College of Engineering and Computing, Biomedical Engineering Program, University of South Carolina, Columbia, SC 29208; College of Engineering and Computing, Department of Mechanical Engineering, University of South Carolina, Columbia, SC 29208; Cardiovascular Translational Research Center, University of South Carolina, Columbia, SC 29208.
College of Engineering and Computing, Biomedical Engineering Program, University of South Carolina, Columbia, SC 29208; Cardiovascular Translational Research Center, University of South Carolina, Columbia, SC 29208; College of Engineering and Computing, Department of Chemical Engineering, University of South Carolina, Columbia, SC 29208.
J Biomech Eng. 2023 Dec 1;145(12). doi: 10.1115/1.4063122.
Drug-coated balloon therapy is a minimally invasive endovascular approach to treat obstructive arterial disease, with increasing utilization in the peripheral circulation due to improved outcomes as compared to alternative interventional modalities. Broader clinical use of drug-coated balloons is limited by an incomplete understanding of device- and patient-specific determinants of treatment efficacy, including late outcomes that are mediated by postinterventional maladaptive inward arterial remodeling. To address this knowledge gap, we propose a predictive mathematical model of pressure-mediated femoral artery remodeling following drug-coated balloon deployment, with account of drug-based modulation of resident vascular cell phenotype and common patient comorbidities, namely, hypertension and endothelial cell dysfunction. Our results elucidate how postinterventional arterial remodeling outcomes are altered by the delivery of a traditional anti-proliferative drug, as well as by codelivery with an anti-contractile drug. Our findings suggest that codelivery of anti-proliferative and anti-contractile drugs could improve patient outcomes following drug-coated balloon therapy, motivating further consideration of novel payloads in next-generation devices.
药物涂层球囊治疗是一种微创的血管内方法，用于治疗阻塞性动脉疾病，由于与其他介入治疗方式相比，其治疗效果更好，因此在周围循环中的应用越来越广泛。由于对设备和患者特异性治疗效果决定因素的认识不完整，包括由介入后适应性向内动脉重构介导的晚期结果，药物涂层球囊的更广泛临床应用受到限制。为了弥补这一知识空白，我们提出了一种基于压力的药物涂层球囊扩张后股动脉重塑的预测数学模型，该模型考虑了药物对常驻血管细胞表型和常见患者合并症（即高血压和内皮细胞功能障碍）的调节作用。我们的研究结果阐明了传统抗增殖药物的输送以及与抗收缩药物的共同输送如何改变介入后的动脉重塑结果。我们的发现表明，抗增殖和抗收缩药物的共同输送可能会改善药物涂层球囊治疗后的患者预后，这促使人们进一步考虑下一代器械中的新型有效载荷。
