Development of a novel adenosine-eluting guidewire (Adenowire) for coronary vasodilation during percutaneous coronary intervention

摘要

Aims: Microvascular obstruction (MVO) and "no-reflow phenomenon" (NRP) remain barriers to optimal tissue perfusion after percutaneous coronary intervention (PCI). The purpose of this study was to develop, characterise, and test an adenosine-eluting guidewire (Adenowire) for coronary vasodilation. Methods and results: Utilising polyurethane chemistry, we developed a non-toxic pentameric form of adenosine (PA) that can be coated onto guidewires (Adenowire) and that allows continuous elution of adenosine into the distal vascular bed during PCI. We characterised PA with Fourier transform infrared spectroscopy, NMR and MALDI time-of-flight mass spectrometry, established its stability by calorimetry, and confirmed its safety by extensive toxicological testing. Adenowires reliably released adenosine in vitro over 60 minutes. In pigs, insertion of an Adenowire into the left circumflex or left anterior descending coronary artery resulted in immediate and sustained (40 minutes) vasodilation. Electron microscopy demonstrated smooth thin coating of the terminal portion of guidewires and showed lack of fibrin or platelet adhesion to the Adenowire after in vivo use. Conclusions: Since guidewires are the first devices to cross a culprit lesion, Adenowires would prophylactically medicate vascular beds with adenosine at the target site without the need for additional manipulations by the interventionalist.