Impact of Paclitaxel Dose on Tissue Pharmacokinetics and Vascular Healing A Comparative Drug-Coated Balloon Study in the Familial Hypercholesterolemic Swine Model of Superficial Femoral In-Stent Restenosis

Carlos A. Gongora, Masahiko Shibuya, Jeffrey D. Wessler, Jenn McGregor, Armando Tellez, Yanping Cheng, Gerard B. Conditt, Greg L. Kaluza, Juan F. Granada

Research output: Contribution to journalArticlepeer-review

89 Scopus citations

Abstract

Objectives This study sought to compare the effect of paclitaxel-coated balloon (PCB) concentration on tissue levels and vascular healing using 3 different PCB technologies (In.Pact Pacific = 3 μg/mm2, Lutonix = 2 μg/mm2 and Ranger = 2 μg/mm2) in the experimental setting. Background The optimal therapeutic dose for PCB use has not been determined yet. Methods Paclitaxel tissue levels were measured up to 60 days following PCB inflation (Ranger and In.Pact Pacific) in the superficial femoral artery of healthy swine (18 swine, 36 vessels). The familial hypercholesterolemic swine model of superficial femoral artery in-stent restenosis (6 swine, 24 vessels) was used in the efficacy study. Two weeks following bare-metal stent implantation, each in-stent restenosis site was randomly treated with a PCB or an uncoated control balloon (Sterling). Quantitative vascular analysis and histology evaluation was performed 28 days following PCB treatment. Results All PCB technologies displayed comparable paclitaxel tissue levels 4 h following balloon inflation. At 28 days, all PCB had achieved therapeutic tissue levels; however, the In.Pact PCB resulted in higher tissue concentrations than did the other PCB groups at all time points. Neointimal inhibition by histology was decreased in all PCB groups compared with the control group, with a greater decrease in the In.Pact group. However, the neointima was more mature and contained less peri-strut fibrin deposits in both 2-μg/mm2 PCB groups. Conclusions Compared with the clinically established PCB dose, lower-dose PCB technologies achieve lower long-term tissue levels but comparable degrees of neointimal inhibition and fewer fibrin deposits. The impact of these findings in restenosis reduction and clinical outcomes needs to be further investigated.

Original languageEnglish (US)
Pages (from-to)1115-1123
Number of pages9
JournalJACC: Cardiovascular Interventions
Volume8
Issue number8
DOIs
StatePublished - Jul 1 2015
Externally publishedYes

Keywords

  • in-stent restenosis
  • Key Words familial hypercholesterolemic swine
  • paclitaxel-coated balloon

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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