Local insulin application on the carotid artery inhibits neointima formation

2013 ◽  
Vol 91 (12) ◽  
pp. 1086-1094 ◽  
Author(s):  
Simon Chiang ◽  
Danna M. Breen ◽  
June Guo ◽  
Yusaku Mori ◽  
Adria Giacca
Keyword(s):  
Carotid Artery ◽  
Insulin Treatment ◽  
Arterial Injury ◽  
Drug Eluting Stents ◽  
Late Stent Thrombosis ◽  
Vascular Effect ◽  
Smooth Muscle Cell Migration ◽  
Drug Eluting ◽  
New Treatments

Anti-mitogenic agents currently used to prevent restenosis in drug-eluting stents delay re-endothelialization. Delayed re-endothelialization is now considered as the main cause of late stent thrombosis with drug-eluting stents, which emphasizes the need for new treatments. We have shown that systemic insulin treatment decreases neointimal growth and accelerates re-endothelialization after arterial injury in a rat model of restenosis. However, systemic insulin treatment cannot be given to non-diabetic individuals because of the risk of hypoglycemia. Thus, we investigated whether local insulin treatment is also effective in reducing neointimal growth after arterial injury. Rats were given local vehicle or local insulin delivered via Pluronic gel applied around the carotid artery immediately following balloon injury. Plasma glucose and systemic insulin levels were not affected by local insulin treatment. Insulin decreased intimal area at 28 days (P < 0.05) and also inhibited vascular smooth muscle cell migration by 60% at 4 days (P < 0.05). NPH (a longer-lasting insulin) also decreased neointimal area. These results indicate that local insulin treatment can lead to decreased restenosis, suggesting a protective vascular effect of insulin in vivo and that local insulin treatment, possibly via insulin-eluting stents, may be clinically relevant.

In Vivo Evaluation of the Synergic Effect of Metformin and mTOR Inhibitors on the Endothelial Healing of Drug-eluting Stents in Diabetic Patients

2018 ◽  
Vol 71 (11) ◽  
pp. 917-925
Author(s):  
Héctor Cubero-Gallego ◽  
Rafael Romaguera ◽  
Josep Gómez-Lara ◽  
Joan A. Gómez-Hospital ◽  
Manel Sabaté ◽  
...  
Keyword(s):  
Mtor Inhibitors ◽  
Drug Eluting Stents ◽  
Diabetic Patients ◽  
Synergic Effect ◽  
In Vivo Evaluation ◽  
Drug Eluting

Dynamics of Arterial Wall Transport for Small Hydrophobic Drugs

2012 ◽  
Author(s):  
Franz Bozsak ◽  
Jean-Marc Chomaz ◽  
Abdul I. Barakat
Keyword(s):  
Smooth Muscle ◽  
Stent Implantation ◽  
Side Effect ◽  
Arterial Wall ◽  
Drug Eluting Stents ◽  
Adverse Side Effect ◽  
Late Stent Thrombosis ◽  
Increased Risk ◽  
Drug Eluting ◽  
Small Hydrophobic

Drugs used in drug-eluting stents (DES) to inhibit proliferation of smooth muscle cells (SMCs) also limit re-endothelialization at the site of stent implantation [1]. Thus, treated patients face an increased risk of late-stent thrombosis. Avoiding this adverse side effect represents one of the major challenges in the design of next-generation DES.

Drug-Eluting Stents Ameliorate Pulmonary Vein Stenotic Changes in Pigs In Vivo

2010 ◽  
Vol 31 (6) ◽  
pp. 773-779 ◽  
Author(s):  
Takeshi Furukawa ◽  
Masahiko Kishiro ◽  
Hideo Fukunaga ◽  
Masahiro Ohtsuki ◽  
Ken Takahashi ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Drug Eluting Stents ◽  
Drug Eluting

Abstract 11542: Prognostic Significance of Insulin Treatment and Glucose Control Status on Clinical Cardiovascular Outcomes in Diabetic Patients Who Underwent Elective PCI Using Drug-Eluting Stents

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ayako Kunimura ◽  
Tadayuki Uetani ◽  
Takashi Kataoka ◽  
Masataka Takeshita ◽  
Kazuhiro Harada ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Confidence Interval ◽  
Insulin Treatment ◽  
Coronary Intervention ◽  
Treated Group ◽  
The Other ◽  
Drug Eluting Stents ◽  
Diabetic Patients ◽  
Drug Eluting ◽  
Fatal Myocardial Infarction

Background: The aim of this study was to evaluate prognostic impact of insulin treatment and glucose control status on cardiovascular outcomes in diabetic patients after elective coronary intervention using drug-eluting stents (DES). Methods: A total of 198 consecutive diabetic patients undergoing elective percutaneous coronary intervention (PCI) with DES in Chubu Rosai Hospital from October 2005 to March 2008 were enrolled. The median HbA1c value of the patients was 7.5%. Patients were divided into four groups based on the presence or absence of insulin treatment and the HbA1c value at baseline (<7.5% or ≧7.5%). The endpoint of this study was major adverse cardiac event (MACE) defined as the composite of cardiovascular death, non-fatal myocardial infarction and any revascularization. Results: During the median follow-up of 1454 days, total 87 events occurred. MACE occurred more frequently in insulin-treated group with HbA1c<7.5% (78.9%) than in the other groups (log-rank p < 0.0001). The incidence of cardiac death or non-fatal myocardial infarction (p=0.022) and any revascularization (p=0.025) were significantly increased in insulin-treated group with HbA1c<7.5% than the other groups. In cox analysis, after adjustment for conventional risk factors (age, sex, body mass index, smoking status, hypertention, dyslipidemia) and duration of diabetes, fasting blood glucose, hemodialysis, the hazard ratio for MACE relative to non-insulin-treated group with HbA1c<7.5% was 2.91 (95% confidence interval 1.09 - 7.81, p = 0.034) in insulin-treated group with HbA1c<7.5%. Compared with insulin-treated group with HbA1c≧7.5%, the hazard ratio was 3.83 (95% confidence interval 1.01 - 14.54, p = 0.049) in insulin-treated group with HbA1c<7.5%. Conclusion: Insulin treatment with lower HbA1c value was proven to be an independent predictor of MACE in diabetic patients after PCI using DES.

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