To: James Marks who wrote (188 ) 3/16/1998 9:10:00 PM From: Aishwarya Respond to of 2887
Ah ! there you go Mr.Rogers performing a thorough Sanity check on this thread and I like your logic and appreciate your feedback as always. Someone in the yahoo board raised a doubt about Stenting due to high Restenosis .This is my reply to that poster. Diseased blood vessels develop blockages which limit blood flow and can lead to pain in the chest or legs when exercising or more severe problems such as heart attack, limb loss or stroke. Both surgical and nonsurgical procedures have been devised to reestablish better blood flow,either by opening the artery with catheters or by bypassing the blockage using vein grafts. Restenosis is the process of the renarrowing of the treated vessel due to an excessive accumulationof cells and tissue between cells (extracellular matrix) in response to the original procedure. Within 6 months of angioplasty, for example, as many as 25-40% of vessels can become renarrowed, often necessitating additional procedures. In veins used for bypass grafts in patients with heart disease, as many as 50% can become severely narrowed or occluded within 10 years.* Patients undergoing chronic hemodialysis require vascular access grafts which almost universally fail with time, due for the most part to thickening of the wall of the vein at the site of the graft placement. Restenosis can also occur after carotid endarterectomy or after peripheral vascular surgery. There are many factors which contribute to the restenosis process. Technically inadequate results (i.e. inadequate lumen enlargement, blood clot formation) can lead to early restenosis as can recoil of the elastic artery. Metal stents have significantly improved early results, and have essentially eliminated recoil as a cause of restenosis. However, all known forms of vascular intervention, including angioplasty, stenting, atherectomy and grafting are associated with thickening of the lining of the blood vessels to varying degrees. Smooth muscle cells in this lining begin to divide and secrete substances into the vessel wall which cause further accumulation of tissue. A variety of heparin-binding growth factors (HBGF) such as Fibroblast Growth Factor (FGF), and Platelet-Derived Growth Factor (PDGF) may drive this process and worsen the amount of thickening. A lot of researchers are developing patented, sulfated cyclodextrins for the prevention of restenosis and intimal thickening in multiple situations where vascular injury limits the long-term success of the procedure. These negatively charged molecules avidly bind with HBGF. In several animal studies, monomeric and polymeric formulations of sulfatedhave significantly prevented the narrowing of blood vessels after vascular injury.these compounds, like heparin, avidly bind to growth factors thought to mediate the restenosis process. This class of compounds may limit the overstimulation by growth factors and thereby limit the restenosis process. There is also some evidence that these compounds may affect the accumulation of tissue between cells (extracellular matrix) which also contributes to intimal thickening cyclodextrin, the monomeric version, is orally bioavailable and, due to its high solubility, appears to manifest no potential for nephrotoxicity. In a series of studies, animals treated orally for one month with this compound demonstrated a reduced rate of restenosis. this can also be delivered locally to the blood vessel wall using catheters as an adjuct to conventional angioplasty or stenting. is a proprietary polymeric molecule. It was developed for direct application to the outside of bypass grafts, endarterectomy sites, arterial venous shunts, and vasular stents. Preliminary data in an animal model has demonstrated inhibition of vein graft and arterial wall thickening one month after implantation when the polymer was placed around the graft at the time of surgery.around a balloon-injured carotid artery reduced intimal thickening by > 50% at 14 days. The use of coronary artery stents to provide mechanical patency is becoming widespread. Intermediate and long-term restenosis rates appear to be lower but remain a significant problem. Smooth muscle encroachment still occurs as does the accumulation of extracellular matrix. A variety of vascular stents are available at present, and companies exploring the feasibility of coating these stents with slow-release forms of these compounds is increasing. The development of drug-coated stents that would provide both mechanical support and inhibition of smooth muscle proliferation will likely further reduce the frequency of restenosis. This will insure an exciting future for vascular stents as a vital interventional therapy. THIS IS FROM THE ABMI SITE ON OmniStentAlthough angioplasty and atherectomy contributed greatly to less invasive treatment of atherosclerosis, it was not until 1994 that a third less invasive means of treatment was developed. This new treatment, consisting of simple, spring-like devices call stents, which when place in a treated vessel, greatly reduces the acute and chronic clinical failure rate of restenosis. Stents provide a foundation to support a weakened vessel. The most common design is the metal stent which is comprised of a tubular structure, normally having a pattern of slots which, when expanded, produce a tiny tubular grillwork that can hold a diseased vessel open, thereby providing a channel for blood flow to the hear or limbs. Once the vessel is acutely dilated, the stent could be passed through the stenosis on a guide wire, in its endless, elongated configuration, then released to allow the coils to reform at the stenosis. The gradual mural pressure of the "memory" reforming coil produces a subsequent chronic vessel dilation over a period of several hours or days until the "memory" diameter of the coil is reached. This could greatly impact the restenosis problem in that the acute trauma of angioplasty (i.e., rapid vessel wall stretching, dissection of internal elastic lamina and media) could be modulated over the succeeding days after angioplasty by gentle though constant vessel wall "remolding." This technology is here to stay believe it or not. Other technologies to complement this will develop markets in the near future to prevent Restenosis and ABMI will use any commercially available compound to coat their stents if necessary. Please see my previous post and I am sure lot of folks would have dumped their stocks with stent companies at that time reading just one news article but in reality that market has grown 1000 folds. Regards, Sri