Nanomedicine and the Treatment of Coronary In-Stent Restenosis - A Clinical Review

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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.