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Magnetic Delivery of Cell-Based Therapies
Published in Jon Dobson, Carlos Rinaldi, Nanomagnetic Actuation in Biomedicine, 2018
Boris Polyak, Richard Sensenig
In this section, we discuss a magnetic cell delivery application in the context of treatment of coronary and peripheral artery disease. Angioplasty has become the most common revascularization procedure for coronary and peripheral artery disease. However, recurrent arterial narrowing (restenosis) is the major complication limiting the success of this revascularization procedure. A combination of processes causes restenosis. In the short term, it may be caused by elastic recoil of the vessel wall, thrombus formation at the site of injury, and variations in operative technique that lead to a smaller anastomosis or kinking of the vessel. Longer term patency over the preceding months to years may be limited by intimal hyperplasia, involving the proliferation and migration of intimal smooth muscle cells (SMCs).71,72 The overall incidence or restenosis is approximately 30% a year after coronary angioplasty and bare metal stenting,73 and there is a similar incidence following angioplasty for peripheral arterial disease.74 Drug-eluting stents have been developed as a means of preventing intimal hyperplasia and appear to have reduced the early risk of coronary restenosis, although this still occurs in over 10% of stented vessels at 12 months.73 There are also concerns of an increased incidence of stent thrombosis and myocardial infarction in patients who have had a drug-eluting stent inserted.73
Characterization of a heparinized decellularized scaffold and its effects on mechanical and structural properties
Published in Journal of Biomaterials Science, Polymer Edition, 2020
Ji Li, Zhiwen Cai, Jin Cheng, Cong Wang, Zhiping Fang, Yonghao Xiao, Zeng-Guo Feng, Yongquan Gu
Cardiovascular diseases, including coronary heart disease (CHD) and peripheral arterial disease (PAD), are the principal cause of death worldwide [1]. The worldwide annual incidence of deaths related to cardiovascular disease is expected to rise to 23.3 million by 2030 [2]. Current revascularization techniques consist of angioplasty, placement of a stent, or surgical bypass grafting. In the United States, more than 1 million vascular grafts are needed in clinical practice every year [3]. To date, the most successful vascular conduits are autologous blood vessels, often the greater saphenous veins and mammary arteries, which have been established as the gold standard for small diameter blood vessel (<6 mm) grafting. However, limited availability as a result of trauma, vessel diseases, prior usage [4, 5], and high rate of venous graft failure necessitates the search for alternative strategies [6, 7].
A review on the treatment of intimal hyperplasia with perivascular medical devices: role of mechanical factors and drug release kinetics
Published in Expert Review of Medical Devices, 2023
Ankur J. Raval, Jigisha K. Parikh, Meghal A. Desai
Endovascular percutaneous interventions have significantly improved the treatment of various vascular diseases. Medical devices like stents and vascular grafts have become a preferred treatment option. However, the surgical recanalization procedure remains the most suitable treatment option for many patients with vascular diseases. Annually, millions of patients worldwide are treated with revascularization surgeries to restore blood flow due to atherosclerosis in the coronary artery, hemodialysis access, arteriovenous fistulas, and carotid artery stenosis [1]. It was estimated that annually two million or more coronary and non-coronary bypasses were performed annually in the U.S.A. and EU [2].
Device profile of the tack endovascular system® for the treatment of peripheral arterial disease: overview of safety and efficacy
Published in Expert Review of Medical Devices, 2021
Mark Vanderland, Yinn Shaung Ooi, William A. Gray
Approximately 6.5 million people over the age of 40 suffer from PAD in the United States of America [1] and it is estimated that PAD effects over 200 million people worldwide [2]. The incidence of PAD is expected to increase over time as a result of the aging population and the diabetic pandemic. The signs and symptoms of PAD are variable and can range from asymptomatic to lifestyle limiting claudication. A minority of these patients progress to critical limb ischemia, with devasting results. The management of PAD is complex and involves a multimodal approach including risk factor modification, medical therapy, supervised exercise therapy, endovascular intervention and surgical revascularization. Risk factor modification consists of smoking cessation and aggressive glucose control in diabetic patients with PAD [3]. Current guidelines recommend antiplatelet therapy, statin therapy, and blood pressure control to reduce the risk of myocardial infarction, stroke and vascular death in patients with symptomatic PAD. Cilostazol can be used in patients with claudication to improve symptoms and increase total walking distance. Supervised exercise programs are an important part of care for patients with PAD and have been shown to improve functional status, quality of life, and reduce claudication. Revascularization is usually considered when patients continue to suffer from claudication despite these more conservative measures. Since only a minority of patients with refractory claudication will go on to develop critical limb ischemia, the goal of revascularization in these patients is not limb salvage but rather to improve symptoms and functional status. Several revascularization strategies may be utilized in isolation or in combination with one another, including surgical revascularization and endovascular intervention with either stenting or balloon angioplasty.