Nanomedicine and the Treatment of Coronary In-Stent Restenosis - A Clinical Review
Pp. 32-42 (11)
Coronary in-stent restenosis remains a significant limitation to the long term efficacy of
coronary artery stent placement. In this Chapter the author reviews the pathophysiology of coronary instent
restenosis, together with an overview of the current treatment modalities. The potential for the use
of nanotechnology is also reviewed.
The first human safety trial of systemic nanoparticle paclitaxel (nab-paclitaxel) for in-stent restenosis
(SNAPIST-I) is discussed. The results showed no significant adverse advents attributable to the nabpaclitaxel
at 10 or 30 mg/m2, although moderate neutropenia, sensory neuropathy and mild to moderate
reversible alopecia occurred at higher doses. No major adverse cardiac events were recorded at 2
months, whilst at 6 months 4 target lesions required revascularisation. The investigators concluded
therefore that systemic nab-paclitaxel was well tolerated at a dose of less that 70 mg/m2. To date
however no formal clinical evaluation has been reported as to the clinical utility of nab-paclitaxel or any
of the nano preparations discussed for the suppression of coronary in-stent restenosis.
Nanoparticles; coronary in-stent restenosis; pathophysiology; treatment; animal models;
human; clinical trials; vascular disease; atherosclerosis; clinical review.
Senior Lecturer, Faculty of Health, Edge Hill University, St Helens Road, Ormskirk, Lancashire, L39 4QP, UK.