Safety and pharmacokinetics of sirolimus-eluting stents in the canine cerebral vasculature: 180 Day assessment

Elad I. Levy, Ricardo A. Hanel, Fermin O. Tio, David S. Garlick, Lynn Bailey, Mark R. Cunningham, Clark Williard, Darren Sherman, John F. Dooley, Gregory A. Kopia

Research output: Contribution to journalArticlepeer-review

14 Scopus citations

Abstract

OBJECTIVE: We evaluated local and systemic pharmacokinetics and pharmacodynamics of sirolimus-eluting stents (SES) in canine cerebral vessels. METHODS: SES (1.5 x 8 mm, 79 μg/479 μg sirolimus) and control stents (1.5 x 8 mm stainless steel with or without polymer) were implanted in canine basilar and ventral spinal arteries. Animals were sacrificed for local pharmacokinetic (36 animals at 1, 3, 8, 30, 90, 180 days) and pharmacodynamic (60 animals at 3, 30, 90, 180 days) assessment. RESULTS: Postrecovery adverse clinical events were not serious, requiring no unscheduled treatment. Histologically, brain and spinal cord sections revealed scattered microinfarcts and minimal gliosis consistent with postprocedure changes in all four stent-treatment groups. All stented vessels at all time points demonstrated good luminal patency with low injury and inflammation scores and no thrombosis of either stented or branch arteries. Endothelialization was complete in all stent groups by 30 days. Intimal smooth muscle cell scores were reduced in both SES groups at 30, 90, and 180 days. Systemic sirolimus levels peaked between 1 and 7 hours postimplant (maximum concentration, 1.2 ± 1.47, 79 μg; 4.5 ± 1.23 ng/ml, 479 μg), then declined rapidly to 1 ng/ml or less by 96 hours. Peak local tissue sirolimus levels were 41.5 ng/mg (79 μg) and 65 ng/mg (479 μg). CONCLUSION: SES in canine cerebral vessels were associated with good luminal patency to 180 days, with complete endothelialization and no evidence of acute thrombosis. This model has shown that SES deployed within the brain do not cause neurotoxicity during a 180-day time course, even when exaggerated doses are used. The findings support the contention that SES are safe to use and maintain patency in cerebral vessels.

Original languageEnglish (US)
Pages (from-to)925-933
Number of pages9
JournalNeurosurgery
Volume59
Issue number4
DOIs
StatePublished - Oct 2006
Externally publishedYes

Keywords

  • Angioplasty
  • Arteries (cerebral)
  • Pharmacology
  • Revascularization
  • Stents

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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