Targeted delivery for treatments for restenosis and vein graft disease

Surgery to restore blood flow in arteries blocked by atherosclerotic plaque is a common treatment in cardiovascular disease. Longterm
complications of surgical treatment are vein graft disease and restenosis, a renarrowing of the blood vessel after bypass
or removal of the culprit atherosclerotic plaque. Attempts to prevent or treat these complications by systemic pharmacological
approaches have been largely unsuccessful in the clinic. This has led to an interest in developing targeted or locally delivered
strategies. This paper discusses many of the various site-delivered therapies that are under examination as potential antirestenotic
and antivein graft disease agents (including antithrombotic, antiproliferative, and anti-inflammatory agents) and why many
therapies developed in animal models fail in clinical trials. Techniques of targeted delivery (including stents, “magic bullets,” and
adventitial delivery) and delivery systems (including nanoparticles and the use of gene therapy) are also discussed.