Local drug delivery: Current applications

Catheter-based treatment of coronary artery disease has historically been based on expansion or ablating vessels. Only in the last 3 years have we had devices that allow us to choose the location to apply agents directly onto or into the arterial wall. Previous trials of pharmaceutical agents in humans have failed despite animal trials showing efficacy. These agents were given in high systemic doses of drugs that may have toxic side effects with minimal effect at the site of arterial injury. Percutaneous interventions are still limited by our need to treat thrombus, alter or passivate the arterial wall, and deliver new treatments into or through the arterial wall. This review discusses the current designs of delivery catheters, ongoing trials of locally delivered agents and gene therapy. The limits of our current understanding of delivery location and efficiency as well as future investigations are also discussed.