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WIREs Nanomed Nanobiotechnol
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Cardiac catheterization: consequences for the endothelium and potential for nanomedicine

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Cardiac catheterization results in interactions between the catheter and surfaces and the artery lumen, which is lined by the endothelium. These interactions can range from minor rubbing to severe mechanical injury. Further, in the case of radial access, even atraumatic interactions have consequences ranging from clinical complications, such as radial spasm and radial occlusion, to lasting endothelial cell dysfunction. These consequences may be underappreciated; however, endothelial cells play a central role in maintaining vascular homeostasis via nitric oxide production. Existing treatment paradigms do not address endothelial dysfunction or damage and, thus, novel therapeutic approaches are needed. Nanomedicine, in particular, offers great potential in the form of targeted drug delivery, via functionalized coatings or nanocarriers, aimed at increased nitric oxide bioavailability or reduced inflammation. WIREs Nanomed Nanobiotechnol 2015, 7:458–473. doi: 10.1002/wnan.1316 This article is categorized under: Therapeutic Approaches and Drug Discovery > Nanomedicine for Cardiovascular Disease Implantable Materials and Surgical Technologies > Nanotechnology in Tissue Repair and Replacement
Catheter–lumen interactions. (a) Severe artery wall trauma resulting from poking or prodding with the catheter, including damage to the elastic lamina and medial injury. (b) Mild intimal injury caused by rubbing, resulting in endothelial damage and denudation. Note: Damaged or activated endothelium is indicated by reducing the thickness of the ESL and tinting it red.
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Nanocarrier approach to mitigating the consequences of catheter–lumen interactions. Targeted nanocarriers (dark blue) can be used to deliver drugs (NO, anti‐oxidants, etc.) to injured, denuded areas or to activated endothelium. Non‐targeted carriers (light blue circles) can be used to increase NO bioavailability.
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NO‐functionalized, hydrophilic catheter coating. Hydrophilic, NO releasing coating increases NO bioavailability leading to vasodilation (blue highlighting) and reduced intravascular inflammation and endothelial activation.
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Catheter‐induced spasm. At top, mild catheter–lumen interactions have caused endothelial activation and dysfunction, leading to an increase in ROS and a reduction in NO bioavailability. At bottom, more severe intimal injury caused by rubbing, results in denudation, and a loss of endothelial NO production. Note: Damaged or activated endothelium is indicated by reducing the thickness of the ESL and tinting it red. Reduced NO bioavailability in the media and consequent vasoconstriction is indicated by orange highlighting.
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Implantable Materials and Surgical Technologies > Nanotechnology in Tissue Repair and Replacement
Therapeutic Approaches and Drug Discovery > Nanomedicine for Cardiovascular Disease

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