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Biological aspects of radiation and drug-eluting stents for the prevention of restenosis

Sindermann, Jürgen R. ; Verin, Vitali ; Hopewell, John W. ; Rodemann, Hans Peter ; Hendry, Jolyon H.

In: Cardiovascular Research, 2004, vol. 63, no. 1, p. 22-30

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    Titre
    • Biological aspects of radiation and drug-eluting stents for the prevention of restenosis
    Auteur
    • Sindermann, Jürgen R.. Department of Cardiology and Angiology, and Institute for Arteriosclerosis Research, University of Münster, Münster, Germany
    • Verin, Vitali. Cardiology Center, University Hospital, Geneva, Switzerland
    • Hopewell, John W.. Department of Clinical Oncology, The Churchill Hospital, Oxford, UK
    • Rodemann, Hans Peter. Section of Radiobiology and Molecular Environmental Research, Dept. of Radiation Oncology, Eberhard-Karls University, Tübingen, Germany
    • Hendry, Jolyon H.. Applied Radiobiology and Radiotherapy Section, Division of Human Health, International Atomic Energy Agency, Wagramer Strasse 5, PO Box 100, A-1400, Vienna 48149, Austria
    Type de document
    • Postprint
    Identifiant OAI-PMH
    • oai:doc.rero.ch:292860
    Summary
    Based on recent advances, this article aims to review the biological basis for the use of either radiation or drug-eluting stents for the prevention of restenosis, and to elucidate the complementary role that they may play in the future. Vascular restenosis is a multifactorial process primarily driven by the remodeling of the arterial wall, as well as by the hyperproliferation of smooth muscle cells (SMC). These pathophysiological features are the target of therapeutic strategies aimed at inhibiting constrictive remodeling as well as inhibiting SMC proliferation. The success of radiation as well as anti-proliferative drugs such as paclitaxel and sirolimus lies in the primary and/or multifactorial inhibition of cell proliferation. Radiation has the additional feature of preventing constrictive remodeling while sirolimus has the potential property of being anti-inflammatory, which may be a desirable feature. The effects of radiation are not reliant on any uptake and "metabolism” by the target cells, as in the case with drugs, and thus radiation potentially may be more effective as a result of its more-direct action. However, radiation does have some significant drawbacks compared to drug-eluting stents, including a much delayed re-endothelialization resulting in the need for prolonged anti-platelet therapy. Based on recent clinical data, drug-eluting stents have been shown to markedly reduce the likelihood of restenosis, which actually favors this approach for the prevention of restenosis. From a biological perspective, drug-eluting stents and radiation have certain differences, which are reviewed in this article