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Felbel D, Bozic F, Mayer B, Krohn-Grimberghe M, Paukovitsch M, d’Almeida S, Mörike J, Gonska B, Imhof A, Buckert D, Rottbauer W, Markovic S, Stephan T. Drug-coated balloon: an effective alternative to stent strategy in small-vessel coronary artery disease-a meta-analysis. Front Cardiovasc Med 2023; 10:1213992. [PMID: 37671137 PMCID: PMC10475729 DOI: 10.3389/fcvm.2023.1213992] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/31/2023] [Indexed: 09/07/2023] Open
Abstract
Background Small-vessel coronary artery disease (CAD) is frequently observed in coronary angiography and linked to a higher risk of lesion failure and restenosis. Currently, treatment of small vessels is not standardized while having drug-eluting stents (DES) or drug-coated balloons (DCBs) as possible strategies. We aimed to conduct a meta-analytic approach to assess the effectiveness of treatment strategies and outcomes for small-vessel CAD. Methods Comprehensive literature search was conducted using PubMed, Embase, MEDLINE, and Cochrane Library databases to identify studies reporting treatment strategies of small-vessel CAD with a reference diameter of ≤3.0 mm. Target lesion revascularization (TLR), target lesion thrombosis, all-cause death, myocardial infarction (MI), and major adverse cardiac events (MACE) were defined as clinical outcomes. Outcomes from single-arm and randomized studies based on measures by means of their corresponding 95% confidence intervals (CI) were compared using a meta-analytic approach. Statistical significance was assumed if CIs did not overlap. Results Thirty-seven eligible studies with a total of 31,835 patients with small-vessel CAD were included in the present analysis. Among those, 28,147 patients were treated with DES (24 studies) and 3,299 patients with DCB (18 studies). Common baseline characteristics were equally distributed in the different studies. TLR rate was 4% in both treatment strategies [0.04; 95% CI 0.03-0.05 (DES) vs. 0.03-0.07 (DCB)]. MI occurred in 3% of patients receiving DES and in 2% treated with DCB [0.03 (0.02-0.04) vs. 0.02 (0.01-0.03)]. All-cause mortality was 3% in the DES group [0.03 (0.02-0.05)] compared with 1% in the DCB group [0.01 (0.00-0.03)]. Approximately 9% of patients with DES developed MACE vs. 4% of patients with DCB [0.09 (0.07-0.10) vs. 0.04 (0.02-0.08)]. Meta-regression analysis did not show a significant impact of reference vessel diameter on outcomes. Conclusion This large meta-analytic approach demonstrates similar clinical and angiographic results between treatment strategies with DES and DCB in small-vessel CAD. Therefore, DES may be waived in small coronary arteries when PCI is performed with DCB.
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Affiliation(s)
- Dominik Felbel
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Filip Bozic
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Benjamin Mayer
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Marvin Krohn-Grimberghe
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Michael Paukovitsch
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Sascha d’Almeida
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Johannes Mörike
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Birgid Gonska
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Armin Imhof
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Dominik Buckert
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Wolfgang Rottbauer
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Sinisa Markovic
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Tilman Stephan
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
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Nakamura H, Ishikawa T, Mizutani Y, Yamada K, Ukaji T, Kondo Y, Shimura M, Aoki H, Hisauchi I, Itabashi Y, Nakahara S, Kobayashi S, Taguchi I. Clinical and Angiographic Outcomes of Elective Paclitaxel-Coated Balloon Angioplasty in Comparison with Drug-Eluting Stents for De Novo Coronary Lesions in Large Vessels. Int Heart J 2023; 64:145-153. [PMID: 37005310 DOI: 10.1536/ihj.22-498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
We retrospectively examined the feasibility of paclitaxel-coated balloon (PCB) angioplasty for de novo stenosis in large coronary vessels (LV; pre- or postprocedural reference vessel diameter ≥ 2.75 mm) in comparison with placement of drug-eluting stents (DESs).Consecutive de novo stenotic lesions in the LV electively and successfully treated with either PCB (n = 73) or DESs (n = 81) from January 2016 to December 2018 at our center were included. The primary endpoint was the incidence of target lesion failure (TLF), including cardiac death, nonfatal myocardial infarction, and target vessel revascularization. The impact of PCB on TLF was examined using Cox proportional hazards models by including 39 variables. The secondary endpoint, angiographic restenosis, defined as a follow-up percent diameter stenosis > 50, was examined in angiographic follow-up lesions after PCB angioplasty (n = 56) and DES placement (n = 53). This retrospective investigation was conducted in July 2022.The mean PCB size and length were 3.23 ± 0.42 and 18.4 ± 4.3 mm, respectively. The TLF frequency in the PCB group (6.8% during the mean observational interval of 1536 ± 538 days) was not significantly different from that in the DES group (14.6%, 1344 ± 606 days, P = 0.097). PCB was not a significant predictor of TLF in the univariate analysis (hazard ratio: 0.424; 95%CI: 0.15-1.21; P = 0.108). There was no angiographic restenosis after PCB angioplasty.The present observational single-center study showed that PCB for de novo stenosis in the LV had no significant adverse impact on TLF and had favorable angiographic outcomes.
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Affiliation(s)
- Hidehiko Nakamura
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center
| | - Tetsuya Ishikawa
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center
| | - Yukiko Mizutani
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center
| | - Kota Yamada
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center
| | - Tomoaki Ukaji
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center
| | - Yuki Kondo
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center
| | - Masatoshi Shimura
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center
| | - Hideyuki Aoki
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center
| | - Itaru Hisauchi
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center
| | - Yuji Itabashi
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center
| | - Shiro Nakahara
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center
| | - Sayuki Kobayashi
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center
| | - Isao Taguchi
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center
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3
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Yamada K, Ishikawa T, Nakamura H, Mizutani Y, Ukaji T, Shimura M, Kondo Y, Aoki H, Hisauchi I, Itabashi Y, Nakahara S, Kobayashi S, Taguchi I. Midterm safety and efficacy of elective drug-coated balloon angioplasty in comparison to drug-eluting stents for unrestrictive de novo coronary lesions: A single center retrospective study. J Cardiol 2022; 81:537-543. [PMID: 36481299 DOI: 10.1016/j.jjcc.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/05/2022] [Accepted: 11/08/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The safety and efficacy of elective drug-coated balloon (DCB) angioplasty for unrestrictive de novo coronary stenosis in daily practice is not fully understood, especially in comparison to those of drug-eluting stents (DESs). METHODS A total of 588 consecutive de novo coronary stenotic lesions electively and successfully treated with either DCB (n = 275) or DESs (n = 313) between January 2016 and December 2019 at our medical center were included. The primary safety endpoint was the incidence of target lesion failure (TLF), comprising cardiac death, non-fatal myocardial infarction, and target vessel revascularization. The secondary angiographic efficacy endpoint was angiographic restenosis frequency, defined as a follow-up percent diameter stenosis of >50. The endpoints were compared after baseline adjustment using propensity score matching. In addition, the frequency and predictors of late lumen enlargement (LLE), defined as minus late luminal loss, were examined in 201 crude angiographic follow-up lesions after DCB angioplasty. RESULTS A total of 31 baseline parameters were adjusted to analyze 177 lesions in each group. The TLF frequencies (DCB group: 9.6 % during a mean observational interval of 789 ± 488 days vs. DES group: 10.2 %, 846 ± 484 days, p = 0.202) and cumulative TLF-free ratios of both groups were not significantly different (p = 0.892, log-rank test). The angiographic restenosis frequency in the DCB group (6.3 %, n = 128) was not significantly different from that of the DES group (10.1 %, n = 100, p = 0.593). LLE was observed in 45.3 % of entire lesions, and a type-A dissection was a significant predictor of LLE among 23 variables (odds ratio: 3.02, 95 % CI: 1.31-6.95, p = 0.010). CONCLUSIONS The present single-center retrospective study revealed statistically equivalent midterm clinical safety and angiographic efficacy among both elective DCB angioplasty and DESs placements in the treatment of unrestrictive de novo coronary lesions. In our daily practice environment, LLE was achieved in approximately half after DCB angioplasty.
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Affiliation(s)
- Kota Yamada
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Tetsuya Ishikawa
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Saitama, Japan.
| | - Hidehiko Nakamura
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Yukiko Mizutani
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Tomoaki Ukaji
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Masatoshi Shimura
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Yuki Kondo
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Hidehiko Aoki
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Itaru Hisauchi
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Yuji Itabashi
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Shiro Nakahara
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Sayuki Kobayashi
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Isao Taguchi
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Saitama, Japan
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4
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Mizutani Y, Ishikawa T, Nakamura H, Yamada K, Shimura M, Kondo Y, Ukaji T, Aoki H, Hisauchi I, Itabashi Y, Nakahara S, Taguchi I. A Propensity Score-Matched Comparison of Midterm Outcomes Between Drug-Coated Balloons and Drug-Eluting Stents for Patients with Acute Coronary Syndrome. Int Heart J 2022; 63:217-225. [DOI: 10.1536/ihj.21-576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Yukiko Mizutani
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center
| | - Tetsuya Ishikawa
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center
| | - Hidehiko Nakamura
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center
| | - Kota Yamada
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center
| | - Masatoshi Shimura
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center
| | - Yuki Kondo
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center
| | - Tomoaki Ukaji
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center
| | - Hideyuki Aoki
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center
| | - Itaru Hisauchi
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center
| | - Yuji Itabashi
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center
| | - Shiro Nakahara
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center
| | - Isao Taguchi
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center
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5
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A randomized comparison of a novel iopromide-based paclitaxel-coated balloon Shenqi versus SeQuent Please for the treatment of in-stent restenosis. Coron Artery Dis 2021; 32:526-533. [PMID: 33229940 DOI: 10.1097/mca.0000000000000994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Treatment of coronary in-stent restenosis (ISR) remains challenging in contemporary clinical applications. Drug-coated balloon (DCB) angioplasty offers an effective treatment for ISR. Shenqi is a novel iopromide-based paclitaxel-coated balloon and its clinical safety, effectiveness and angiographic efficacy in patients with ISR have not been investigated. METHODS A total of 216 subjects with the first occurrence of ISR at 11 investigational sites in China were randomly allocated in a 1:1 fashion to treatment with DCB SeQuent Please or Shenqi. Clinical follow-up was planned at 1, 6, 9 and 12 months, and angiographic follow-up was planned at 9 months. The study was powered for the primary endpoint of 9-month in-segment late loss. RESULTS At 9-month follow-up, the in-segment late loss was 0.29 ± 0.43 mm with Shenqi versus 0.30 ± 0.46 mm with SeQuent Please, and the one-sided 97.5% upper confidence limit of the difference was 0.14 mm, achieving noninferiority of Shenqi compared with SeQuent Please (P = 0.002). In total, 12 patients developed target lesion failure (TLF) in the Shenqi group compared with 16 patients in the SeQuent Please group (10.91% versus 15.09%; P = 0.42) within 1 year. TLF was mainly driven by target lesion revascularization (9.09%) followed by target vessel-related myocardial infarction (1.82%) and cardiovascular death (0.91%) in the Shenqi group. CONCLUSIONS Shenqi DCB was noninferior to SeQuent Please DCB for the primary endpoint of 9-month in-segment late loss. Shenqi DCB may become an attractive alternative treatment for patients with coronary ISR, withholding the need for additional stent implantation.
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6
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Sogabe K, Koide M, Fukui K, Kato Y, Kitajima H, Akabame S, Zen K, Nakamura T, Matoba S. Optical coherence tomography analysis of late lumen enlargement after paclitaxel-coated balloon angioplasty for de-novo coronary artery disease. Catheter Cardiovasc Interv 2021; 98:E35-E42. [PMID: 33369836 DOI: 10.1002/ccd.29435] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/05/2020] [Accepted: 11/29/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Paclitaxel-coated balloon angioplasty for de-novo coronary artery lesions causes late lumen enlargement (LLE), however, the mechanisms and predictors of LLE have not been elucidated. METHODS AND RESULTS We retrospectively analyzed 91 consecutive patients with 95 de-novo coronary lesions, who underwent paclitaxel-coated balloon angioplasty without stenting from August 2018 to July 2019 as well as follow-up coronary angiography and optical coherence tomography (OCT). The mean follow-up duration was 8.2 ± 2.9 months. The target lesion revascularization rate was 7.3%. OCT demonstrated LLE in 50.5% of lesions. The lesions with LLE had a higher incidence of vessel enlargement (76.6 vs. 29.2%, p < .01), regression of plaque or dissection flap (55.3 vs. 10.4%, p < 0.01; 40.4 vs. 14.6%, p < .01, respectively), and reattachment and healing of dissection flaps (74.5 vs. 27.1%, p < .01) compared with those without LLE. Preprocedure thick-cap fibroatheroma plaques and postprocedure deep dissection reaching the tunica media were positive predictors of LLE (hazard ratio, HR 3.74 [1.93-7.25], p < .001; HR 2.04 [1.02-4.05], p < .05, respectively). CONCLUSIONS OCT analysis after paclitaxel-coated balloon treatment of de-novo coronary artery lesions revealed that the mechanism of LLE was associated with vessel enlargement, healing of dissection flaps, and regression of plaque or dissection flap. Preprocedure thick-cap fibroatheroma plaques and postprocedure deep dissection reaching the tunica media on OCT were predictors of LLE.
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Affiliation(s)
- Koji Sogabe
- Department of Cardiovascular Medicine, Kyoto Okamoto Memorial Hospital, Kyoto, Japan.,Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masahiro Koide
- Department of Cardiovascular Medicine, Kyoto Okamoto Memorial Hospital, Kyoto, Japan
| | - Kento Fukui
- Department of Cardiovascular Medicine, Kyoto Okamoto Memorial Hospital, Kyoto, Japan
| | - Yukinori Kato
- Department of Cardiovascular Medicine, Kyoto Okamoto Memorial Hospital, Kyoto, Japan.,Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroki Kitajima
- Department of Cardiovascular Medicine, Kyoto Okamoto Memorial Hospital, Kyoto, Japan
| | - Satoshi Akabame
- Department of Cardiovascular Medicine, Kyoto Okamoto Memorial Hospital, Kyoto, Japan
| | - Kan Zen
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takeshi Nakamura
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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7
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Cut-off values of lesion and vessel quantitative flow ratio in de novo coronary lesion post-drug-coated balloon therapy predicting vessel restenosis at mid-term follow-up. Chin Med J (Engl) 2021; 134:1450-1456. [PMID: 34091522 PMCID: PMC8213272 DOI: 10.1097/cm9.0000000000001577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Drug-coated balloons (DCBs) have emerged as potential alternatives to drug-eluting stents in specific lesion subsets for de novo coronary lesions. Quantitative flow ratio (QFR) is a method based on the three-dimensional quantitative coronary angiography and contrast flow velocity during coronary angiography (CAG), obviating the need for an invasive fractional flow reserve procedural. This study aimed to assess the serial angiographic changes of de novo lesions post-DCB therapy and further explore the cut-off values of lesion and vessel QFR, which predict vessel restenosis (diameter stenosis [DS] ≥50%) at mid-term follow-up. METHODS The data of patients who underwent DCB therapy between January 2014 and December 2019 from the multicenter hospital were retrospectively collected for QFR analysis. From their QFR performances, which were analyzed by CAG images at follow-up, we divided them into two groups: group A, showing target vessel DS ≥50%, and group B, showing target vessel DS <50%. The median follow-up time was 287 days in group A and 227 days in group B. We compared the clinical characteristics, parameters during DCB therapy, and QFR performances, which were analyzed by CAG images between the two groups, in need to explore the cut-off value of lesion/vessel QFR which can predict vessel restenosis. Student's t test was used for the comparison of normally distributed continuous data, Mann-Whitney U test for the comparison of non-normally distributed continuous data, and receiver operating characteristic (ROC) curves for the evaluation of QFR performance which can predict vessel restenosis (DS ≥50%) at mid-term follow-up using the area under the curve (AUC). RESULTS A total of 112 patients with 112 target vessels were enrolled in this study. Group A had 41 patients, while group B had 71. Vessel QFR and lesion QFR were lower in group A than in group B post-DCB therapy, and the cut-off values of lesion QFR and vessel QFR in the ROC analysis to predict target vessel DS ≥50% post-DCB therapy were 0.905 (AUC, 0.741 [95% confidence interval, CI: 0.645, 0.837]; sensitivity, 0.817; specificity, 0.561; P < 0.001) and 0.890 (AUC, 0.796 [95% CI: 0.709, 0.882]; sensitivity, 0.746; specificity, 0.780; P < 0.001). CONCLUSIONS The cut-off values of lesion QFR and vessel QFR can assist in predicting the angiographic changes post-DCB therapy. When lesion/vessel QFR values are <0.905/0.890 post-DCB therapy, a higher risk of vessel restenosis is potentially predicted at follow-up.
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8
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Lee HS, Kang J, Park KW, Ki Y, Chang M, Han J, Yang H, Kang H, Koo B, Kim H. Procedural optimization of
drug‐coated
balloons in the treatment of coronary artery disease. Catheter Cardiovasc Interv 2021; 98:E43-E52. [DOI: 10.1002/ccd.29492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/15/2020] [Accepted: 01/08/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Hak Seung Lee
- Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Republic of Korea
| | - Jeehoon Kang
- Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Republic of Korea
| | - Kyung Woo Park
- Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Republic of Korea
| | - You‐Jeong Ki
- Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Republic of Korea
| | - Mineok Chang
- Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Republic of Korea
| | - Jung‐Kyu Han
- Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Republic of Korea
| | - Han‐Mo Yang
- Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Republic of Korea
| | - Hyun‐Jae Kang
- Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Republic of Korea
| | - Bon‐Kwon Koo
- Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Republic of Korea
| | - Hyo‐Soo Kim
- Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Republic of Korea
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9
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Wybraniec MT, Bańka P, Bochenek T, Roleder T, Mizia-Stec K. Small vessel coronary artery disease: How small can we go with myocardial revascularization? Cardiol J 2020; 28:767-778. [PMID: 32986235 DOI: 10.5603/cj.a2020.0127] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/21/2020] [Indexed: 11/25/2022] Open
Abstract
The issue of small coronary artery atherosclerosis represents an intriguing aspect of coronary artery disease, which is related with higher rates of peri- and post-procedural complications and impaired long-term outcome. This problem is further complicated by the unclear definition of small coronary vessel. Recent randomized controlled trials have provided new data on possible novel interventional treatment of small coronary vessels with drug-coated balloons instead of traditional new-generation drug-eluting stent implantation. Also, the conservative management represents a therapeutic option in light of the results of the recent ISCHEMIA trial. The current article provides an overview of the most appropriate definition, interventional management, and prognosis of small coronary artery atherosclerosis.
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Affiliation(s)
- Maciej T Wybraniec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland. .,Upper Silesia Medical Center, Katowice, Poland.
| | - Paweł Bańka
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.,Upper Silesia Medical Center, Katowice, Poland
| | - Tomasz Bochenek
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.,Upper Silesia Medical Center, Katowice, Poland
| | - Tomasz Roleder
- Regional Specialist Hospital, Research and Development Center, Wroclaw, Poland
| | - Katarzyna Mizia-Stec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.,Upper Silesia Medical Center, Katowice, Poland
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10
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Rodríguez-Arias JJ, Ortega-Paz L, Brugaletta S. Durable polymer everolimus-eluting stents: history, current status and future prospects. Expert Rev Med Devices 2020; 17:671-682. [PMID: 32543934 DOI: 10.1080/17434440.2020.1784005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Coronary percutaneous interventions have evolved from plain old balloon angioplasty (POBA) to stent implantation, which itself evolved from bare-metal stents (BMS) to the new biodegradable stents which try to restore endothelial function. Currently, the most commonly used stent is the everolimus-eluting stent. AREAS COVERED This review will cover the current status of durable polymer everolimus-eluting stent, its history, and future perspectives. Nowadays, the everolimus-eluting stent is the most used device in the acute and chronic settings due to its safety and efficacy. EXPERT OPINION Durable polymer everolimus-eluting stent, supported by much evidence, has demonstrated its efficacy and safety, not only in de novo artery lesions, but in multiples scenarios, such as the acute setting and diabetic population, becoming one of the most polyvalent stents available. Nowadays, research is focused on the reduction of antiplatelet treatment duration. Similar rates of stent thrombosis with short dual antiplatelet treatment regimens of 1 to 3 months compared to pronged treatment have been observed. However, specific studies should be performed to evaluate this possibility.
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Affiliation(s)
- Juan J Rodríguez-Arias
- Clinic Cardiovascular Institute, Department of Cardiology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona , Barcelona, Spain
| | - Luis Ortega-Paz
- Clinic Cardiovascular Institute, Department of Cardiology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona , Barcelona, Spain
| | - Salvatore Brugaletta
- Clinic Cardiovascular Institute, Department of Cardiology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona , Barcelona, Spain
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11
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Giannini F, Khokhar AA, Albani S. Percutaneous Intervention in Small-Vessel Coronary Disease: Time to Clear the Fog? JACC Cardiovasc Interv 2020; 13:805-807. [PMID: 32061603 DOI: 10.1016/j.jcin.2019.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/12/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy.
| | - Arif A Khokhar
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Stefano Albani
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, University of Trieste, Trieste, Italy
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12
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Scheller B, Ohlow MA, Ewen S, Kische S, Rudolph TK, Clever YP, Wagner A, Richter S, El-Garhy M, Böhm M, Degenhardt R, Mahfoud F, Lauer B. Bare metal or drug-eluting stent versus drug-coated balloon in non-ST-elevation myocardial infarction: the randomised PEPCAD NSTEMI trial. EUROINTERVENTION 2020; 15:1527-1533. [DOI: 10.4244/eij-d-19-00723] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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13
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Li M, Guo C, Lv YH, Zhang MB, Wang ZL. Drug-coated balloon versus drug-eluting stent in de novo small coronary vessel disease: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e15622. [PMID: 31124941 PMCID: PMC6571399 DOI: 10.1097/md.0000000000015622] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Drug-coated balloon as a novel therapeutic strategy has been used to treat restenosis in cases of bare metal and drug-eluting stents. However, evidence of its safety and efficacy is scarce in de novo small coronary artery vessel disease. This meta-analysis aimed to compare the safety and efficacy of the drug-coated balloon and the drug-eluting stent. METHODS The PubMed, EMBASE, Web of Science, and Cochrane library databases were searched for studies published up to October 17, 2018. Studies comparing the drug-coated balloon with the drug-eluting stent strategy in patients with de novo small coronary artery vessel disease (reference diameter, <3 mm) were identified. The clinical outcomes were nonfatal myocardial infarction, cardiac death, all-cause death, target lesion revascularization, and target-vessel revascularization. Data were analyzed using the statistical software RevMan (version 5.3). Fixed effects models were performed to calculate the pooled odds ratios (ORs) and 95% confidence intervals (95% CIs). Sensitivity analyses were used to detect potential sources of heterogeneity, while subgroup analyses were implemented to assess the differential effects. RESULTS Three randomized controlled trials and 3 nonrandomized controlled studies were identified. Six studies including a total of 1800 patients compared the differences between the drug-coated balloon and the drug-eluting stent strategies in patients with de novo small coronary artery vessel disease. The results indicated that the drug-coated balloon strategy was associated with a significant reduction in nonfatal myocardial infarction (OR 0.53, 95% CI 0.31-0.90, P = .02) compared with the drug-eluting stent strategy, while insignificant inter-strategy differences were observed in cardiac death (OR 1.56, 95% CI 0.73-3.33, P = .25), all-cause death (OR 0.56, 95% CI 0.25-1.23, P = .15), target lesion revascularization (OR 1.24, 95% CI 0.73-2.1, P = .43), and target-vessel revascularization (OR 0.95, 95% CI 0.59-1.52, P = .84). CONCLUSIONS This meta-analysis suggests that the drug-coated balloon strategy is noninferior to the drug-eluting stent strategy, delivering a good outcome in nonfatal myocardial infarction, and can be recommended as an optimal treatment strategy in patients with de novo small coronary artery vessel disease. Larger randomized controlled studies with longer follow-up periods are needed to further confirm the benefits of the drug-coated balloon strategy.
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Affiliation(s)
- Min Li
- The First Clinical Medical College of Lanzhou University
| | - Chen Guo
- The First Clinical Medical College of Lanzhou University
| | - Yong-Hui Lv
- The First Clinical Medical College of Lanzhou University
| | - Ming-Bo Zhang
- The First Clinical Medical College of Lanzhou University
| | - Zhi-Lu Wang
- Department of Cardiology, The First Hospital of Lanzhou University, China
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14
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Yang JQ, Peng JH, Xu T, Liu LY, Tu JH, Li SH, Chen H. Meta-analysis of the effects of drug-coated balloons among patients with small-vessel coronary artery disease. Medicine (Baltimore) 2019; 98:e15797. [PMID: 31145306 PMCID: PMC6709063 DOI: 10.1097/md.0000000000015797] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study evaluated the clinical value of drug-coated balloons for patients with small-vessel coronary artery disease (SVD). METHODS A computerized literature search was performed using the databases to conduct a meta-analysis and evaluate the clinical value of drug-coated balloons among patients with SVD. RESULTS This review enrolling 1545 patients receiving drug-coated balloons and 1010 patients receiving stents (including drug-eluting stents and bare-metal stents). The meta-analysis results showed that the incidence of major adverse cardiovascular events among patients with SVD did not significantly differ between the drug-coated balloon group and the stent group within 1 postoperative year (odds ratio = 0.81, P = .5). A subgroup analysis showed that the incidence of myocardial infarction among the drug-coated balloon group was significantly lower than that among the stent group (odds ratio = 0.58, P = .04). Nevertheless, the late lumen loss of the drug-coated balloon group was significantly lower than that of the stent group (mean difference = 0.31, P = .01). CONCLUSIONS Drug-coated balloons can be used to effectively reduce the incidence of myocardial infarction in patients with SVD within 1 year and decrease the extent of late lumen loss without increasing the incidence of major adverse cardiovascular events.
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Affiliation(s)
- Jing-qi Yang
- Department of Cardiovascular Medicine, The Third Affiliated Hospital of Nanchang University, The First Hospital of Nanchang, Nanchang City, Jiangxi Province, China
| | - Jin-hua Peng
- Department of Cardiovascular Medicine, The Third Affiliated Hospital of Nanchang University, The First Hospital of Nanchang, Nanchang City, Jiangxi Province, China
| | - Ting Xu
- Women and Child Health Care Hospital of Jiangxi Province, China
| | - Li-yun Liu
- Department of Cardiovascular Medicine, The Third Affiliated Hospital of Nanchang University, The First Hospital of Nanchang, Nanchang City, Jiangxi Province, China
| | - Jie-hong Tu
- Department of Cardiovascular Medicine, The Third Affiliated Hospital of Nanchang University, The First Hospital of Nanchang, Nanchang City, Jiangxi Province, China
| | - Shun-hui Li
- Department of Cardiovascular Medicine, The Third Affiliated Hospital of Nanchang University, The First Hospital of Nanchang, Nanchang City, Jiangxi Province, China
| | - Hui Chen
- Department of Cardiovascular Medicine, The Third Affiliated Hospital of Nanchang University, The First Hospital of Nanchang, Nanchang City, Jiangxi Province, China
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15
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Chen Y, Gao L, Qin Q, Chen S, Zhang J, Chen H, Wang L, Jin Z, Zheng Y, Zhang Z, Li H, Li X, Fu G, Chen L, Sun Z, Wang Y, Jin Q, Cao F, Guo J, Zhao Y, Guan C, Li W, Xu B, Chen Y, Chen Y, Chen S, Xu B, Zeng Y, Yang Q, Zhang J, Chen Y, Gao L, Chen L, Sun Z, Wang Y, Jin Q, Cao F, Guo J, Qin Q, Yang J, Chen S, Li X, Zhang JJ, San S, Ge Z, Chen L, You W, Wu Z, Tian N, Zhang J, Wang J, Fu J, Niu H, Chen H, Liang S, Zhao H, Li D, Jin Z, Yang D, Meng S, Wang L, Zhang Z, Zheng Y, Hao S, Zhang Z, Bai M, Zhao C, Li H, Wang M, Wang J, Li X, Xue Y, Wang B, Fu G, Qiu F, Zhao Y, Jin C, Xu S, Wu L. Comparison of 2 Different Drug-Coated Balloons in In-Stent Restenosis. JACC Cardiovasc Interv 2018; 11:2368-2377. [DOI: 10.1016/j.jcin.2018.09.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/09/2018] [Accepted: 09/10/2018] [Indexed: 10/27/2022]
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16
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Mohiaddin H, Wong TDFK, Burke-Gaffney A, Bogle RG. Drug-Coated Balloon-Only Percutaneous Coronary Intervention for the Treatment of De Novo Coronary Artery Disease: A Systematic Review. Cardiol Ther 2018; 7:127-149. [PMID: 30368735 PMCID: PMC6251821 DOI: 10.1007/s40119-018-0121-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Indexed: 02/06/2023] Open
Abstract
Percutaneous coronary intervention (PCI) with a drug coated balloon (DCB) is a novel treatment which seeks to acutely dilate a coronary stenosis and deliver an anti-proliferative drug to the vessel wall (reducing the risk of re-stenosis), without implanting a drug eluting stent (DES). In this study, we performed a systematic review of stentless DCB-only angioplasty in de novo coronary artery disease. We identified 41 studies examining the effects of DCB-only PCI in a variety of clinical scenarios including small vessels, bifurcations, calcified lesions, and primary PCI. DCB-only PCI appears to be associated with comparable clinical outcomes to DESs and superior angiographic outcomes to plain-old balloon angioplasty. Although current data are promising, there is still a need for further long-term randomized control trial data comparing a DCB-only approach specifically against a second- or third-generation DES. A 4-week period of dual antiplatelet therapy provides a real advantage for the DCB-only PCI approach, which is not possible with most DESs. Since rates of adverse clinical outcomes are very low for all PCI procedures attention should be turned to the development of robust endpoints with which to compare DCB-only PCI approaches to the standard treatment with a DES.
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Affiliation(s)
| | | | - Anne Burke-Gaffney
- Vascular Biology, National Heart & Lung Institute (NHLI), Faculty of Medicine, Imperial College London, London, UK
| | - Richard G Bogle
- Clinical Academic Group, St George's University Foundation Hospitals NHS Trust, London, UK
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17
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18
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Mitomo S, Jabbour RJ, Mangieri A, Ancona M, Regazzoli D, Tanaka A, Giannini F, Carlino M, Montorfano M, Chieffo A, Latib A, Colombo A. Mid-term clinical outcomes after bailout drug-eluting stenting for suboptimal drug-coated balloon results: Insights from a Milan registry. Int J Cardiol 2018; 263:17-23. [PMID: 29685691 DOI: 10.1016/j.ijcard.2018.04.050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 03/27/2018] [Accepted: 04/10/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Drug-coated balloon (DCB) is an alternative to drug-eluting stent (DES) for the treatment of small vessel or in-stent restenosis (ISR) lesions, with bailout stenting reserved for poor results after DCB inflation (residual stenosis or dissection). Data regarding bailout stenting with DES are limited. The aim of this study was to evaluate clinical outcomes after bailout stenting with DES for suboptimal DCB results. METHODS From June 2009 to December 2015, patients who underwent bailout DES implantation for suboptimal results after DCB (residual stenosis > 30% or type C-F dissection) in 2 high-volume centers in Italy were analyzed. The primary endpoint was target lesion failure (TLF) defined as composite of cardiac mortality, target vessel myocardial infarction (MI) and target lesion revascularization (TLR). RESULTS A total of 103 patients (125 lesions) were analyzed. Mean age was 68.8 ± 9.5 years, 21.4% were diabetic, and 92.2% underwent PCI for stable angina. The left anterior descending artery was most commonly treated (35.2%), followed by right coronary artery (17.6%) and left circumflex artery (17.6%). Lesion complexity was high (type B2/C: 88.8%) and 24.8% were ISR lesions. During the follow-up period (median: 858 days [interquartile range: 467-1665]), the TLF rate was 4.3% at 1 year and 15.4% at 2 years, and mainly driven by TLR (3.3% at 1 year, 14.5% at 2 years, respectively). There were no target vessel MI or definite/probable stent thrombosis events. CONCLUSIONS Bailout stenting with DES for suboptimal DCB results is a feasible and safe strategy at mid-term follow-up.
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Affiliation(s)
- Satoru Mitomo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | | | - Antonio Mangieri
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Ancona
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Damiano Regazzoli
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Akihito Tanaka
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Giannini
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Mauro Carlino
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Matteo Montorfano
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Alaide Chieffo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Azeem Latib
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Colombo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
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Masiero G, Mojoli M, Ueshima D, Tarantini G. Current concepts on coronary revascularization using BRS in patients with diabetes and small vessels disease. J Thorac Dis 2017; 9:S940-S949. [PMID: 28894600 PMCID: PMC5583088 DOI: 10.21037/jtd.2017.06.36] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 05/17/2017] [Indexed: 01/19/2023]
Abstract
Diabetes mellitus (DM) and small vessel (SV) disease are two major predictors of adverse outcome in patients treated by percutaneous coronary intervention (PCI), even when last generation metallic drug-eluting stents (DES) are used. Bioresorbable scaffold (BRS) technology has been recently developed to overcome the disadvantages of metallic DES due to their permanent struts. Through the resorption process, BRS may provide a vascular restoration that appears very attractive especially when distal or diffusely diseased coronary segments are involved, as in diabetic patients and SV disease. However, robust evidence on the use of BRS in diabetics is lacking, and recent data have raised concerns on the use of BRS in SVs, particularly when reference vessel diameter (RVD) is <2.25 mm. This review aims at summarizing current evidence related to the use of BRS in diabetics and SV disease.
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Affiliation(s)
- Giulia Masiero
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Marco Mojoli
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Daisuke Ueshima
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
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