Perivascular medical devices and drug delivery systems: Making the right choices

Abstract

Perivascular medical devices and perivascular drug delivery systems are conceived for local application around a blood vessel during open vascular surgery. These systems provide mechanical support and/or pharmacological activity for the prevention of intimal hyperplasia following vessel injury. Despite abundant reports in the literature and numerous clinical trials, no efficient perivascular treatment is available. In this review, the existing perivascular medical devices and perivascular drug delivery systems, such as polymeric gels, meshes, sheaths, wraps, matrices, and metal meshes, are jointly evaluated. The key criteria for the design of an ideal perivascular system are identified. Perivascular treatments should have mechanical specifications that ensure system localization, prolonged retention and adequate vascular constriction. From the data gathered, it appears that a drug is necessary to increase the efficacy of these systems. As such, the release kinetics of pharmacological agents should match the development of the pathology. A successful perivascular system must combine these optimized pharmacological and mechanical properties to be efficient.

Employing the Sirolimus-Eluting Poly (Propylene Carbonate) Mesh for the Prevention of Arteriovenous Graft Stenosis in Rats

“…Polymers such as PLA, polyglycolide (PGA), and PLGA remain the most commonly explored vehicles for perivascular drug delivery. 26 These polymers, however, generate acidic products after degradation in vivo, which can cause aseptic inflammation and tissue necrosis. 27,28 Poly (propylene carbonate) is made by the copolymerization of carbon dioxide and propylene oxide.…”

Unimolecular Micelle-Based Hybrid System for Perivascular Drug Delivery Produces Long-Term Efficacy for Neointima Attenuation in Rats

“…2,8 We synthesized a UM and a thermosensitive triblock hydrogel, and the combination of UMs and triblock gel resulted in substantially prolonged steady rapamycin release over 4 months. The perivascular application of this hybrid system in rats produced a pronounced IH-inhibitory effect that persisted for at least 3 months, providing a foundation for further optimization.…”

“…2,9 In the past decade, various materials and platforms have been tried for perivascular drug delivery and shown efficacy in animal models, 9–16 but none has reached clinical application. 2,8,17 (Re)stenosis in humans is progressive; thus, it demands sustained drug release for treatment. Unfortunately, the majority of the animal tests on perivascular drug delivery were short-term (2–4 weeks).…”

Microfabricated Drug Delivery Devices: Design, Fabrication, and Applications

“…It can be used alone or be bonded to silicon using anodic bonding or silicone rubbers to form complex systems with different microstructures (e.g., microfluidic chips) for controlled drug delivery. [50,51] Other rigid materials such as metals, [52][53][54] ceramics, [55,56] silicon nitride, [57,58] and polycrystalline silicon [59,60] have also been used in developing various drug delivery devices. [48,49] In addition, functionalization of the porous materials with molecular, supramolecular, or polymer moieties enable fabrication of new devices with great versatility in controlled drug delivery utilizations including sustained release, targeted release, and stimuli-responsive release.…”

“…[48,49] In addition, functionalization of the porous materials with molecular, supramolecular, or polymer moieties enable fabrication of new devices with great versatility in controlled drug delivery utilizations including sustained release, targeted release, and stimuli-responsive release. [50,51] Other rigid materials such as metals, [52][53][54] ceramics, [55,56] silicon nitride, [57,58] and polycrystalline silicon [59,60] have also been used in developing various drug delivery devices.…”