Nanotechnology in interventional cardiology

Focus Article

Tillmann Cyrus, Samuel A. Wickline, Gregory M. Lanza

Published Online: Jul 11 2011

DOI: 10.1002/wnan.154

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Abstract High‐grade atherosclerotic stenoses are reduced to zero or minimal residual stenosis grades by a single or a series of balloon angioplasties. Currently, stents are implanted to prevent immediate vascular recoil and elution of an antimitotic drug from the stent struts minimizes restenosis. An unwanted side‐effect of this drug elution is delayed re‐endothelialization which requires treatment with two anti‐platelet drugs, in many cases for a minimum of 1 year to prevent acute in‐stent thrombosis. Advances in stent design and drug elution technology, now in its fourth generation, have not abated this issue. Nanotechnology‐based local drug delivery has the potential to achieve restenosis prevention while not impeding endothelial healing. Molecularly targeted drugs can be aimed to specifically bind to epitopes in the injured media and adventitia. Thus, endothelial healing may progress unhindered. To prevent restenosis, this technology may be used with bare metal or biodegradable stents. In this article novel nanoparticulate agents will be compared regarding their potential to deliver drugs to molecular targets within the vascular wall. Potential molecular targets, targeting mechanisms, drug‐delivery propensities, and biocompatibility will be reviewed. WIREs Nanomed Nanobiotechnol 2012, 4:82–95. doi: 10.1002/wnan.154 This article is categorized under: Therapeutic Approaches and Drug Discovery > Emerging Technologies Diagnostic Tools > In Vivo Nanodiagnostics and Imaging Therapeutic Approaches and Drug Discovery > Nanomedicine for Cardiovascular Disease

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(a) MR time‐of‐flight angiogram 30 min after balloon stretch‐injury showing patent femoral arteries treated with α_vβ₃‐integrin‐targeted paramagnetic nanoparticles with rapamycin (left artery) and saline in the right artery of a NZW rabbit. (b and c) MR angiograms 2 weeks after injury and treatment. (b) α_vβ₃‐Integrin‐targeted nanoparticles without drug (right) with arterial plaque versus the widely patent contralateral artery treated with α_vβ₃‐integrin‐targeted nanoparticles with rapamycin (left). (c) α_vβ₃‐Integrin‐targeted nanoparticles with rapamycin in the widely patent right femoral artery versus the partially occluded left artery treated with non‐targeted nanoparticles with rapamycin (left). Arrows identify regions of intraluminal plaque due to balloon overstretch injury.

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