Caves Jeffrey M, Chaikof Elliot L
Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, GA 30322, USA.
J Vasc Surg. 2006 Dec;44(6):1363-8. doi: 10.1016/j.jvs.2006.08.046.
Noncoronary atherosclerotic vascular disease, including symptomatic lower extremity peripheral arterial disease (PAD), promises to extract a steadily rising medical and economic toll over the coming decades. Although drug-eluting stents have led to substantial advances in the management of coronary atherosclerosis, endovascular treatment of noncoronary, peripheral arterial lesions continues to yield high restenosis rates and early clinical failures. In this report, we review recent developments in microfabrication and nanotechnology strategies that offer new opportunities for improving stent-based technology for the treatment of more extensive and complex lesions. In this regard, stents with microfabricated reservoirs for controlled temporal and spatial drug release have already been successfully applied to coronary lesions. Microfabricated needles to pierce lesions and deliver therapeutics deep within the vascular wall represent an additional microscale approach. At the nanoscale, investigators have primarily sought to alter the strut surface texture or coat the stent to enhance inductive or conductive schemes for endothelialization and host artery integration. Nanotechnology research that identifies promising strategies to limit restenosis through targeted drug delivery after angioplasty and stenting is also reviewed.
非冠状动脉粥样硬化性血管疾病，包括有症状的下肢外周动脉疾病（PAD），预计在未来几十年将带来持续上升的医疗和经济负担。尽管药物洗脱支架在冠状动脉粥样硬化的治疗方面取得了重大进展，但非冠状动脉外周动脉病变的血管内治疗仍持续产生较高的再狭窄率和早期临床失败率。在本报告中，我们回顾了微制造和纳米技术策略的最新进展，这些进展为改进基于支架的技术以治疗更广泛和复杂的病变提供了新机会。在这方面，具有用于可控时空药物释放的微制造储库的支架已成功应用于冠状动脉病变。用于刺穿病变并将治疗药物输送到血管壁深处的微制造针代表了另一种微观尺度的方法。在纳米尺度上，研究人员主要致力于改变支架支柱的表面纹理或对支架进行涂层处理，以增强用于内皮化和宿主动脉整合的诱导或传导方案。本文还综述了纳米技术研究，该研究确定了通过血管成形术和支架置入术后的靶向药物递送限制再狭窄的有前景的策略。
