Yale Cardiovascular Research Group, Yale University Medical Center, New Haven, CT, USA.
Eur J Clin Invest. 2015 Mar;45(3):333-45. doi: 10.1111/eci.12407. Epub 2015 Feb 14.
Despite advancements from balloon angioplasty to drug-eluting stents, primary patency rates after endovascular revascularization of peripheral artery disease have remained inferior compared to surgery. Endovascular revascularization has been limited by restenosis and mechanical stent failure. Thus, there is increased research into other nonstent-based local drug delivery modalities, which can provide an active drug to inhibit restenosis focally and avoid the risk of systemic adverse effects.
This review will summarize the unique properties of paclitaxel and studies on paclitaxel local delivery for the treatment of peripheral artery disease. A MEDLINE search for relevant peer-reviewed scientific literature published in English was conducted. Search terms included but were not limited to paclitaxel pharmacodynamics, paclitaxel local drug delivery, and drug eluting balloons, with a focus on the use of paclitaxel in the context of coronary and peripheral vascular disease.
The primary search produced 182 results of which 51 papers were relevant. Of the 51 relevant papers, 27 were original research papers and 24 were either review papers, commentary or opinion papers.
Paclitaxel has several chemical properties, which make it ideal for local drug delivery including its hydrophobicity, ability to concentrate into the arterial intima layer and prolonged effect on cells even after brief exposure periods. Local delivery of paclitaxel via injection catheters, balloon catheters and coated balloons has shown encouraging results in terms of efficacy and safety in small-scale animal and clinical studies. Additional preclinical and clinical studies are needed to determine the long-term efficacy and safety of these treatments in humans.
尽管血管成形术球囊到药物洗脱支架的技术进步，外周动脉疾病血管腔内血运重建后的原发性通畅率仍低于手术治疗。血管腔内血运重建受到再狭窄和机械支架失败的限制。因此，人们越来越关注其他非支架的局部药物输送方式，这些方式可以提供一种活性药物，有针对性地抑制再狭窄，避免全身不良反应的风险。
本综述将总结紫杉醇的独特特性和紫杉醇局部给药治疗外周动脉疾病的研究。对英文同行评议科学文献进行了 MEDLINE 检索。检索词包括但不限于紫杉醇药代动力学、紫杉醇局部药物输送和药物洗脱球囊，重点是紫杉醇在冠状动脉和外周血管疾病中的应用。
初步搜索产生了 182 个结果，其中 51 篇论文是相关的。在 51 篇相关论文中，27 篇为原始研究论文，24 篇为评论、评论或意见论文。
紫杉醇具有多种化学特性，使其成为局部药物输送的理想选择，包括其疏水性、能够集中到动脉内膜层以及在短暂暴露后对细胞的延长作用。通过注射导管、球囊导管和涂层球囊局部递送紫杉醇在小型动物和临床研究中在疗效和安全性方面取得了令人鼓舞的结果。需要进行更多的临床前和临床研究，以确定这些治疗方法在人类中的长期疗效和安全性。
