Faculty Collaboration Database

Endoluminal Atherosclerotic Plaque Debulking Using Enzymatic and Ultrasonic Energy. J Surg Res 2019 Jan;233:335-344

Date

12/07/2018

Pubmed ID

30502268

DOI

10.1016/j.jss.2018.08.012

Scopus ID

2-s2.0-85052943603 (requires institutional sign-in at Scopus site)

Abstract

BACKGROUND: Current procedures to treat severe atherosclerosis are traumatic to the arterial wall and often result in restenosis due to neointimal hyperplasia. We developed a novel therapy using a specially designed double occlusion balloon catheter, ultrasonic wire, and enzymatic digestion solution to atraumatically debulk atherosclerotic plaques.

MATERIALS AND METHODS: A combination of different enzymes, chemicals, and treatment conditions were evaluated for its effect at reducing atherosclerotic plaque harvested from human carotid artery endarterectomies ex vivo. The optimized digestion solution was examined in harvested intact human superficial femoral arteries in situ. A conventional Yorkshire/Landrace and a genetically modified Yucatan minipig homozygous for a nonfunctional LDLR mutation were used to evaluate the endovascular therapy in nonatherosclerotic and atherosclerotic environments in vivo.

RESULTS: Ex vivo, the technology successfully digested human carotid artery plaques by 75%. In situ, the therapy successfully reduced plaque area in harvested superficial femoral arteries by 46%. In vivo, the endovascular therapy was technically feasible and demonstrated initial safety with no thrombosis, dissection, or aneurysmal dilatation in a nonatherosclerotic porcine model. In an atherosclerotic porcine model, the therapy demonstrated initial efficacy by successfully reducing atherosclerotic plaque while preserving the arterial wall with an intact internal elastic lamina.

CONCLUSIONS: Using human plaque, human artery, and a normal and atherosclerotic pig model, we demonstrated that delivery of our therapy to the vasculature is technically feasible, appears safe, and shows initial efficacy. Our percutaneous plaque debulking method is a unique and promising therapy for the treatment of atherosclerosis and warrants further study.

Author List

Wang Z, Mansukhani NA, Emond ZM, Varu VN, Chen A, Morgan CE, Vercammen JM, Kibbe MR

MESH terms used to index this publication - Major topics in bold

Angioplasty, Balloon
Animals
Animals, Genetically Modified
Atherosclerosis
Carotid Arteries
Diet, High-Fat
Disease Models, Animal
Feasibility Studies
Femoral Artery
Humans
Hydrolases
Iliac Artery
Male
Plaque, Atherosclerotic
Receptors, LDL
Swine
Swine, Miniature
Treatment Outcome
Ultrasonic Therapy