineering

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