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(Circulation. 1995;92:2299-2305.)
© 1995 American Heart Association, Inc.

Articles

Intramural Delivery of Agent via a Novel Drug-Delivery Sleeve

Histological and Functional Evaluation

Alvaro Moura, MD; Jules Y.T. Lam, MD; Daniel Hébert; James R. Kermode; Gordon W. Grant; Danielle Robitaille, MD; Enrique J. Klein, PhD; Paul G. Yock, MD; John B. Simpson, PhD, MD; Aaron V. Kaplan, MD

From the Montreal Heart Institute (A.M., J.Y.T.L., D.H., D.R.), Montreal, Canada; Cardiac Catheterization Laboratory (A.V.K.), Palo Alto Veterans Administration Hospital, Palo Alto, Calif; Division of Cardiovascular Medicine (P.G.Y., A.V.K.), Stanford University School of Medicine, Stanford, Calif; LocalMed, Inc (J.R.K., G.W.G., E.J.K., J.B.S., A.V.K.), Palo Alto, Calif; and the Department of Medicine (J.B.S.), Sequoia Hospital, Redwood City, Calif.

Correspondence to Aaron V. Kaplan, MD, 1820 Embarcadero Rd, Palo Alto, CA 94303.

Background The infusion sleeve is a novel drug-delivery catheter system designed to deliver an agent under controlled conditions into the arterial wall at the site of angioplasty. The purpose of the present study was to characterize the delivery agent via the infusion sleeve in ex vivo and in vivo models.

Methods and Results The delivery of horseradish peroxidase via the infusion sleeve was studied in a porcine explanted heart model. Under physiological conditions, arteries underwent balloon injury (10% overstretch), after which horseradish peroxidase (2.5 mL) was delivered at specific pressures. Cross-sectional analysis demonstrated greater staining when the agent was delivered at increasing pressures. The infusion sleeve was evaluated in an in vivo canine coronary model. With an infusion sleeve loaded over a standard dilatation catheter through a 9F guide, overstretch balloon injury was performed, after which fluoresceinated heparin was delivered. Animals were killed 2 hours after delivery. Fluoresceinated heparin–treated segments demonstrated high fluorescence signals, localizing with smooth muscle cell nuclei with less activity in the interstitium. The functional significance of intramural heparin delivery was studied in a porcine carotid model. In the presence of ¹¹¹In-labeled platelets, arteries underwent overstretch injury followed by delivery of heparin (50 or 100 units/kg) or vehicle. Platelet deposition was reduced at 30 minutes (57%, P<.01) and 12 hours (39%, P=.06) compared with saline controls.

Conclusions Agent delivery via the infusion sleeve is pressure dependent; transmural delivery is possible with minimal disruption of arterial wall architecture; the infusion sleeve is compatible with standard angioplasty equipment; and heparin delivery at the site of balloon injury significantly reduces platelet deposition in a porcine model for a minimum of 12 hours.

Key Words: angioplasty • restenosis • drug delivery system

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