1
|
Rivero-Santana B, Jurado-Roman A, Galeote G, Jimenez-Valero S, Gonzalvez A, Tebar D, Moreno R. Drug-Eluting Balloons in Calcified Coronary Lesions: A Meta-Analysis of Clinical and Angiographic Outcomes. J Clin Med 2024; 13:2779. [PMID: 38792321 PMCID: PMC11122257 DOI: 10.3390/jcm13102779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/16/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
Background: The usefulness of drug-eluting balloons (DEBs) has not been fully elucidated in calcified coronary lesions (CCLs). This meta-analysis aimed to evaluate the efficacy of DEBs compared to a drug-eluting stent (DES) in this setting. Methods: PubMed, EMBASE and Cochrane were searched through December 2023. The primary endpoint was 12 months major adverse cardiac events (MACE). Secondary endpoints included clinical outcomes and angiographic results after PCI and at a 12-month follow-up. Results: Five studies and a total of 1141 patients with 1176 coronary lesions were included. Overall, the DEB was comparable to DES in MACE (RR = 0.86, 95% CI: 0.62-1.19, p = 0.36), cardiac death (RR = 0.59, 95% CI: 0.23-1.53, p = 0.28), myocardial infarction (RR = 0.89, 95% CI: 0.25-3.24, p = 0.87) and target lesion revascularization (RR = 1.1, 95% CI: 0.68-1.77, p = 0.70). Although the DEB was associated with worse acute angiographic outcomes (acute gain; MD = -0.65, 95% CI: -0.73, -0.56 and minimal lumen diameter; MD = -0.75, 95% CI: -0.89, -0.61), it showed better results at 12 months follow-up (late lumen loss; MD = -0.34, 95% CI: -0.62, -0.07). Conclusions: This meta-analysis showed that the DEB strategy is comparable to DES in the treatment of CCLs in terms of clinical outcomes. Although the DEB strategy had inferior acute angiographic results, it may offer better angiographic results at follow-up.
Collapse
Affiliation(s)
- Borja Rivero-Santana
- Cardiology Department, La Paz University Hospital, 28046 Madrid, Spain; (G.G.); (S.J.-V.); (A.G.); (D.T.); (R.M.)
- Hospital La Paz Institute for Health Research (IdiPAZ), 28040 Madrid, Spain
| | - Alfonso Jurado-Roman
- Cardiology Department, La Paz University Hospital, 28046 Madrid, Spain; (G.G.); (S.J.-V.); (A.G.); (D.T.); (R.M.)
- Hospital La Paz Institute for Health Research (IdiPAZ), 28040 Madrid, Spain
| | - Guillermo Galeote
- Cardiology Department, La Paz University Hospital, 28046 Madrid, Spain; (G.G.); (S.J.-V.); (A.G.); (D.T.); (R.M.)
- Hospital La Paz Institute for Health Research (IdiPAZ), 28040 Madrid, Spain
| | - Santiago Jimenez-Valero
- Cardiology Department, La Paz University Hospital, 28046 Madrid, Spain; (G.G.); (S.J.-V.); (A.G.); (D.T.); (R.M.)
- Hospital La Paz Institute for Health Research (IdiPAZ), 28040 Madrid, Spain
| | - Ariana Gonzalvez
- Cardiology Department, La Paz University Hospital, 28046 Madrid, Spain; (G.G.); (S.J.-V.); (A.G.); (D.T.); (R.M.)
| | - Daniel Tebar
- Cardiology Department, La Paz University Hospital, 28046 Madrid, Spain; (G.G.); (S.J.-V.); (A.G.); (D.T.); (R.M.)
| | - Raul Moreno
- Cardiology Department, La Paz University Hospital, 28046 Madrid, Spain; (G.G.); (S.J.-V.); (A.G.); (D.T.); (R.M.)
- Hospital La Paz Institute for Health Research (IdiPAZ), 28040 Madrid, Spain
| |
Collapse
|
2
|
Jeger RV, Fahrni G. Rest in PEACE? REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024:S1885-5857(24)00039-2. [PMID: 38316356 DOI: 10.1016/j.rec.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/17/2024] [Indexed: 02/07/2024]
Affiliation(s)
- Raban V Jeger
- Cardiology Triemli Hospital Zürich and University of Basel, Basel, Switzerland.
| | - Gregor Fahrni
- Cardiology Triemli Hospital Zürich and University of Basel, Basel, Switzerland
| |
Collapse
|
3
|
Lazar FL, Onea HL, Olinic DM, Cortese B. A 2024 scientific update on the clinical performance of drug-coated balloons. ASIAINTERVENTION 2024; 10:15-25. [PMID: 38425817 PMCID: PMC10900242 DOI: 10.4244/aij-d-23-00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 10/12/2023] [Indexed: 03/02/2024]
Abstract
Continuous advances in the field of interventional cardiology have led to the development of drug-coated balloons (DCB). These represent a promising device for overcoming the well-known limitations of traditional metallic stents, which are associated with a persistent yearly increased risk of adverse events. This technology has the ability to homogeneously transfer the drug into the vessel wall in the absence of a permanent prosthesis implanted in the coronary vessel. Robust data support the use of DCB for the treatment of in-stent restenosis, but there is also currently growing evidence from long-term follow-up of large randomised clinical trials regarding the use of these devices in other scenarios, such as de novo small and large vessel disease, complex bifurcations, and diffuse coronary disease. Other critical clinical settings such as diabetes mellitus, high bleeding risk patients and acute coronary syndromes could be approached in the upcoming future by using DCB, alone or as part of a blended strategy in combination with drug-eluting stents. There have been important scientific and technical advances in the DCB field in recent years. The purpose of this paper is to review the most current data regarding the use of DCB, including the mid- and long-term follow-up reports on the safety and efficacy of this novel strategy in different clinical and angiographic scenarios.
Collapse
Affiliation(s)
- Florin-Leontin Lazar
- Iuiliu Hatieganu University of Medicine and Pharmacy, 5th Department, Internal Medicine, Medical Clinic No. 1, Cluj-Napoca, Romania
| | - Horea-Laurentiu Onea
- Iuiliu Hatieganu University of Medicine and Pharmacy, 5th Department, Internal Medicine, Medical Clinic No. 1, Cluj-Napoca, Romania
| | - Dan-Mircea Olinic
- Iuiliu Hatieganu University of Medicine and Pharmacy, 5th Department, Internal Medicine, Medical Clinic No. 1, Cluj-Napoca, Romania
| | - Bernardo Cortese
- Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy
- DCB Academy, Milan, Italy
- CardioParc, Lyon, France
| |
Collapse
|
4
|
Kasbaoui S, Payot L, Zabalawi A, Delaunay R, Amara WB, Boukhris M, Taldir G. Safety and Efficacy of a Hybrid Approach Combining a Paclitaxel-Coated Balloon With a New Generation Drug-Eluting Stent in Patients With De Novo True Coronary Bifurcation Lesions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 54:47-56. [PMID: 37150642 DOI: 10.1016/j.carrev.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/25/2023] [Accepted: 04/11/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND The use of drug-coated balloon in the management of true bifurcation lesions appears to be an attractive option to reduce the rate of stent thrombosis and restenosis particularly at the level of the side branch ostium. We aim to assess the safety and the efficacy of a hybrid approach combining a drug-eluting stent in the main branch and a drug-coated balloon to treat the side branch ostium in patients with de novo true bifurcation. METHODS From September 2020 to March 2022, 45 patients with a de novo true bifurcation lesion Medina (1.1.1) or Medina (0.1.1) were enrolled. All patients underwent a percutaneous coronary intervention with the hybrid approach. Clinical assessment with functional stress imaging test was scheduled at 6 months. In case of documented ischemia, coronary angiography was performed. The primary endpoint was the composite of target lesion failure at 6 months including cardiac death, target vessel MI or ischemia-driven target lesion revascularization. The secondary endpoints were technical success, defined by performing the percutaneous coronary intervention without an additional drug-eluting stent at the level of the side branch ostium, and clinical success, defined by a technical success associated with the absence of severe complications during in-hospital phase. RESULTS The immediate results show a technical success of the procedure in the majority of cases (88.9 %) with a low rate of bailout side branch stenting (11.1 %). The clinical success was obtained in 86.7 % and only one patient experienced a severe in-hospital complication. A side branch ostial lesion length > 10 mm was the only independent predictor of clinical failure of the procedure (OR 12.49, 95 % CI 1.17-133.6; p = 0.037). At 6 months, the TLF was low and occurred in 1 patient (2.2 %). No cardiac death was observed. No TVMI was observed. Importantly, at 6 months, no side branch thrombosis was observed. CONCLUSION The use of a hybrid approach combining a drug-eluting stent in the main branch and a drug-coated balloon in the side branch to treat true bifurcation lesions appears to be safe and efficient with few immediate complications and with satisfactory results at mid-term follow up.
Collapse
Affiliation(s)
- Sami Kasbaoui
- Centre Hospitalier de Saint-brieuc, 10 rue Marcel Proust 22000 Saint-Brieuc, France; Centre Hospitalier de l'Université de Montréal, 1000 rue Saint-Denis, H2X 0C1 Montréal, QC Canada.
| | - Laurent Payot
- Centre Hospitalier de Saint-brieuc, 10 rue Marcel Proust 22000 Saint-Brieuc, France.
| | - Amer Zabalawi
- Centre Hospitalier de Saint-brieuc, 10 rue Marcel Proust 22000 Saint-Brieuc, France.
| | - Regis Delaunay
- Centre Hospitalier de Saint-brieuc, 10 rue Marcel Proust 22000 Saint-Brieuc, France.
| | - Wael Ben Amara
- Centre Hospitalier de Saint-brieuc, 10 rue Marcel Proust 22000 Saint-Brieuc, France.
| | - Marouane Boukhris
- Centre Hospitalier Universitaire de Limoges, 2 avenue Martin Luther King 87000 Limoges, France.
| | - Guillaume Taldir
- Centre Hospitalier de Saint-brieuc, 10 rue Marcel Proust 22000 Saint-Brieuc, France.
| |
Collapse
|
5
|
Dash D, Mody R, Ahmed N, Malan SR, Mody B. Drug-coated balloon in the treatment of coronary bifurcation lesions: A hope or hype? Indian Heart J 2022; 74:450-457. [PMID: 36347323 PMCID: PMC9773284 DOI: 10.1016/j.ihj.2022.10.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/24/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
When compared to non-bifurcation lesions, percutaneous coronary intervention in coronary bifurcation lesions is technically demanding and has historically been limited by lower procedural success rates and inferior clinical results. Following the development of drug-eluting stents, dramatically better results have been demonstrated. In most of the bifurcation lesions, the provisional technique of implanting a single stent in the main branch (MB) remains the default approach. However, some cases require more complex two-stent techniques which carry the risk of side branch (SB) restenosis. The concept of leaving no permanent implant behind is appealing because of the complexity of bifurcation anatomy with significant size mismatch between proximal and distal MB which may drive rates of in-stent restenosis and the potential impact of MB stenting affecting SB coronary flow dynamics. With the perspective of leaving lower metallic burden, a drug-coated balloon (DCB) has been utilized to treat bifurcations in both the MB and SB. The author gives an overview of the existing state of knowledge and prospects for the future for using DCB to treat bifurcation lesions.
Collapse
Affiliation(s)
- Debabrata Dash
- Department of Cardiology, Aster Hospital, Dubai, United Arab Emirates.
| | - Rohit Mody
- Department of Cardiology, Max Superspeciality Hospital, Bathinda, India
| | - Naveed Ahmed
- Department of Cardiology, Aster Hospital, Dubai, United Arab Emirates
| | | | - Bhavya Mody
- Department of Medicine, Kasturba Medical College, Manipal, Karnataka, India
| |
Collapse
|
6
|
Alfonso F, Cortese B. Drug-Coated Balloons for Unselected Real World Patients: Are We There Yet? Korean Circ J 2022; 52:455-459. [PMID: 35656903 PMCID: PMC9160644 DOI: 10.4070/kcj.2022.0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/13/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Universidad Autonoma de Madrid, IIS-IP, CIBER-CV, Madrid, Spain
| | - Bernardo Cortese
- Department of Cardiology, Clinica Polispecialistica San Carlo, Paderno Dugnano, Milano, Italy
- Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy
| |
Collapse
|
7
|
Nef HM, Achenbach S, Birkemeyer R, Bufe A, Dörr O, Elsässer A, Gaede L, Gori T, Hoffmeister HM, Hofmann FJ, Katus HA, Liebetrau C, Massberg S, Pauschinger M, Schmitz T, Süselbeck T, Voelker W, Wiebe J, Zahn R, Hamm C, Zeiher AM, Möllmann H. Manual der Arbeitsgruppe Interventionelle Kardiologie (AGIK) der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung e.V. (DGK). DER KARDIOLOGE 2021. [DOI: 10.1007/s12181-021-00504-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
8
|
Spaulding C. Drug-eluting balloons are coming, but are we ready? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 35:83-84. [PMID: 34824039 DOI: 10.1016/j.carrev.2021.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 11/16/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Christian Spaulding
- Cardiology Department, European Hospital Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris University and Sudden Cardiac Death Expert Center, Paris, France.
| |
Collapse
|
9
|
In-stent restenosis treatment with seal-wing paclitaxel-eluting balloon catheters. COR ET VASA 2021. [DOI: 10.33678/cor.2021.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
10
|
Kang WC, Park SM, Jang AY, Oh PC, Shin ES, Yu CW, Oh SJ, Kim YH, Won H, Lee SR, Lee SY, Hong YJ, Lee SY, Kim BO, Kim SW. Predictors of Favorable Angiographic Outcomes After Drug-Coated Balloon Use for de novo Small Vessel Coronary Disease (DCB-ONLY). Angiology 2021; 72:986-993. [PMID: 33982603 DOI: 10.1177/00033197211015534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We evaluated the angiographic parameter and clinical outcomes of drug-coated balloon (DCB) to assess the optimal angiographic criteria in de novo small vessel disease (SVD). Patients (n = 424, mean age: 64.4 ± 11.2 years, men: 69.8%) at 20 sites in Korea were prospectively enrolled. The primary end point was late luminal loss (LLL) at 9-month follow-up angiography. Secondary end points included restenosis rates, target lesion failure (TLF), and DCB-related thrombosis during the 12-month follow-up period. We included 403 patients for analysis excluding 21 patients who required bailout stenting. Baseline mean reference vessel .diameter was 2.52 ± 0.39 mm and mean minimal luminal diameter (MLD) was 0.71 ± 0.40 mm. The mean MLD was 1.54 ± 0.37 mm after DCB. Late luminal loss was -0.01 ± 0.43 mm and restenosis was noted in 26 patients (12.2%). Minimal luminal diameter >1.6 mm and %diameter stenosis (DS) <45% after DCB was associated maintenance of MLD without LLL at 9-months. Multivariate analysis demonstrated that %DS at baseline and post-MLD was associated with the restenosis. During 12-month follow-up, TLF was 2.6% including 1 cardiac death, 1 myocardial infarction, and 10 ischemia-driven target lesion revascularizations. Drug-coated balloon showed a low restenosis and lower LLL despite high in-segment DS. Post-MLD and % DS may be helpful to get optimal results in de novo SVD after DCB.
Collapse
Affiliation(s)
- Woong Chol Kang
- Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Sang Min Park
- Eulji University Hospital, College of Medicine, Seoul, Republic of Korea
| | - Albert Youngwoo Jang
- Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Pyung Chun Oh
- Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Eun-Seok Shin
- Ulsan Medical Center, Ulsan Hospital, Ulsan, Republic of Korea
| | - Cheol Woong Yu
- Korea University Anam Hospital, Seoul, Republic of Korea
| | | | - Yong Hoon Kim
- Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Hoyoun Won
- Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Sang-Rok Lee
- Chonbuk National University, School of Medicine, Jeonju, Republic of Korea
| | - Sang Yeub Lee
- Chungbuk National University, School of Medicine, Cheongju, Republic of Korea
| | - Young Joon Hong
- Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung Yun Lee
- Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Byung Ok Kim
- Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
| | - Sang-Wook Kim
- Chung-Ang University Hospital, Seoul, Republic of Korea
| | | |
Collapse
|
11
|
Megaly M, Buda K, Saad M, Tawadros M, Elbadawi A, Basir M, Abbott JD, Rinfret S, Alaswad K, Brilakis ES. Outcomes with drug-coated balloons vs. drug-eluting stents in small-vessel coronary artery disease. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 35:76-82. [PMID: 33858783 DOI: 10.1016/j.carrev.2021.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/07/2021] [Accepted: 03/15/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND The use of drug-coated balloons (DCBs) in small-vessel coronary artery disease (SVD) remains controversial. METHODS We performed a meta-analysis of all randomized controlled trials (RCTs) reporting the outcomes of DCB vs. DES in de-novo SVD. We included a total of 5 RCTs (1459 patients), with (DCB n = 734 and DES n = 725). RESULTS Over a median follow-up duration of 6 months, DCB was associated with smaller late lumen loss (LLL) compared with DES (mean difference -0.12 mm) (95% confidence intervals (CI) [-0.21, -0.03 mm], p = 0.01). Over a median follow-up of 12 months, both modalities had similar risk of major adverse cardiovascular events (MACE) (8.7% vs. 10.2%; odds ratio (OR): 0.94, 95% CI [0.49-1.79], p = 084), all-cause mortality (1.17% vs. 2.38%; OR: 0.53, 95% CI [0.16-1.75], p = 0.30), target lesion revascularization (TLR) (7.9% vs. 3.9%; OR: 1.26, 95% CI [0.51-3.14], p = 0.62), and target vessel revascularization (TVR) (8.2% vs. 7.8%; OR: 1.06, 95% CI [0.40-2.82], p = 0.91). DCBs were associated with lower risk of myocardial infarction (MI) compared with DES (1.55% vs. 3.31%; OR: 0.48, 95% CI [0.23-1.00], p = 0.05, I2 = 0%). CONCLUSION PCI of SVD with DCBs is associated with smaller LLL, lower risk of MI, and similar risk of MACE, death, TLR, and TVR compared with DES over one year. DCB appears as an attractive alternative to DES in patients with de-novo SVD, but long-term clinical data are still needed.
Collapse
Affiliation(s)
- Michael Megaly
- Division of Cardiology, Banner University Medical Center, Phoenix, AZ, USA
| | - Kevin Buda
- Division of Internal Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | - Marwan Saad
- Division of Cardiology, Brown University, Providence, RI, USA; Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | | | - Mir Basir
- Division of Cardiology, Henry Ford Hospital, Detroit, MI, USA
| | - J Dawn Abbott
- Division of Cardiology, Brown University, Providence, RI, USA
| | - Stephane Rinfret
- Division of Cardiology, McGill University Health Centre, Quebec, Canada
| | | | | |
Collapse
|
12
|
Rathore S, Tehrani S, Prvulovic D, Araya M, Lefèvre T, Banning AP, Burzotta F, Rigatelli G, Gutierrez-Chico JL, Bonaventura K, Chevalier B, Kinoshita Y, Sikic J, Alfonso F, Louvard Y, Stankovic G. Drug coated balloons and their role in bifurcation coronary angioplasty: appraisal of the current evidence and future directions. Expert Rev Med Devices 2020; 17:1021-1033. [PMID: 33000952 DOI: 10.1080/17434440.2020.1831385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Coronary Bifurcation lesions are technically more challenging and Bifurcation percutaneous coronary intervention (PCI) remains a challenge with unpredictable and sub-optimal clinical and angiographic results. Drug-Coated Balloons (DCB) are emerging devices in the field of coronary intervention with promising results that may overcome some of drug eluting stents limitations and may have potential advantages in complex bifurcation PCI. AREAS COVERED We have performed a re-appraisal about the issues with current bifurcation PCI techniques and the use of DCB in the treatment of Bifurcation lesions. Several studies performed utilizing DCB are described and critically appraised. Over the recent years, there have been tremendous developments in the DCB technology, lesion preparation, clinical experience, and clinical data during bifurcation PCI. The current review describes the advances in the DCB technology, pharmacokinetics, role of excipients, and optimization of the technique. Special emphasis in lesion preparation and potential pathway of using DCB in bifurcation PCI is proposed. EXPERT OPINION Although different proof of concept and pilot studies have shown promising results in treatment of bifurcation lesions with DCB, larger randomized trials and/or international consensus papers are required to enable worldwide translation of this idea to clinical practice.
Collapse
Affiliation(s)
- Sudhir Rathore
- Department of Cardiology, Frimley Health NHS Foundation Trust , Camberley, UK
| | - Shana Tehrani
- Department of Cardiology, Frimley Health NHS Foundation Trust , Camberley, UK
| | - Deiti Prvulovic
- Department of Cardiology, General Hospital "Dr. Josip Benčević" , Slavonski Brod, Croatia
| | - Mario Araya
- Department of Cardiology, Clinica Alemana , Santiago, Chile
| | - Thierry Lefèvre
- Ramsay Générale De Santé - Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier , Massy, France
| | - Adrian P Banning
- Cardiovascular Medicine Division, Radcliffe Department of Medicine, John Radcliffe Hospital , Oxford, England
| | - Francesco Burzotta
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Del Sacro Cuore , Rome, Italy
| | - Gianluca Rigatelli
- Department of Cardiology, Cardiovascular Diagnosis and Endoluminal Interventions Santa Maria Della Misericordia Hospital , Rovigo, Italy
| | | | - Klaus Bonaventura
- Department of Cardiology, Angiology, Heart, Thorax and Vascular Centre , Potsdam, Germany
| | | | | | - Jozica Sikic
- Interventional Cardiologist, School of Medicine University of Zagreb , Zagreb, Croatia
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario La Princesa , Madrid, Spain
| | - Yves Louvard
- Ramsay Générale De Santé - Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier , Massy, France
| | - Goran Stankovic
- Department of Cardiology, Clinical Center of Serbia, and Medical Faculty, University of Belgrade , Belgrade, Serbia
| |
Collapse
|
13
|
Long term outcome after treatment of de novo coronary artery lesions using three different drug coated balloons. Int J Cardiol 2020; 325:30-36. [PMID: 32980433 DOI: 10.1016/j.ijcard.2020.09.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/09/2020] [Accepted: 09/20/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the long-term efficacy of three currently available drug coated balloons (DCB) for the treatment of de-novo coronary lesions. METHODS This was a retrospective analysis of prospectively collected data from the Swedish Coronary Angiography and Angioplasty Registry. Between 2009 and 2017, three currently available DCB brands used in the treatment of de novo lesions were included. Outcomes were clinically driven restenosis and target lesion thrombosis (TLT) (per device) and major adverse cardiac events (MACE) including death, myocardial infarction or target vessel revascularization (per patient) at 4 years. Multivariable Cox regression models were used to adjust for differences. RESULTS We included 6715 lesions treated with DCBs, 4483 SeQuent® Please (S-DCB), 1071 IN.PACT Falcon (I-DCB) and 1161 Pantera® Lux (P-DCB), in 5670 patients. The mean DCB diameter was 2.4 mm. Bailout stenting occurred in 6.7% of lesions. Angiographic success was 98.5%. The overall cumulative rate of restenosis was 5.5% (299 events). The risk for reported restenosis did not significantly differ between I-DCB vs S-DCB, adjusted hazard ratio (aHR) 0.96; 95% confidence interval (CI) 0.69-1.34, P-DCB vs S-DCB aHR 0.88; 95% CI 0.63-1.23 and I-DCB vs P-DCB aHR 1.10; 95% CI 0.72-1.68. The cumulative risk for TLT was 0.8% in all three DCBs. The risk for MACE or individual components of MACE did not differ between the three patient-groups. CONCLUSION In de novo coronary lesions, we found comparable long-term efficacy with three currently available DCB brands. DCB angioplasty was feasible with low risk for long-term restenosis and TLT.
Collapse
|
14
|
Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferovic PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J 2020; 40:87-165. [PMID: 30165437 DOI: 10.1093/eurheartj/ehy394] [Citation(s) in RCA: 3802] [Impact Index Per Article: 950.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
|
15
|
Hamm CW, Dörr O, Woehrle J, Krackhardt F, Ince H, Zeus T, Berland J, Piot C, Roubille F, Schult I, Allocco DJ, Nef H. A multicentre, randomised controlled clinical study of drug-coated balloons for the treatment of coronary in-stent restenosis. EUROINTERVENTION 2020; 16:e328-e334. [DOI: 10.4244/eij-d-19-00051] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
16
|
Silverio A, James S, Sarno G. Reply: Swedish Coronary Angiography and Angioplasty Registry Scare on Drug-Coated Balloons: Is It Really Scary? JACC Cardiovasc Interv 2020; 13:1380-1381. [PMID: 32499029 DOI: 10.1016/j.jcin.2020.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
|
17
|
Lee K, Lee J, Lee SG, Park S, Yang DS, Lee JJ, Khademhosseini A, Kim JS, Ryu W. Microneedle drug eluting balloon for enhanced drug delivery to vascular tissue. J Control Release 2020; 321:174-183. [DOI: 10.1016/j.jconrel.2020.02.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/03/2020] [Accepted: 02/05/2020] [Indexed: 10/25/2022]
|
18
|
Tian J, Tang Y, Qiao S, Su X, Chen Y, Jin Z, Chen H, Xu B, Kong X, Pang W, Liu Y, Yu Z, Li X, Li H, Zhao Y, Wang Y, Li W, Guan C, Gao R, Xu B. Two‐year follow‐up of a randomized multicenter study comparing a drug‐coated balloon with a drug‐eluting stent in native small coronary vessels: The RESTORE Small Vessel Disease China trial. Catheter Cardiovasc Interv 2020; 95 Suppl 1:587-597. [PMID: 31943693 DOI: 10.1002/ccd.28705] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 12/29/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Jian Tian
- Department of CardiologyFu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Yi‐da Tang
- Department of CardiologyFu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Shubin Qiao
- Department of CardiologyFu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Xi Su
- Department of CardiologyWuhan Asia Heart Hospital Wuhan China
| | - Yundai Chen
- Department of CardiologyChinese PLA General Hospital Beijing China
| | - Zening Jin
- Department of CardiologyBeijing Anzhen Hospital, Capital Medical University Beijing China
| | - Hui Chen
- Department of CardiologyBeijing Friendship Hospital, Capital Medical University Beijing China
| | - Biao Xu
- Department of CardiologyAffiliated Nanjing Drum Tower Hospital of Nanjing University School of Medicine Nanjing China
| | - Xiangqing Kong
- Department of CardiologyJiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Wenyue Pang
- Department of CardiologyShengjing Hospital of China Medical University Shenyang China
| | - Yong Liu
- Department of CardiologyThe Fourth Central Hospital of Tianjin Tianjin China
| | - Zaixin Yu
- Department of CardiologyXiangya Hospital of Central South University Changsha China
| | - Xue Li
- Department of CardiologyTangdu Hospital of the Fourth Military Medical University Xi'an China
| | - Hui Li
- Department of CardiologyDaqing Oilfield General Hospital Daqing China
| | - Yanyan Zhao
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases of China Beijing China
| | - Yang Wang
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases of China Beijing China
| | - Wei Li
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases of China Beijing China
| | - Changdong Guan
- Catheterization LaboratoriesFu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences Beijing China
| | - Runlin Gao
- Department of CardiologyFu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Bo Xu
- Catheterization LaboratoriesFu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences Beijing China
| | | |
Collapse
|
19
|
Chen L, Pang S, Hao C, Xie A, Zhu K, He Y, Zhang X, Lu W, Ma G, Chen Z. Prevention of neointimal formation after angioplasty using tetramethylpyrazine-coated balloon catheters in a rabbit iliac artery model. Cardiovasc Diagn Ther 2019; 9:472-480. [PMID: 31737518 DOI: 10.21037/cdt.2019.09.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Restenosis remains a clinical problem; drug-coated balloons (DCBs) have demonstrated high efficiency in this situation. DCBs prevent neointimal hyperplasia by inhibiting cell proliferation and migration. Tetramethylpyrazine (TMP) is a traditional Chinese medicine originally isolated from the rhizome of Ligusticum Walliichii, which can inhibit platelet aggregation and smooth muscle cell proliferation. We hypothesized that TMP-coated balloons (TCB) could reduce neointimal hyperplasia through the NF-κB signalling pathway. Methods Twenty-one New-Zealand White rabbits (2.5-3.0 kg, male) were fed high-fat diets; 36 bilateral iliac artery stenosis models were successfully established by balloon straining. Rabbits were randomly treated with TCB (n=20) or plain balloons (PBA, n=16) (3 died during model construction). Angiographies were recorded at baseline, the immediate period, and 4 weeks later. Animals were euthanized and arteries collected for histological analysis and immunohistochemical staining. Protein expression of proliferating cell nuclear antigen (PCNA) and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) p65 of the vessel samples were analyzed using Western blotting. Results No difference existed in the baseline lesion characteristics or procedural results. Angiographic follow-up was successfully performed on 18 rabbits (TCB: n=20, PBA: n=16), except for 3 deaths related to the operation. Treatment with TCB was superior to that with PBA, with lower late lumen loss (0.45±0.23 vs. 0.84±0.17 mm, P<0.01). Pathological analysis confirmed the efficiency of TCB through decreasing the area stenosis rate compared with PBA (46.48%±8.22% vs. 75.24%±6.10%, P<0.01). As determined by Western blotting, significant reductions occurred in PCNA and NF-κB p65 protein intensity in the TCB group versus the PBA group (all P<0.01). TCB efficiently mitigated restenosis in the rabbit iliac artery model. Conclusions This study elucidated that TCB could restrain intimal hyperplasia of vessels by inhibiting the activation of the NF-κB pathway to reduce inflammatory response and decrease the rate of cell proliferation through suppressing PCNA expression.
Collapse
Affiliation(s)
- Lijuan Chen
- Department of Cardiology, Zhongda Hospital Affiliated to Southeast University, Nanjing 210009, China
| | - Si Pang
- Department of Cardiology, Zhongda Hospital Affiliated to Southeast University, Nanjing 210009, China
| | - Chunshu Hao
- Department of Cardiology, Zhongda Hospital Affiliated to Southeast University, Nanjing 210009, China
| | - Aiming Xie
- Department of Cardiology, Zhongda Hospital Affiliated to Southeast University, Nanjing 210009, China
| | - Kongbo Zhu
- Department of Cardiology, Zhongda Hospital Affiliated to Southeast University, Nanjing 210009, China
| | - Yanru He
- Department of Cardiology, Zhongda Hospital Affiliated to Southeast University, Nanjing 210009, China
| | - Xiaoguo Zhang
- Department of Cardiology, Zhongda Hospital Affiliated to Southeast University, Nanjing 210009, China
| | - Wenbing Lu
- Department of Cardiology, Zhongda Hospital Affiliated to Southeast University, Nanjing 210009, China
| | - Genshan Ma
- Department of Cardiology, Zhongda Hospital Affiliated to Southeast University, Nanjing 210009, China
| | - Zhong Chen
- Department of Cardiology, Shanghai University of Medicine and Health Sciences Affiliated Sixth People's Hospital East, Shanghai 201306, China.,Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| |
Collapse
|
20
|
Rissanen TT, Uskela S, Eränen J, Mäntylä P, Olli A, Romppanen H, Siljander A, Pietilä M, Minkkinen MJ, Tervo J, Kärkkäinen JM. Drug-coated balloon for treatment of de-novo coronary artery lesions in patients with high bleeding risk (DEBUT): a single-blind, randomised, non-inferiority trial. Lancet 2019; 394:230-239. [PMID: 31204115 DOI: 10.1016/s0140-6736(19)31126-2] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/10/2019] [Accepted: 04/15/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND The optimal technique of percutaneous coronary intervention in patients at high bleeding risk is not known. The hypothesis of the DEBUT trial was that percutaneous coronary intervention with drug-coated balloons is non-inferior to percutaneous coronary intervention with bare-metal stents for this population. METHODS The DEBUT trial is a randomised, single-blind non-inferiority trial done at five sites in Finland. Patients were eligible if they had an ischaemic de-novo lesion in a coronary artery or bypass graft that could be treated with drug-coated balloons, at least one risk factor for bleeding, and a reference vessel diameter of 2·5-4·0 mm. Those with myocardial infarction with ST-elevation, bifurcation lesions needing a two-stent technique, in-stent restenosis, and flow-limiting dissection or substantial recoil (>30%) of the target lesion after predilation were excluded. After successful predilation of the target lesion, patients were randomly assigned (1:1), by use of a computer-generated random sequence, to percutaneous coronary intervention with a balloon coated with paclitaxel and iopromide or a bare-metal stent. The primary outcome was major adverse cardiac events at 9 months. Non-inferiority was shown if the absolute risk difference was no more than 3%. All prespecified analyses were done in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT01781546. FINDINGS Between May 22, 2013, and Jan 16, 2017, 220 patients were recruited for the study and 208 patients were assigned to percutaneous coronary intervention with drug-coated balloon (n=102) or bare metal stent (n=106). At 9 months, major adverse cardiac events had occurred in one patient (1%) in the drug-coated balloon group and in 15 patients (14%) in the bare-metal stent group (absolute risk difference -13·2 percentage points [95% CI -6·2 to -21·1], risk ratio 0·07 [95% CI 0·01 to 0·52]; p<0·00001 for non-inferiority and p=0·00034 for superiority). Two definitive stent thrombosis events occurred in the bare metal stent group but no acute vessel closures in the drug-coated balloon group. INTERPRETATIONS Percutaneous coronary intervention with drug-coated balloon was superior to bare-metal stents in patients at bleeding risk. The drug-coated balloon-only coronary intervention is a novel strategy to treat this difficult patient population. Comparison of this approach to the new generation drug-eluting stents is warranted in the future. FUNDING B Braun Medical AG, AstraZeneca, and Competitive State Research Funding of the Kuopio University Hospital Catchment Area.
Collapse
Affiliation(s)
- Tuomas T Rissanen
- Heart Center, North Karelia Central Hospital, Siunsote, Joensuu, Finland.
| | - Sanna Uskela
- Heart Center, North Karelia Central Hospital, Siunsote, Joensuu, Finland
| | - Jaakko Eränen
- Heart Center, North Karelia Central Hospital, Siunsote, Joensuu, Finland
| | - Pirjo Mäntylä
- Heart Center, North Karelia Central Hospital, Siunsote, Joensuu, Finland
| | - Annika Olli
- Heart Center, Lapland Central Hospital, Rovaniemi, Finland
| | | | | | - Mikko Pietilä
- Heart Center, Turku University Hospital, Turku, Finland
| | - Mikko J Minkkinen
- Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Jerry Tervo
- Heart Center, North Karelia Central Hospital, Siunsote, Joensuu, Finland
| | | |
Collapse
|
21
|
Megaly M, Saad M, Brilakis ES. Role of Drug-coated Balloons in Small-vessel Coronary Artery Disease. US CARDIOLOGY REVIEW 2019. [DOI: 10.15420/usc.2019.4.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Percutaneous coronary intervention of small-vessel coronary artery disease (SVD) remains challenging due to difficulties with device delivery and high restenosis rate, even with the use of newer-generation drug-eluting stents. Drug-coated balloons represent an attractive emerging percutaneous coronary intervention option in patients with SVD. Potential advantages of drug-coated balloons in SVD include enhanced deliverability because of their small profile, avoidance of foreign-body implantation, and shorter duration of dual antiplatelet therapy.
Collapse
Affiliation(s)
- Michael Megaly
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN; Division of Cardiovascular Medicine, Hennepin Healthcare, Minneapolis, MN
| | - Marwan Saad
- Division of Cardiovascular Medicine, Department of Medicine, University of Arkansas, Little Rock, AR; Department of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt
| | | |
Collapse
|
22
|
Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferović PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. EUROINTERVENTION 2019; 14:1435-1534. [PMID: 30667361 DOI: 10.4244/eijy19m01_01] [Citation(s) in RCA: 300] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Franz-Josef Neumann
- Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Venetsanos D, Lawesson SS, Panayi G, Tödt T, Berglund U, Swahn E, Alfredsson J. Long-term efficacy of drug coated balloons compared with new generation drug-eluting stents for the treatment of de novo coronary artery lesions. Catheter Cardiovasc Interv 2018; 92:E317-E326. [PMID: 29481718 DOI: 10.1002/ccd.27548] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 01/12/2018] [Accepted: 01/27/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Studies comparing drug coated balloons (DCB) with new generation drug-eluting stents (nDES) for the treatment of de novo coronary artery lesions are lacking. METHODS From 2009 to 2016, DCB or nDES used for treatment of de novo coronary lesions at our institution were included, in total 1,197 DEB and 6,458 nDES. We evaluated target lesions restenosis (TLR) and definite target lesion thrombosis (TLT). Propensity score modeling were utilized to study adjusted associations between treatment and outcomes. RESULTS Median follow-up was 901days. DCB patients were older, with higher cardiovascular risk profile. Bailout stenting after DCB was performed in 8% of lesions. The cumulative rate of TLR and TLT was 7.0 vs. 4.9% and 0.2 vs. 0.8% for DCB vs. nDES, respectively. Before adjustment, DCB was associated with a higher risk of TLR [hazard ratio (HR) 1.44; 95% confidence interval (CI) 1.07-1.94] and a non-significantly lower risk of TLT (HR 0.30; 95% CI 0.07-1.24), compared to nDES. In the propensity matched population consisted of 1,197 DCB and 1,197 nDES, treatment with DCB was associated with similar risk for TLR (adjusted HR 1.05; 95% CI 0.72-1.53) but significantly lower risk for TLT (adjusted HR 0.18; 95% CI 0.04-0.82) compared to nDES. CONCLUSIONS Treatment with DCB was associated with a similar risk of TLR and a lower risk of definite TLT compared with nDES. In selected cases, DCB appears as a good alternative to nDES for the treatment of de novo coronary lesions.
Collapse
Affiliation(s)
- Dimitrios Venetsanos
- Department of Cardiology, Linköping University, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Sofia Sederholm Lawesson
- Department of Cardiology, Linköping University, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Georgios Panayi
- Department of Cardiology, Linköping University, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Tim Tödt
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Ulf Berglund
- Department of Cardiology, Linköping University, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Eva Swahn
- Department of Cardiology, Linköping University, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Joakim Alfredsson
- Department of Cardiology, Linköping University, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
24
|
Uskela S, Kärkkäinen JM, Eränen J, Siljander A, Mäntylä P, Mustonen J, Rissanen TT. Percutaneous coronary intervention with drug‐coated balloon‐only strategy in stable coronary artery disease and in acute coronary syndromes: An all‐comers registry study. Catheter Cardiovasc Interv 2018; 93:893-900. [DOI: 10.1002/ccd.27950] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 09/16/2018] [Accepted: 10/08/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Sanna Uskela
- Heart CenterCentral Hospital of North Karelia Joensuu Finland
| | | | - Jaakko Eränen
- Heart CenterCentral Hospital of North Karelia Joensuu Finland
| | | | - Pirjo Mäntylä
- Heart CenterCentral Hospital of North Karelia Joensuu Finland
| | - Juha Mustonen
- Heart CenterCentral Hospital of North Karelia Joensuu Finland
| | | |
Collapse
|
25
|
Meneguz-Moreno RA, Ribamar Costa J, Abizaid A. Drug-Coated Balloons: Hope or Hot Air: Update on the Role of Coronary DCB. Curr Cardiol Rep 2018; 20:100. [PMID: 30171374 DOI: 10.1007/s11886-018-1025-4] [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] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW The present manuscript reviews the mechanism of action of drug-coated balloons (DCBs), offering a brief summary of the main clinical evidence on these devices. RECENT FINDINGS DCBs are regular semi-compliant balloons coated with antiproliferative agents that are rapidly released on contact with the vessel intima, exerting an anti-restenotic effect. This technology may offer some benefits of drug-eluting stents, in particular for the treatment of restenotic lesions, small vessels, and in patients at high-bleeding risk, when the prolonged dual antiplatelet regimen should be avoided. Most recent data have pointed to a possible benefit of these devices in treating bare metal stents (BMS) or drug-eluting stents in-stent restenosis (DES ISR), effectively reducing the recurrence of restenosis and avoiding additional layers of metal in the same coronary segment. In other clinical scenarios such as bifurcations, small vessels, and de novo lesions, data is more scarce and the benefits are still unclear. There are potential benefits related to the use of DCB in selected populations. However, larger clinical trials with longer follow-up are still needed to confirm the enthusiastic initial results.
Collapse
Affiliation(s)
- Rafael A Meneguz-Moreno
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, Av. Dr. Dante Pazzanese, 500 - Vila Mariana, São Paulo, SP, 04012-180, Brazil.,Department of Medicine, Universidade Federal de Sergipe, Aracaju, Sergipe, Brazil
| | - J Ribamar Costa
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, Av. Dr. Dante Pazzanese, 500 - Vila Mariana, São Paulo, SP, 04012-180, Brazil
| | - Alexandre Abizaid
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, Av. Dr. Dante Pazzanese, 500 - Vila Mariana, São Paulo, SP, 04012-180, Brazil. .,Hospital Sírio Libanês, São Paulo, Brazil.
| |
Collapse
|
26
|
Sousa-Uva M, Neumann FJ, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferovic PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur J Cardiothorac Surg 2018; 55:4-90. [PMID: 30165632 DOI: 10.1093/ejcts/ezy289] [Citation(s) in RCA: 347] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
|
27
|
Lunardi M, Zivelonghi C, van den Brink FS, Ghione M, Vinco G, Benfari G, Scarsini R, Ribichini F, Agostoni P. Drug eluting balloon for the treatment of patients with coronary artery disease: Current perspectives. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:215-220. [DOI: 10.1016/j.carrev.2017.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/03/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
|
28
|
Bukka M, Rednam PJ, Sinha M. Drug-eluting balloon: design, technology and clinical aspects. ACTA ACUST UNITED AC 2018; 13:032001. [PMID: 29227279 DOI: 10.1088/1748-605x/aaa0aa] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A drug-eluting balloon is a non-stent technology in which the effective homogenous delivery of anti-proliferative drugs is processed by the vessel wall through an inflated balloon. This is done to restore luminal vascularity in order to treat atherosclerosis, in-stent restenosis and reduce the risk of late thrombosis without implanting a permanent foreign object. The balloon technology relies on the concept of targeted drug delivery, which helps in the rapid healing of the vessel wall and prevents the proliferation of smooth muscle cells. Several drug eluting devices in the form of coated balloons are currently in clinical use, namely DIOR®, PACCOCATH®, SeQuent®Please and IN.PACT™. The device varies in terms of the material used for making the balloon, the coating techniques, the choice of coated drug and the release pattern of the drug at the site. This review gives an insight into the evolution, rationale and comparison of the marketed drug-eluting balloons. Here, different coating techniques have been analysed for the application and critical analysis of available DEB technologies, and a technical comparison has been done.
Collapse
Affiliation(s)
- Meenasree Bukka
- Department of Medical Devices, National Institute of Pharmaceutical Education and Research, Ahmedabad (NIPER-A) Palaj, Opp. Air Force Station, Gandhinagar-382355, Gujarat, India
| | | | | |
Collapse
|
29
|
Nef HM, Abdel-Wahab M, Achenbach S, Joner M, Levenson B, Mehilli J, Möllmann H, Thiele H, Zahn R, Zeus T, Elsässer A. Medikamentenfreisetzende Koronarstents/-scaffolds und medikamentenbeschichtete Ballonkatheter. DER KARDIOLOGE 2018. [DOI: 10.1007/s12181-017-0202-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
30
|
Pleva L, Kukla P, Zapletalova J, Hlinomaz O. Efficacy of a seal-wing paclitaxel-eluting balloon catheters in the treatment of bare metal stent restenosis. BMC Cardiovasc Disord 2017. [PMID: 28651572 PMCID: PMC5485564 DOI: 10.1186/s12872-017-0602-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background Our study aimed to compare the efficacy of seal-wing paclitaxel-eluting balloon catheters (PEB) with iopromide-coated PEB and everolimus-eluting stents (EES) for treating bare metal stent restenosis (BMS-ISR). Methods We enrolled 64 patients with 69 BMS-ISR. The control group comprised patients from the iopromide-PEB and EES arms of a previous TIS study. The primary end-point was 12-month in-segment late lumen loss (LLL). Secondary end-points included incidence of binary in-stent restenosis and 12-month major adverse cardiac events (MACE). Results Compared to iopromide-coated PEB, seal-wing PEB was associated with significantly higher 12-month LLL (0.30 vs. 0.02 mm; p < 0.0001), repeated binary restenosis (28.12% vs. 8.7%; p = 0.012), 12-month MACE (26.98% vs. 10.29%; p = 0.003), and target vessel revascularization (TVR; 20.63% vs. 7.35%; p = 0.009). Compared to EES, no significant differences were found in the 12-month LLL (0.30 vs. 0.19 mm; p = 1.000), repeated binary restenosis (28.12% vs. 19.12%; p = 0.666), 12-month MACE (26.98% vs. 19.12%; p = 0.102) or TVR (20.63% vs. 16.18%; p = 0.360). Conclusion BMS-ISR treatment using seal-wing PEB led to significantly higher 12-month LLL, repeated binary restenosis, MACE, and TVR compared to iopromide-coated PEB. However, no significant differences were found in comparison with EES. Trial registration ClinicalTrials.gov; NCT01735825
Collapse
Affiliation(s)
- Leos Pleva
- Department of Cardiovascular Diseases, University Hospital Ostrava, tr. 17. listopadu 1790, 708 52, Ostrava, Czech Republic.
| | - Pavel Kukla
- Department of Cardiovascular Diseases, University Hospital Ostrava, tr. 17. listopadu 1790, 708 52, Ostrava, Czech Republic
| | - Jana Zapletalova
- Department of Medical Biophysics, Palacky University, Hněvotínská 3, 775 15, Olomouc, Czech Republic
| | - Ota Hlinomaz
- Department of Cardioangiology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Pekařská 664/53, Brno, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| |
Collapse
|
31
|
Contemporary use of drug-coated balloons in coronary artery disease: Where are we now? Arch Cardiovasc Dis 2017; 110:259-272. [DOI: 10.1016/j.acvd.2017.01.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 01/03/2017] [Accepted: 01/04/2017] [Indexed: 11/24/2022]
|
32
|
Lu W, Zhu Y, Han Z, Wang X, Wang X, Qiu C. Drug-coated balloon in combination with bare metal stent strategy for de novo coronary artery disease: A PRISMA-compliant meta-analysis of randomized clinical trials. Medicine (Baltimore) 2017; 96:e6397. [PMID: 28328833 PMCID: PMC5371470 DOI: 10.1097/md.0000000000006397] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Studies examining the efficiency of drug-coated balloon (DCB) + bare metal stent (BMS) compared with stents alone for de novo lesions have reported inconsistent results. The present comprehensive meta-analysis of randomized controlled trials (RCTs) assessed and compared the clinical efficacy and safety of DCB + BMS with those of stents alone for de novo coronary artery disease. METHODS We formally searched electronic databases before September 2016 to identify potential studies. All RCTs were eligible for inclusion if they compared DCB + BMS with a control treatment (drug-eluting stent [DES] alone or BMS alone) in patients with de novo coronary artery disease. RESULTS Eleven RCTs with a total of 2196 patients met the inclusion criteria were included in our meta-analysis. Subgroup analysis indicated DCB plus BMS was associated with poorer outcomes when compared with DES alone in primary endpoint {(in-segment late lumen loss [LLL]: mean difference [MD], 0.19; 95% confidence interval [CI], 0.06-0.32; P = 0.0042) and (major adverse cardiovascular events [MACEs]: risk ratio [RR], 1.88; 95% CI, 1.44-2.45; P < 0.0001)}. However, DCB + BMS had nonsignificantly lower LLL than BMS alone (in-segment LLL: MD, -0.14; 95% CI, -0.33-0.04; P = 0.24), and was more advantageous in reducing MACE incidence, with borderline significance (MACEs: RR, 0.67; 95% CI, 0.45-0.99; P = 0.05). CONCLUSIONS In summary, the present results do not favor the DCB + BMS strategy as an alternative therapeutic method to DES implantation for de novo coronary artery lesions in percutaneous coronary intervention (PCI). Additional well-designed large RCTs with long-follow-up periods are required to clarify the inconsistent results.
Collapse
|
33
|
Rissanen TT, Uskela S, Siljander A, Kärkkäinen JM, Mäntylä P, Mustonen J, Eränen J. Percutaneous Coronary Intervention of Complex Calcified Lesions With Drug-Coated Balloon After Rotational Atherectomy. J Interv Cardiol 2017; 30:139-146. [PMID: 28116778 DOI: 10.1111/joic.12366] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES We investigated the safety and efficacy of PCI using drug-coated balloon (DCB) after rotational atherectomy (rotablation) in a retrospective single center study in patients with calcified de novo coronary lesions. The majority of patients had an increased risk for bleeding. BACKGROUND DCB has been effective in the treatment of in-stent restenosis, small vessels, and bifurcations. DCB enables short one month dual antiplatelet treatment. No published data exist on the use of DCB after rotablation. METHODS 82 PCIs were performed in 65 patients (mean age 72 ± 10 years) using rotablation followed by DCB treatment. The median follow-up time was 17 months. 82% of the patients had at least one risk factor for bleeding such as oral anticoagulation. 32% had an acute coronary syndrome. Median duration of dual antiplatelet treatment was 1 month. RESULTS MACE (the composite of cardiovascular death, ischemia-driven target-lesion revascularization [TLR] or non-fatal myocardial infarction) occurred in 14% and 20% of the patients at 12 and 24 months, respectively. The rate of ischemia-driven TLR was 1.5% at 12 months and 3.0% at 24 months. No acute closure of the treated vessel occurred. Bailout stenting was needed in 10% of the PCIs. The incidence of significant bleeding was 9% at 12 months. CONCLUSIONS This is the first study to show that PCI using DCB after preparation of calcified lesions with rotablation is safe and effective. This novel strategy may be considered especially in patients with a bleeding risk such as those using an oral anticoagulant.
Collapse
Affiliation(s)
| | - Sanna Uskela
- Heart Center, Central Hospital of North Karelia, Joensuu, Finland
| | | | | | - Pirjo Mäntylä
- Heart Center, Central Hospital of North Karelia, Joensuu, Finland
| | - Juha Mustonen
- Heart Center, Central Hospital of North Karelia, Joensuu, Finland
| | - Jaakko Eränen
- Heart Center, Central Hospital of North Karelia, Joensuu, Finland
| |
Collapse
|
34
|
Femoropopliteal In-stent Restenosis Repair: Midterm Outcomes After Paclitaxel Eluting Balloon Use (PLAISIR Trial). Eur J Vasc Endovasc Surg 2017; 53:106-113. [DOI: 10.1016/j.ejvs.2016.10.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 10/09/2016] [Indexed: 11/22/2022]
|
35
|
Seeger J, Markovic S, Birkemeyer R, Rittger H, Jung W, Brachmann J, Rottbauer W, Wöhrle J. Paclitaxel-coated balloon plus bare-metal stent for de-novo coronary artery disease: final 5-year results of a randomized prospective multicenter trial. Coron Artery Dis 2016; 27:84-8. [PMID: 26479969 DOI: 10.1097/mca.0000000000000314] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The PERfECT Stent Study compared paclitaxel-coated balloon (PCB) angioplasty plus bare-metal stent (BMS) implantation with BMS alone in de-novo lesions in native coronary artery disease. Angiographic follow-up after 6 months showed the superiority of the additional PCB. We evaluated a potential late catch-up phenomenon with the use of PCB. METHODS AND RESULTS In the prospective, multicenter, single-blind, randomized PERfECT Stent trial, 120 patients were assigned to either PCB angioplasty plus BMS implantation or BMS alone. For BMS, the endothelial progenitor cell capturing stent was used. Dual antiplatelet therapy was recommended for 3 months. The clinical endpoint for 5-year follow-up was a composite of cardiac death, myocardial infarction attributed to the target vessel, or target lesion revascularization. The follow-up rate after 5 years was 97%. Baseline and procedural characteristics did not differ. At the 5-year follow-up, clinically driven target lesion revascularization was 23.2% in the BMS group versus 15% with PCB plus BMS (P=0.26). The clinical endpoint (major adverse cardiac event) was 30.4% with BMS and with 23.5% lower with PCB plus BMS. No definite or probable stent thrombosis was found in either group with a dual antiplatelet therapy for 3 months for the total period. CONCLUSION PCB angioplasty plus BMS was superior to BMS alone for the treatment of de-novo lesions. The combined clinical endpoint was lower with PCB plus BMS at 6 months and remained lower after 5 years. There was no late catch-up phenomenon (http://www.clinicaltrials.gov; NCT 00732953).
Collapse
Affiliation(s)
- Julia Seeger
- aDepartment of Internal Medicine II and Cardiology, University of Ulm bHerzklinik Ulm, Ulm cKlinikum Fürth, Fürth dDepartment of Internal Medicine III, Schwarzwald-Baar Klinikum, Villingen-Schwenningen eDepartment of Internal Medicine II, Klinikum Coburg, Coburg, Germany
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Herten M, Torsello GB, Schönefeld E, Stahlhoff S. Critical appraisal of paclitaxel balloon angioplasty for femoral-popliteal arterial disease. Vasc Health Risk Manag 2016; 12:341-56. [PMID: 27621646 PMCID: PMC5010165 DOI: 10.2147/vhrm.s81122] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Peripheral arterial disease, particularly critical limb ischemia, is an area with urgent need for optimized therapies because, to date, vascular interventions often have limited life spans. In spite of initial encouraging technical success after femoropopliteal percutaneous transluminal angioplasty or stenting, postprocedural restenosis remains the major problem. The challenging idea behind the drug-coated balloon (DCB) concept is the biological modification of the injury response after balloon dilatation. Antiproliferative drugs administered via DCBs or drug-eluting stents are able to suppress neointimal hyperplasia, the main cause of restenosis. This article reviews the results of DCB treatments of femoropopliteal and infrapopliteal lesions in comparison to standard angioplasty with uncoated balloons. A systematic literature search was performed in 1) medical journals (ie, MEDLINE), 2) international registers for clinical studies (ie, www.clinicaltrials.gov), and 3) abstracts of scientific sessions. Several controlled randomized trials with follow-up periods of up to 5 years demonstrated the efficacy of paclitaxel –DCB technology. However, calcified lesions seem to affect the efficacy of DCB. Combinations of preconditioning methods with DCBs showed promising results. Although the mechanical abrasion of calcium via atherectomy or laser ablation showed favorable periprocedural results, the long-term impact on restenosis and clinical outcome has to be demonstrated. Major advantages of the DCBs are the rapid delivery of drug at uniform concentrations with a single dose, their efficacy in areas wherein stents have been contraindicated until now (ie, bifurcation, ostial lesions), and in leaving no stent scaffold behind. Reinterventions are easier to perform because DCBs leave no metal behind. Various combinations of DCBs with other treatment modalities may prove to be viable options in future. The follow-up results of clinical studies will evaluate the long-term impact of DCBs.
Collapse
Affiliation(s)
- Monika Herten
- Department of Vascular and Endovascular Surgery, University Hospital Münster
| | - Giovanni B Torsello
- Department of Vascular and Endovascular Surgery, University Hospital Münster; Department of Vascular Surgery, St Franziskus Hospital, Münster
| | - Eva Schönefeld
- Institute for Education and Student Affairs, University Hospital Münster, Münster, Germany
| | | |
Collapse
|
37
|
Richelsen RKB, Overvad TF, Jensen SE. Drug-Eluting Balloons in the Treatment of Coronary De Novo Lesions: A Comprehensive Review. Cardiol Ther 2016; 5:133-160. [PMID: 27384194 PMCID: PMC5125107 DOI: 10.1007/s40119-016-0064-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Indexed: 01/03/2023] Open
Abstract
Drug-eluting balloons (DEBs) have emerged as a new application in percutaneous coronary intervention. DEBs have proven successful in the treatment of in-stent restenosis, but their role in de novo lesions is less clear. This paper provides a review of the current studies where DEBs have been used in coronary de novo lesions, either as part of a DEB-only strategy or in combination with another device, mainly a bare metal stent (BMS). By searching Pubmed and Embase we were able to identify 52 relevant studies, differing in design, intervention, and clinical setting, including patients with small vessel disease, bifurcation lesions, complex long lesions, acute myocardial infarction, diabetes mellitus, and elderly. In 23 studies, a DEB was combined with a BMS, 25 studies used a DEB-only strategy with only provisional BMS implantation, and four studies combined a DEB with a drug-eluting stent (DES). In the vast majority of studies, DEB in combination with BMS does not seem to improve clinical or angiographic outcome compared with DES, whereas a DEB-only strategy seems promising, especially when predilatation and geographical mismatch are taken into account. A lower risk of recurrent thrombosis with DEB compared with DES is not evident from the current studies. In conclusion, the main indication for DEB seems to be small vessel disease, especially in clinical scenarios in which a contraindication to dual antiplatelet therapy exists. The main approach should be a DEB-only strategy with only provisional bailout stenting, which has shown interesting results in different clinical scenarios. In general, larger randomized controlled studies with prolonged follow-up comparing DEB with best in class DES are warranted. Technical developments of DEBs including the use of different drugs might potentially improve the efficacy of such treatment.
Collapse
Affiliation(s)
| | - Thure Filskov Overvad
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Svend Eggert Jensen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| |
Collapse
|
38
|
Drug-eluting balloons in the treatment of de-novo coronary lesions: a meta-analysis of randomized-controlled trials. Coron Artery Dis 2016; 27:467-77. [PMID: 27100660 DOI: 10.1097/mca.0000000000000372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM The aim of this meta-analysis was to evaluate the efficacy of drug-eluting balloons (DEBs) plus bare-metal stents (BMS) for the treatment of de-novo coronary lesions. METHODS AND RESULTS Eleven trials involving 1279 patients were included in this study. The main endpoints were as follows: late lumen loss (LLL), binary restenosis, stent thrombosis (ST), and major adverse cardiovascular events (MACEs). The definition of MACEs was a composite of death, myocardial infarction (MI), and target lesion revascularization (TLR). Compared with BMS alone, DEB plus BMS showed a lower risk for LLL (P=0.007) and MACEs (P=0.010). There were no significant differences in binary restenosis (P=0.212), ST (P=0.199), death (P=0.141), MI (P=0.439), and TLR (P=0.340). Compared with drug-eluting stents (DES), DEB plus BMS could increase the risk of LLL (P=0.002) and MACEs (P=0.026). The risks of binary restenosis (P=0.113), ST (P=0.832), death (P=0.115), MI (P=0.831), and TLR (P=0.111) were similar between DEB plus BMS and DES. CONCLUSION DEB plus BMS was better than BMS alone in reducing LLL and MACEs, especially when dilatation was performed after stenting for de-novo coronary lesions, but it was inferior to DES. Therefore, the treatment strategy with DEB plus BMS should not be recommended for de-novo coronary lesions, except for patients who have contraindications for DES.
Collapse
|
39
|
Comparison of two different drug-coated balloons for the treatment of in-stent restenosis: A long-term single-centre experience. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:176-80. [DOI: 10.1016/j.carrev.2016.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 01/22/2016] [Accepted: 01/29/2016] [Indexed: 11/21/2022]
|
40
|
Cheng Y, Leon MB, Granada JF. An update on the clinical use of drug-coated balloons in percutaneous coronary interventions. Expert Opin Drug Deliv 2016; 13:859-72. [PMID: 26924794 DOI: 10.1517/17425247.2016.1154530] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Drug-coated balloons (DCB) promise to deliver anti-proliferative drugs and prevent restenosis leaving nothing behind. Although, randomized clinical trials have demonstrated their efficacy for the treatment of in-stent restenosis, clinical evidence supporting their use in other coronary applications is still lacking. AREAS COVERED This review summarizes the development status of clinically available DCB technologies and provides an update on the current data for their coronary use. EXPERT OPINION Current generation DCB prevent restenosis by delivering paclitaxel particles on the surface of the vessel wall. Although clinically available technologies share a common mechanism of action, important differences in pharmacokinetic behavior and safety profiles do exist. Future technological improvements include the development of coatings displaying: high transfer efficiency; low particle embolization potential; and alternative drug formulations. Optimized balloon-based delivery systems and drug encapsulation technologies also promise to improve the technical limitations of current generation DCB. Although proving clinical superiority against DES may prove to be difficult in mainstream applications (i.e., de novo), new generation DCB technologies have the potential to achieve a strong position in the interventional field in clinical settings in which the efficacy of DES use is not proven or justified (i.e., bifurcations).
Collapse
Affiliation(s)
- Yanping Cheng
- a CRF-Skirball Center for Innovation , Orangeburg , NY , USA
| | - Martin B Leon
- b Center for Interventional Vascular Therapy , Columbia University Medical Center , New York , NY , USA
| | - Juan F Granada
- a CRF-Skirball Center for Innovation , Orangeburg , NY , USA
| |
Collapse
|
41
|
Kleber FX, Rittger H, Ludwig J, Schulz A, Mathey DG, Boxberger M, Degenhardt R, Scheller B, Strasser RH. Drug eluting balloons as stand alone procedure for coronary bifurcational lesions: results of the randomized multicenter PEPCAD-BIF trial. Clin Res Cardiol 2016; 105:613-21. [DOI: 10.1007/s00392-015-0957-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 12/22/2015] [Indexed: 01/17/2023]
|
42
|
Nijhoff F, Stella PR, Troost MS, Belkacemi A, Nathoe HM, Voskuil M, Samim M, Doevendans PA, Agostoni P. Comparative assessment of the antirestenotic efficacy of two paclitaxel drug-eluting balloons with different coatings in the treatment of in-stent restenosis. Clin Res Cardiol 2015; 105:401-11. [PMID: 26541146 PMCID: PMC4841852 DOI: 10.1007/s00392-015-0934-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 10/19/2015] [Indexed: 11/17/2022]
Abstract
Background/objectives Preclinical investigations have suggested that coating technology is crucial for the efficacy of drug-eluting balloons (DEB). Aim of this study is to compare the antirestenotic efficacy of two paclitaxel DEB with different coatings in the treatment of in-stent restenosis (ISR) by means of a morphological and functional assessment. Methods In a single center, prospective, non-randomized study, the shellac-paclitaxel coated DIOR, and the urea-paclitaxel coated IN.PACT Falcon were compared in the setting of ISR. Quantitative angiography, fractional flow reserve (FFR), and optical coherence tomography (OCT) were performed at baseline, postprocedure and 6-month follow-up. Main endpoints were QCA, FFR and OCT-based parameters of restenosis. Results Forty-five patients were included, 20 (44 %) received treatment with the DIOR and 25 (56 %) with the IN.PACT Falcon. Angiographic and device success were 100 and 90 % for the DIOR, and 100 and 92 % for the IN.PACT Falcon, respectively. After 6-months, in-segment late lumen loss (−0.03 ± 0.43 vs. 0.36 ± 0.48 mm, p = 0.014) and diameter stenosis (30.7 ± 16.2 vs. 41.3 ± 22.6 %, p = 0.083) were lower for the IN.PACT Falcon. FFR distal of the stent was significantly higher in the IN.PACT Falcon group (0.92 ± 0.07 vs. 0.84 ± 0.13, p = 0.029) and in-stent FFR gradient was lower (0.05 ± 0.05 vs. 0.13 ± 0.12, p = 0.002). Between postprocedure and follow-up, a 16 % decrease in neointimal volume was observed for the IN.PACT Falcon, while a 30 % increase was observed for the DIOR (p = 0.006). Conclusions The IN.PACT Falcon DEB showed higher antirestenotic efficacy than the DIOR in the treatment of ISR, demonstrating that DEB with an excipient-based coating is not equally effective. Electronic supplementary material The online version of this article (doi:10.1007/s00392-015-0934-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Freek Nijhoff
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pieter R Stella
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maartje S Troost
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anouar Belkacemi
- Department of Cardiology, Isala Clinics, Zwolle, The Netherlands
| | - Hendrik M Nathoe
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mariam Samim
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pieter A Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pierfrancesco Agostoni
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands. .,Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435, CM, Nieuwegein, The Netherlands.
| |
Collapse
|
43
|
Jukema JW, Lettino M, Widimský P, Danchin N, Bardaji A, Barrabes JA, Cequier A, Claeys MJ, De Luca L, Dörler J, Erlinge D, Erne P, Goldstein P, Koul SM, Lemesle G, Lüscher TF, Matter CM, Montalescot G, Radovanovic D, Lopez-Sendón J, Tousek P, Weidinger F, Weston CF, Zaman A, Zeymer U. Contemporary registries on P2Y12 inhibitors in patients with acute coronary syndromes in Europe: overview and methodological considerations: Table 1. EUROPEAN HEART JOURNAL - CARDIOVASCULAR PHARMACOTHERAPY 2015; 1:232-244. [DOI: 10.1093/ehjcvp/pvv024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
|
44
|
Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A. 2014 ESC/EACTS guidelines on myocardial revascularization. EUROINTERVENTION 2015; 10:1024-94. [PMID: 25187201 DOI: 10.4244/eijy14m09_01] [Citation(s) in RCA: 211] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Stephan Windecker
- Cardiology, Bern University Hospital, Freiburgstrasse 4, CH-3010 Bern, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Herten M, Schönefeld E, Stahlhoff S, Schwindt A, Torsello GB. Drug-coated balloons in the treatment of femoro- and infra-popliteal lesions. Interv Cardiol 2015. [DOI: 10.2217/ica.15.32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
46
|
Burzotta F, Brancati MF, Trani C, Pirozzolo G, De Maria G, Leone AM, Niccoli G, Porto I, Prati F, Crea F. Impact of drug-eluting balloon (pre- or post-) dilation on neointima formation in de novo lesions treated by bare-metal stent: the IN-PACT CORO trial. Heart Vessels 2015; 31:677-86. [PMID: 25863804 DOI: 10.1007/s00380-015-0671-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 04/01/2015] [Indexed: 01/28/2023]
Abstract
UNLABELLED The efficacy of DEB in modifying the high restenosis risk associated with BMS implantation is doubtful. Optical coherence tomography (OCT) may allow precise assessment of neointimal formation after stent implantation. We performed a single-center, prospective, 1:2 randomized trial comparing BMS implantation alone (BMS group) vs. additional DEB (DEB group). DEB patients were further randomized 1:1 to DEB before stenting (pre-DEB group), or after stenting (post-DEB group). Primary endpoint was OCT-assessed neointimal hyperplasia (expressed both as mean in-stent neointimal area and as percentage obstruction of the mean stent area) at 6 months. Secondary endpoints were the percentage of uncovered and malapposed stent struts. Thirty patients were enrolled and randomized to BMS (n = 10), pre-DEB (n = 10), post-DEB (n = 10). At 6-month OCT follow-up, DEB significantly reduced neointimal area compared with BMS: mean neointimal area 2.01 ± 0.89 vs. 3.03 ± 1.07 mm(2) (p = 0.02), percentage area obstruction 24.56 ± 12.50 vs. 37.51 ± 12.26 % (p = 0.02). The percentage of uncovered and malapposed stent struts did not differ significantly between BMS and DEB. In the comparison between pre-DEB and post-DEB, no significant difference was observed for both primary and secondary endpoints. In de novo coronary lesions treated with BMS, DEB use could be associated with a mild reduction in neointimal hyperplasia at 6 months; this effect could be unrelated to the timing of DEB dilation (pre- or post-stenting). CLINICAL TRIAL REGISTRATION INFORMATION http://www.clinicaltrials.gov . Identifier: NCT01057563.
Collapse
Affiliation(s)
- Francesco Burzotta
- Institute of Cardiology, Catholic University of the Sacred Heart, L.Go Gemelli 1, 00168, Rome, Italy.
| | - Marta Francesca Brancati
- Institute of Cardiology, Catholic University of the Sacred Heart, L.Go Gemelli 1, 00168, Rome, Italy
| | - Carlo Trani
- Institute of Cardiology, Catholic University of the Sacred Heart, L.Go Gemelli 1, 00168, Rome, Italy
| | - Giancarlo Pirozzolo
- Institute of Cardiology, Catholic University of the Sacred Heart, L.Go Gemelli 1, 00168, Rome, Italy
| | - Gianluigi De Maria
- Institute of Cardiology, Catholic University of the Sacred Heart, L.Go Gemelli 1, 00168, Rome, Italy
| | - Antonio Maria Leone
- Institute of Cardiology, Catholic University of the Sacred Heart, L.Go Gemelli 1, 00168, Rome, Italy
| | - Giampaolo Niccoli
- Institute of Cardiology, Catholic University of the Sacred Heart, L.Go Gemelli 1, 00168, Rome, Italy
| | - Italo Porto
- Cardiovascular Department, San Donato Hospital, Arezzo, Italy
| | - Francesco Prati
- Department of Interventional Cardiology, San Giovanni Hospital, Rome, Italy
| | - Filippo Crea
- Institute of Cardiology, Catholic University of the Sacred Heart, L.Go Gemelli 1, 00168, Rome, Italy
| |
Collapse
|
47
|
Naganuma T, Latib A, Sgueglia GA, Menozzi A, Castriota F, Micari A, Cremonesi A, De Felice F, Marchese A, Tespili M, Presbitero P, Panoulas VF, Buffoli F, Tamburino C, Varbella F, Colombo A. A 2-year follow-up of a randomized multicenter study comparing a paclitaxel drug-eluting balloon with a paclitaxel-eluting stent in small coronary vessels the BELLO study. Int J Cardiol 2015; 184:17-21. [DOI: 10.1016/j.ijcard.2015.01.080] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 01/24/2015] [Indexed: 10/24/2022]
|
48
|
Abstract
Randomized clinical trials provide the foundation of clinical evidence to guide physicians in their selection of treatment options. Importantly, randomization is the only reliable method to control for confounding factors when comparing treatment groups. However, randomized trials have limitations, including the increasingly prohibitive costs of conducting adequately powered studies. Local and national regulatory requirements, delays in approval, and unnecessary trial processes have led to increased costs and decreased efficiency. Another limitation is that clinical trials involve selected patients who are treated according to protocols that might not represent real-world practice. A possible solution is registry-based randomized clinical trials. By including a randomization module in a large inclusive clinical registry with unselected consecutive enrolment, the advantages of a prospective randomized trial can be combined with the strengths of a large-scale all-comers clinical registry. We believe that prospective registry-based randomized clinical trials are a powerful tool for conducting studies efficiently and cost-effectively.
Collapse
|
49
|
Sgueglia GA, Scheller B. Learning from mistakes: The case of drug-coated balloons. Int J Cardiol 2015; 182:224-6. [DOI: 10.1016/j.ijcard.2014.11.139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 11/23/2014] [Indexed: 10/24/2022]
|
50
|
Mamuti W, Jiamali A, Rao F, Zhang W, Pei X, Ablimit A, Kelimu W, Zhang F. Drug-coated balloon angioplasty for drug-eluting stent restenosis: insight from randomized controlled trials. Ann Med 2014; 46:679-83. [PMID: 25134953 DOI: 10.3109/07853890.2014.952329] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The best treatment option for drug-eluting stent (DES) restenosis has not been established. We performed a meta-analysis to assess the clinical efficacy of drug-coated balloon (DCB) for the treatment of DES restenosis. METHODS Trials were identified through a literature search from January 2005 through April 2014. All randomized controlled trials were eligible for inclusion if they compared DCB with a control treatment (plain old balloon angioplasty [POBA] or DES) in patients with DES restenosis. RESULTS Five studies and a total of 864 patients were included in this analysis. Most end-points were significantly reduced for DCB compared with the control groups. For major adverse cardiac events, the relative risk (RR) was 0.49 (P = 0.012); for target lesion revascularization, it was 0.50 (P = 0.044); for recurrent restenosis, it was 0.41 (P = 0.002). There was a lower mortality for DCB (RR 0.29; P = 0.017). The incidence of myocardial infarction was numerically lower, but without statistical significance (RR 0.76; P = 0.55). The DCB effect was more pronounced when compared with POBA than when compared with DES. CONCLUSIONS This meta-analysis showed that DCB was superior to POBA and comparable to DES for treatment of DES restenosis. The findings in this meta-analysis cannot be extrapolated to DCB in general, because all DCB used in trials included was a single brand of paclitaxel-coated balloon.
Collapse
Affiliation(s)
- Wahafu Mamuti
- Department of Cardiology, Kashgar Prefecture Second People's Hospital , Kashi, Xinjiang 844000 , China
| | | | | | | | | | | | | | | |
Collapse
|