Gerard H. Llanos

Twenty-eight-day efficacy and phamacokinetics of the sirolimus-eluting stent.

BackgroundIn-stent restenosis is caused by neointimal hyperplasia. Sirolimus (rapamycin; Wyeth Research, Radnor, Pennsylvania, USA) inhibits vascular smooth muscle cell proliferation and we evaluated the efficacy of sirolimus in reducing neointimal formation in a rabbit iliac model and in-vivo pharmacokinetics in the porcine coronary model. DesignRandomized, blinded, prospective animal study. MethodsBilateral rabbit iliac artery stent implantation was performed using crossflex stents (Cordis Corporation, Warren, New Jersey, USA) coated with sirolimus incorporated in a nonerodable polymer. Arteries were randomized to one of four stent groups: uncoated stents (n  = 8); polymer control stents (n  = 10); low-dose sirolimus-eluting stents (n  = 9); and high-dose sirolimus-eluting stents (n  = 10). Histomorphometry was performed at 28 days. Arterial tissue and stents were retrieved at 8, 14 and 28 days and blood samples were obtained daily during the first week. ResultsTreatment with low-dose sirolimus was associated with a 23% (P  = NS) reduction in neointimal area and treatment with high-dose sirolimus with a 45% (P  < 0.05) reduction. Sustained drug release from the stent and prolonged intramural arterial deposition were confirmed for up to 28 days. No detectable sirolimus was found in the blood after 2 days. ConclusionControlled-release local delivery of a cell-cycle inhibitor from a nonerodable polymer-coated stent reduced neointimal formation in rabbit iliac arteries in a dose-dependent manner and represents a promising strategy for preventing restenosis.