Introduction: Novel strategies to stabilize the arterial bed at the time of stent placement may negate long-term antiplatelet regimens while improving peri-stent atheroma stabilization.
Hypothesis: Local treatment with nitric oxide-loaded echogenic liposomes (NO-ELIP) followed by targeted anti-inflammatory therapeutic Rosiglitazone-loaded liposomes (anti-ICAM-1-RGN-ELIP) stabilizes and protects the stented arterial segment by decreasing stent-induced vasospasm and inhibiting persistent neointimal hyperplasia. Combining ELIP delivery with intra-arterial therapeutic ultrasound (EKOS EndoSonic®) enhances therapeutic delivery and arterial stabilization.
Methods: Percutaneous balloon denudation and an atherogenic diet were used to induce atherosclerosis in 9 Yucatan miniswine arteries. Bare metal stents were deployed in 7 denuded arteries. Intravascular ultrasound (IVUS) was performed before and after stent deployment. Arteries were randomized to receive NO-ELIP + anti-ICAM-1-RGN-ELIP with or without ultrasound. The EKOS EndoSonic® intra-arterial therapeutic ultrasound catheter was used to induce site-specific therapeutic delivery and optimal payload release from ELIP. Eight weeks after treatment, IVUS was performed in the stented arteries and compared with histological analysis of total lesion area.
Results: Ultrasound facilitated delivery of NO and RGN resulted in a greater reduction in neointima formation in the stented arteries than without ultrasound treatment as determined by histological analysis and IVUS quantitation.
Conclusions: This novel strategy allows therapeutic stabilization of the arterial bed at the time of stent therapy, potentially affecting a large portion of the arterial bed while providing an alternative strategy to treat the inflammatory atheroma components irrespective of the type of stent placed.