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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
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Kahata M, Otsuka M, Watarai M, Inagaki Y, Ishii Y. Coronary aneurysm formation after paclitaxel-coated balloon angioplasty for in-stent restenosis of first-generation sirolimus-eluting stent implanted 9 years ago. Cardiovasc Interv Ther 2019; 34:386-387. [DOI: 10.1007/s12928-019-00570-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 01/07/2019] [Indexed: 11/30/2022]
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Otto S, Nitsche K, Jung C, Kryvanos A, Zhylka A, Heitkamp K, Gutiérrez-Chico JL, Goebel B, Schulze PC, Figulla HR, Poerner TC. Endothelial progenitor cells and plaque burden in stented coronary artery segments: an optical coherence tomography study six months after elective PCI. BMC Cardiovasc Disord 2017; 17:103. [PMID: 28441929 PMCID: PMC5405468 DOI: 10.1186/s12872-017-0534-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 04/08/2017] [Indexed: 02/03/2023] Open
Abstract
Background Endothelial progenitor cells (EPC) are involved in neovascularization and endothelial integrity. They might be protective in atherosclerosis. Optical coherence tomography (OCT) is a precise intracoronary imaging modality that allows assessment of subintimal plaque development. We evaluated the influence of EPC on coronary plaque burden in stable disease and implemented a novel computational plaque analysis algorithm using OCT. Methods Forty-three patients (69.8% males, 69.6 ± 7.7 years) were investigated by OCT during re-angiography 6 months after elective stent implantation. Different subpopulations of EPCs were identified by flow cytometry according to their co-expression of antigens (CD34+, CD133+, kinase domain receptor, KDR+). An algorithm was applied to calculate the underlying total plaque burden of the stented segments from OCT images. Plaque morphology was assessed according to international consensus in OCT imaging. Results A cumulative sub-strut plaque volume of 10.87 ± 12.7 mm3 and a sub-stent plaque area of 16.23 ± 17.0 mm2 were found within the stented vessel segments with no significant differences between different stent types. All EPC subpopulations (mean of EPC levels: CD34+/CD133+: 2.66 ± 2.0%; CD34+/KDR+: 7.50 ± 5.0%; CD34+/CD133+/KDR+: 1.12 ± 1.0%) inversely correlated with the identified underlying total plaque volume and plaque area (p ≤ 0.012). Conclusions This novel analysis algorithm allows for the first time comprehensive quantification of coronary plaque burden by OCT and illustration as spread out vessel charts. Increased EPC levels are associated with less sub-stent coronary plaque burden which adds to previous findings of their protective role in atherosclerosis.
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Affiliation(s)
- Sylvia Otto
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Kristina Nitsche
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Christian Jung
- Department of Cardiology, Pulmonology, University, Duesseldorf, Medical Faculty and Vascular Diseases, Düsseldorf, Germany
| | | | - Andrey Zhylka
- Belarusian State University, Faculty of Applied Mathematics and Computer Science, Minsk, Belarus
| | - Kerstin Heitkamp
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | | | - Björn Goebel
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - P Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Hans R Figulla
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Tudor C Poerner
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
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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.
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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.
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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
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Poerner TC, Duderstadt C, Goebel B, Kretzschmar D, Figulla HR, Otto S. Fractional flow reserve-guided coronary angioplasty using paclitaxel-coated balloons without stent implantation: feasibility, safety and 6-month results by angiography and optical coherence tomography. Clin Res Cardiol 2016; 106:18-27. [PMID: 27379610 PMCID: PMC5226992 DOI: 10.1007/s00392-016-1019-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 06/30/2016] [Indexed: 12/11/2022]
Abstract
Background Percutaneous coronary interventions (PCI) with drug-coated balloons (DCB) might be a promising trade-off between balloon angioplasty and drug-eluting stents, since DCB inhibit neointimal proliferation and limit duration of dual antiplatelet therapy. We investigated the safety, feasibility, and 6-month results of fractional flow reserve (FFR)-guided use of the paclitaxel-coated SeQuent Please® balloon without stenting for elective PCI of de novo lesions. Methods and results In 46 patients (54 lesions) with stable symptomatic coronary artery disease (CAD), a FFR-guided POBA (plain old balloon angioplasty) was performed. In case of a sufficient POBA result with residual stenosis < 40 %, FFR > 0.8 and no severe dissection, the target lesion was finally dilated using the DCB. Quantitative coronary angiography (QCA) was performed before and after the index procedure and at 6-month follow-up (f/u) to calculate late lumen loss (LLL) and net luminal gain (NLG). Optical coherence tomography (OCT) was performed at f/u to assess vascular remodeling. DCB-only treatment was applied to 43 patients (51 lesions), while 3 patients (3 lesions) needed provisional stenting. Invasive f/u was completed in 39 patients (47 lesions). At the stenotic site, the lumen diameter showed a trend toward progressive increase at f/u (LLL: −0.13 ± 0.44 mm, n.s.; NLG: 1.10 ± 0.53 mm, p < 0.001) without aneurysm formation or restenosis after DCB-only treatment. Conclusions FFR-guided DCB-only PCI of de novo lesions appeared feasible and safe in stable CAD with clopidogrel discontinuation after 4 weeks, showing a trend toward positive vessel remodeling without lumen loss at 6 months. Clinical trial registration http://www.clinicaltrials.gov. Unique identifier: NCT02120859 Electronic supplementary material The online version of this article (doi:10.1007/s00392-016-1019-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tudor C Poerner
- Division of Cardiology, 1st Department of Medicine, University Hospital of Jena, 07747, Jena, Germany
| | - Corinna Duderstadt
- Division of Cardiology, 1st Department of Medicine, University Hospital of Jena, 07747, Jena, Germany
| | - Björn Goebel
- Division of Cardiology, 1st Department of Medicine, University Hospital of Jena, 07747, Jena, Germany
| | - Daniel Kretzschmar
- Division of Cardiology, 1st Department of Medicine, University Hospital of Jena, 07747, Jena, Germany
| | - Hans R Figulla
- Division of Cardiology, 1st Department of Medicine, University Hospital of Jena, 07747, Jena, Germany
| | - Sylvia Otto
- Division of Cardiology, 1st Department of Medicine, University Hospital of Jena, 07747, Jena, Germany.
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