Drug deposition in coronary arteries with overlapping drug-eluting stents
Drug-eluting stents are accepted as mainstream endovascular therapy, yet concerns for their safety may be under-appreciated. While failure from restenosis has dropped to below 5%, the risk of stent thrombosis and associated mortality remain relatively high. Further optimization of drug release is re...
| Main Authors: | , , , , |
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| Format: | Article |
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Elsevier
2017
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| Online Access: | http://hdl.handle.net/1721.1/112773 https://orcid.org/0000-0002-4210-3177 https://orcid.org/0000-0002-7832-7156 |
| _version_ | 1826188512893861888 |
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| author | Olgac, Ufuk Poulikakos, Dimos Kurtcuoglu, Vartan Rikhtegar Nezami, Farhad Edelman, Elazer R |
| author2 | Massachusetts Institute of Technology. Institute for Medical Engineering & Science |
| author_facet | Massachusetts Institute of Technology. Institute for Medical Engineering & Science Olgac, Ufuk Poulikakos, Dimos Kurtcuoglu, Vartan Rikhtegar Nezami, Farhad Edelman, Elazer R |
| author_sort | Olgac, Ufuk |
| collection | MIT |
| description | Drug-eluting stents are accepted as mainstream endovascular therapy, yet concerns for their safety may be under-appreciated. While failure from restenosis has dropped to below 5%, the risk of stent thrombosis and associated mortality remain relatively high. Further optimization of drug release is required to minimize thrombosis risk while maintaining therapeutic dose. The complex three-dimensional geometry of deployed stents together with the combination of diffusive and advective drug transport render an intuitive understanding of the situation exceedingly difficult. In situations such as this, computational modeling has proven essential, helping define the limits of efficacy, determine the mode and mechanism of drug release, and identify alternatives to avoid toxicity. A particularly challenging conformation is encountered in coronary arteries with overlapping stents. To study hemodynamics and drug deposition in such vessels we combined high-resolution, multi-scale ex vivo computed tomography with a flow and mass transfer computational model. This approach ensures high geometric fidelity and precise, simultaneous calculation of blood flow velocity, shear stress and drug distribution. Our calculations show that drug uptake by the arterial tissue is dependent both on the patterns of flow disruption near the wall, as well as on the relative positioning of drug-eluting struts. Overlapping stent struts lead to localized peaks of drug concentration that may increase the risk of thrombosis. Such peaks could be avoided by anisotropic stent structure or asymmetric drug release designed to yield homogeneous drug distribution along the coronary artery and, at the least, suggest that these issues need to remain in the forefront of consideration in clinical practice. |
| first_indexed | 2024-09-23T08:00:28Z |
| format | Article |
| id | mit-1721.1/112773 |
| institution | Massachusetts Institute of Technology |
| last_indexed | 2024-09-23T08:00:28Z |
| publishDate | 2017 |
| publisher | Elsevier |
| record_format | dspace |
| spelling | mit-1721.1/1127732024-03-20T19:34:45Z Drug deposition in coronary arteries with overlapping drug-eluting stents Olgac, Ufuk Poulikakos, Dimos Kurtcuoglu, Vartan Rikhtegar Nezami, Farhad Edelman, Elazer R Massachusetts Institute of Technology. Institute for Medical Engineering & Science Rikhtegar Nezami, Farhad Edelman, Elazer R Drug-eluting stents are accepted as mainstream endovascular therapy, yet concerns for their safety may be under-appreciated. While failure from restenosis has dropped to below 5%, the risk of stent thrombosis and associated mortality remain relatively high. Further optimization of drug release is required to minimize thrombosis risk while maintaining therapeutic dose. The complex three-dimensional geometry of deployed stents together with the combination of diffusive and advective drug transport render an intuitive understanding of the situation exceedingly difficult. In situations such as this, computational modeling has proven essential, helping define the limits of efficacy, determine the mode and mechanism of drug release, and identify alternatives to avoid toxicity. A particularly challenging conformation is encountered in coronary arteries with overlapping stents. To study hemodynamics and drug deposition in such vessels we combined high-resolution, multi-scale ex vivo computed tomography with a flow and mass transfer computational model. This approach ensures high geometric fidelity and precise, simultaneous calculation of blood flow velocity, shear stress and drug distribution. Our calculations show that drug uptake by the arterial tissue is dependent both on the patterns of flow disruption near the wall, as well as on the relative positioning of drug-eluting struts. Overlapping stent struts lead to localized peaks of drug concentration that may increase the risk of thrombosis. Such peaks could be avoided by anisotropic stent structure or asymmetric drug release designed to yield homogeneous drug distribution along the coronary artery and, at the least, suggest that these issues need to remain in the forefront of consideration in clinical practice. National Institutes of Health (U.S.) (Grant R01 GM 49039) 2017-12-18T14:23:43Z 2017-12-18T14:23:43Z 2016-07 2016-07 2017-12-14T18:59:23Z Article http://purl.org/eprint/type/JournalArticle 0168-3659 http://hdl.handle.net/1721.1/112773 Rikhtegar, Farhad et al. “Drug Deposition in Coronary Arteries with Overlapping Drug-Eluting Stents.” Journal of Controlled Release 238 (September 2016): 1–9 © 2016 Elsevier B.V. https://orcid.org/0000-0002-4210-3177 https://orcid.org/0000-0002-7832-7156 http://dx.doi.org/10.1016/J.JCONREL.2016.07.023 Journal of Controlled Release Creative Commons Attribution-NonCommercial-NoDerivs License http://creativecommons.org/licenses/by-nc-nd/4.0/ application/pdf Elsevier PMC |
| spellingShingle | Olgac, Ufuk Poulikakos, Dimos Kurtcuoglu, Vartan Rikhtegar Nezami, Farhad Edelman, Elazer R Drug deposition in coronary arteries with overlapping drug-eluting stents |
| title | Drug deposition in coronary arteries with overlapping drug-eluting stents |
| title_full | Drug deposition in coronary arteries with overlapping drug-eluting stents |
| title_fullStr | Drug deposition in coronary arteries with overlapping drug-eluting stents |
| title_full_unstemmed | Drug deposition in coronary arteries with overlapping drug-eluting stents |
| title_short | Drug deposition in coronary arteries with overlapping drug-eluting stents |
| title_sort | drug deposition in coronary arteries with overlapping drug eluting stents |
| url | http://hdl.handle.net/1721.1/112773 https://orcid.org/0000-0002-4210-3177 https://orcid.org/0000-0002-7832-7156 |
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