Análisis de la eficacia y la seguridad de distintos balones liberadores de paclitaxel en un modelo animal / Safety and Efficacy of Different Paclitaxel-eluting Balloons in a Porcine Model

Introducción y objetivos Los balones liberadores de paclitaxel tienen demostrada eficacia en el tratamiento y la prevención de la restenosis. Sin embargo, no todos los dispositivos comercializados son igualmente efectivos; por ello es importante comparar los resultados en un modelo preclínico. Nuestro objetivo es analizar la seguridad y la eficacia preclínicas de distintos dispositivos. Métodos En 17 cerdos domésticos (25 ± 3 kg) se implantaron 51 stents metálicos (Architect®, iVascular), uno en cada rama coronaria principal, y se sobredilataron con distintos balones de control (n = 10) o liberadores de paclitaxel: balón liberador de paclitaxel 1 (iVascular) (n = 15); balón liberador de paclitaxel 2 (iVascular) (n = 16) e In. Pact Falcon® (Medtronic) (n = 10). Tras 28 días, se analizaron los resultados de restenosis (angiografía e histomorfometría) y de reparación vascular: daño vascular, endotelización, persistencia de fibrina e inflamación. Resultados Los distintos balones liberadores de paclitaxel mostraron valores similares de estenosis en el seguimiento significativamente menores que los controles: angiografía, el 9 ± 12% frente al 34 ± 18% (p < 0,0001); histomorfometría, el 22 ± 8% frente al 51 ± 18% (p < 0,0001). Los grados de daño vascular (0,6 ± 0,5) e inflamación (0,8 ± 0,3) fueron bajos, sin diferencias entre los grupos. Los marcadores del efecto farmacológico fueron significativamente distintos entre los dispositivos liberadores de paclitaxel (sin diferencias entre ellos) y los controles: superficie endotelizada, el 87 ± 10% frente al 99 ± 2% (p = 0,0007); grado de fibrina, 2,1 ± 0,7 frente a 0,4 ± 0,5 (p < 0,0001). No hubo diferencias entre los distintos balones liberadores de paclitaxel. Conclusiones: En este modelo preclínico, los balones liberadores de paclitaxel analizados mostraron una reducción significativa de la restenosis. Aunque no se observaron datos de daño vascular o inflamación persistentes, sí se apreciaron los efectos de la acción farmacológica en forma de endotelización retrasada y acumulación de fibrina

Introduction and objectives Paclitaxel-eluting balloons have shown high antiproliferative efficacy in the treatment and prevention of restenosis. Nevertheless, not all available devices are equally effective, which makes it interesting to compare results in a preclinical model. Our objective was to assess the preclinical efficacy and safety of different devices. Methods We implanted 51 metallic stents (Architect®, iVascular) in 17 domestic swine (mean, 25 [3] kg), inserting 1 stent per major coronary artery. Stent postdilatation was performed with different control balloons (n = 10) or paclitaxel-eluting balloons: paclitaxel-eluting balloon 1 (iVascular) (n = 15); paclitaxel-eluting balloon 2 (iVascular) (n = 16) and In.Pact Falcon®(Medtronic) (n = 10). The restenosis rate (using angiography and histomorphometry) and vascular healing parameters (balloon-related vascular injury score, endothelialization rate, and fibrin and inflammation scores) were analyzed at 28 days. Results The distinct paclitaxel-eluting balloons showed a similar degree of stenosis at follow-up, which was significantly lower than that in the control group: diameter stenosis was 9% (12%) vs 34% (18%) by angiography (P < .0001) and was 22% (8%) vs 51% (18%) by histomorphometry (P < .0001). Scores for vascular injury (mean, 0.6 [0.5]) and inflammation (mean, 0.8 [0.3]) were uniformly low across all groups. Drug effect markers differed significantly between the paclitaxel-eluting balloons and control groups, with lower endothelialization rates (87% [10%] vs 99% [2%]; P = .0007) and higher fibrin scores (2.1 [0.7] vs 0.4 [0.5]; P < .0001) in the paclitaxel-eluting balloons groups. There were no differences between the different paclitaxel-eluting balloons. Conclusions: In this preclinical model, the paclitaxel-eluting balloons studied significantly reduced in-stent restenosis compared with the control balloons. Although there were no findings of persistent vascular injury or inflammation, delayed endothelialization and fibrin aggregate suggest a drug deposition response

Safety and efficacy of different paclitaxel-eluting balloons in a porcine model.

INTRODUCTION AND OBJECTIVES: Paclitaxel-eluting balloons have shown high antiproliferative efficacy in the treatment and prevention of restenosis. Nevertheless, not all available devices are equally effective, which makes it interesting to compare results in a preclinical model. Our objective was to assess the preclinical efficacy and safety of different devices. METHODS: We implanted 51 metallic stents (Architect(®), iVascular) in 17 domestic swine (mean, 25 [3] kg), inserting 1 stent per major coronary artery. Stent postdilatation was performed with different control balloons (n=10) or paclitaxel-eluting balloons: paclitaxel-eluting balloon 1 (iVascular) (n=15); paclitaxel-eluting balloon 2 (iVascular) (n=16) and In.Pact Falcon(®) (Medtronic) (n=10). The restenosis rate (using angiography and histomorphometry) and vascular healing parameters (balloon-related vascular injury score, endothelialization rate, and fibrin and inflammation scores) were analyzed at 28 days. RESULTS: The distinct paclitaxel-eluting balloons showed a similar degree of stenosis at follow-up, which was significantly lower than that in the control group: diameter stenosis was 9% (12%) vs 34% (18%) by angiography (P<.0001) and was 22% (8%) vs 51% (18%) by histomorphometry (P<.0001). Scores for vascular injury (mean, 0.6 [0.5]) and inflammation (mean, 0.8 [0.3]) were uniformly low across all groups. Drug effect markers differed significantly between the paclitaxel-eluting balloons and control groups, with lower endothelialization rates (87% [10%] vs 99% [2%]; P=.0007) and higher fibrin scores (2.1 [0.7] vs 0.4 [0.5]; P<.0001) in the paclitaxel-eluting balloons groups. There were no differences between the different paclitaxel-eluting balloons. CONCLUSIONS: In this preclinical model, the paclitaxel-eluting balloons studied significantly reduced in-stent restenosis compared with the control balloons. Although there were no findings of persistent vascular injury or inflammation, delayed endothelialization and fibrin aggregate suggest a drug deposition response.