Bailey S R
University of Texas Health Science Center, Cardiac Catheterization Laboratory, San Antonio 78284-7872, USA.
Prog Cardiovasc Dis. 1997 Sep-Oct;40(2):183-204. doi: 10.1016/s0033-0620(97)80008-4.
Catheter-based treatment of coronary artery disease has historically been based on expansion or ablating vessels. Only in the last 3 years have we had devices that allow us to choose the location to apply agents directly onto or into the arterial wall. Previous trials of pharmaceutical agents in humans have failed despite animal trials showing efficacy. These agents were given in high systemic doses of drugs that may have toxic side effects with minimal effect at the site of arterial injury. Percutaneous interventions are still limited by our need to treat thrombus, alter or passivate the arterial wall, and deliver new treatments into or through the arterial wall. This review discusses the current designs of delivery catheters, ongoing trials of locally delivered agents and gene therapy. The limits of our current understanding of delivery location and efficiency as well as future investigations are also discussed.
基于导管的冠状动脉疾病治疗方法历来是基于血管扩张或消融。直到最近三年，我们才有了能够让我们选择将药物直接应用于动脉壁上或壁内的装置。尽管在动物试验中显示出疗效，但之前在人体上进行的药物试验均告失败。这些药物是以高全身剂量给药的，可能会产生有毒副作用，而在动脉损伤部位的效果却微乎其微。经皮干预仍然受到我们在治疗血栓、改变或钝化动脉壁以及将新治疗方法输送到动脉壁内或通过动脉壁方面需求的限制。本文综述讨论了输送导管的当前设计、局部给药药物和基因治疗的正在进行的试验。我们还讨论了目前对给药位置和效率的理解的局限性以及未来的研究方向。
