From endovascular therapy to perivascular therapy: A new concept and perspective
6 affiliations
- 1Center of Interventional Radiology & Vascular Surgery, Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, 210009, China
- 2Department of Cardiology of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310009, China; Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310058, China; State Key Laboratory of Transvascular Implantation Devices, Hangzhou, 310013, China
- 3Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Clinical Center for Coronary Heart Disease, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
- 4Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
- 5Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Basic and Translational Medicine Center, China National Clinical Research Center for Neurological Diseases, Beijing, China; Collaborative Innovation Center, Beijing Institute of Brain Disorders, Beijing, 100070, China
- 6Center of Interventional Radiology & Vascular Surgery, Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, 210009, China; Corresponding author.
Abstract
The cardiovascular system relies on an organ-spanning vascular network not only for transport but also for systemic homeostatic control. Surrounding the vessel wall is a complex perivascular microenvironment, including the vasa vasorum, autonomic and sensory nerves, perivascular adipose tissue, and lymphatics, which together constitute a neuro–immune–metabolic interface with regulatory reach far beyond hemodynamics. The close apposition and shared microanatomy of these components enable the coordinated control of vascular tone, remodeling, inflammation, tissue clearance, and organ function, creating a rich, multi-component therapeutic target space and access corridor for endovascular and extravascular interventions across cardiovascular and selected cardiometabolic disorders. However, therapies framed around a single nominal target often perturb multiple perivascular components, complicating mechanism attribution and contributing to heterogeneous responses. Emphasizing the perivascular microenvironment as an integrated domain makes whole-domain effects an important consideration, thereby forcing a clearer disentanglement of component-specific functions and treatment-linked adaptations. This whole-domain perspective underpins the concept of perivascular therapy and emphasizes the integration and co-development of device-based interventions and local drug-delivery strategies that target this microenvironment. Here, we synthesized the perivascular anatomy and physiology, surveyed established and emerging interventions, and outlined a roadmap integrating real-time imaging and mapping, targeted modulation, sensing-guided titration, and closed-loop control to enable precise, minimally invasive therapies targeting the perivascular microenvironment.
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BibTeX
@article{wang2026from,
title = {{From endovascular therapy to perivascular therapy: A new concept and perspective}},
author = {Zhi Wang and Peng Shi and Yu-Jie Zhou and Wei Guo and Yong Cao and Shijie Mao and Gao-Jun Teng},
journal = {EngMedicine},
year = {2026},
month = oct,
doi = {10.1016/j.engmed.2026.100164},
url = {https://doi.org/10.1016/j.engmed.2026.100164},
note = {CC BY},
}
RIS
TY - JOUR
TI - From endovascular therapy to perivascular therapy: A new concept and perspective
AU - Zhi Wang
AU - Peng Shi
AU - Yu-Jie Zhou
AU - Wei Guo
AU - Yong Cao
AU - Shijie Mao
AU - Gao-Jun Teng
PY - 2026
DA - 2026/10/30
JO - EngMedicine
DO - 10.1016/j.engmed.2026.100164
UR - https://doi.org/10.1016/j.engmed.2026.100164
AB - The cardiovascular system relies on an organ-spanning vascular network not only for transport but also for systemic homeostatic control. Surrounding the vessel wall is a complex perivascular microenvironment, including the vasa vasorum, autonomic and sensory nerves, perivascular adipose tissue, and lymphatics, which together constitute a neuro–immune–metabolic interface with regulatory reach far beyond hemodynamics. The close apposition and shared microanatomy of these components enable the coordinated control of vascular tone, remodeling, inflammation, tissue clearance, and organ function, creating a rich, multi-component therapeutic target space and access corridor for endovascular and extravascular interventions across cardiovascular and selected cardiometabolic disorders. However, therapies framed around a single nominal target often perturb multiple perivascular components, complicating mechanism attribution and contributing to heterogeneous responses. Emphasizing the perivascular microenvironment as an integrated domain makes whole-domain effects an important consideration, thereby forcing a clearer disentanglement of component-specific functions and treatment-linked adaptations. This whole-domain perspective underpins the concept of perivascular therapy and emphasizes the integration and co-development of device-based interventions and local drug-delivery strategies that target this microenvironment. Here, we synthesized the perivascular anatomy and physiology, surveyed established and emerging interventions, and outlined a roadmap integrating real-time imaging and mapping, targeted modulation, sensing-guided titration, and closed-loop control to enable precise, minimally invasive therapies targeting the perivascular microenvironment.
SN - 2950-4899
ER -