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Liu Y, Zhang B, Lv H, Zhu Y, Zhou X, Zhu H, Guo L. Drug-Coated Balloon for de-novo Coronary Artery Lesions Exceeding 2.5 mm in Diameter: Optical Coherence Tomography Analysis and Clinical Follow-Up. Int J Gen Med 2024; 17:225-236. [PMID: 38283074 PMCID: PMC10812136 DOI: 10.2147/ijgm.s451329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/18/2024] [Indexed: 01/30/2024] Open
Abstract
Objective To investigate the precise changes in the lumen and lesions, and clinical outcomes after DCB treatment for de-novo coronary lesions exceeding 2.5 mm in diameter through a detailed analysis of OCT. Methods This is a prospective study including 53 consecutive patients with 55 de-novo coronary lesions, who underwent DCB angioplasty-only between January 2021 and April 2022. Quantitative coronary angiography (QCA) and OCT were performed before percutaneous coronary interventions (PCI), immediately after PCI, and at 6-9 months follow-up after PCI. Target lesion failure (TLF) was the primary endpoint of the present study. Multivariate logistic regression analysis was performed to identify the predictors or risks for late lumen enlargement (LLE). Results A total of 52 patients were successfully treated with DCB. The median follow-up was 7 months, and the incidence of TLF was 7.5%. After the DCB procedure, 43 patients had their scheduled angiographic and OCT examination. QCA demonstrated that the late lumen loss was -0.79 ± 0.28 mm. OCT demonstrated LLE in 79.1% and dissection healing in 65.1% of lesions. After multivariable logistic analysis, type B dissection (odds ratio [OR] 2.92, 95% confidence interval [CI] 1.34-7.41, p = 0.037) was found to be a predictor of LLE, but lipid plaque (OR 0.09, 95% CI 0.01-0.63, p = 0.015) was a risk of LLE. Conclusion This is the first and largest prospective study to assess the outcomes of DCB treatment for de-novo coronary lesions exceeding 2.5 mm in diameter and the detection of significant vessel enlargement and dissection healing guide by OCT. DCB could be a novel, safe and effective treatment for de-novo coronary lesions exceeding 2.5 mm in diameter through a detailed analysis of OCT.
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Affiliation(s)
- Yuguo Liu
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Bo Zhang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Haichen Lv
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Yifan Zhu
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Xuchen Zhou
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Hao Zhu
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Lei Guo
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
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Gitto M, Sticchi A, Chiarito M, Novelli L, Leone PP, Mincione G, Oliva A, Condello F, Rossi ML, Regazzoli D, Gasparini G, Cozzi O, Stefanini GG, Condorelli G, Reimers B, Mangieri A, Colombo A. Drug-Coated Balloon Angioplasty for De Novo Lesions on the Left Anterior Descending Artery. Circ Cardiovasc Interv 2023; 16:e013232. [PMID: 37874646 DOI: 10.1161/circinterventions.123.013232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/25/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Drug-coated balloons (DCB) are an emerging tool for modern percutaneous coronary intervention (PCI), but evidence on their use for de novo lesions on large vessels is limited. METHODS Consecutive patients undergoing DCB-based PCI on the left anterior descending artery in 2 Italian centers from 2018 to 2022 were retrospectively enrolled and compared with patients who received left anterior descending PCI with contemporary drug-eluting stents (DES). In-stent restenosis was excluded. The DCB group included both patients undergoing DCB-only PCI and those receiving hybrid PCI with DCB and DES combined. The primary end point was target lesion failure at 2 years, defined as the composite of target lesion revascularization, cardiac death, and target vessel myocardial infarction. RESULTS We included 147 consecutive patients undergoing DCB-based treatment on the left anterior descending artery and compared them to 701 patients who received conventional PCI with DES. In the DCB group, 43 patients (29.2%) were treated with DCB only and 104 (70.8%) with a hybrid approach; DCB length was greater than stent length in 55.1% of cases. Total treated length was higher in the DCB group (65 [40-82] versus 56 [46-66] mm; P=0.002), while longer DESs were implanted (38 [24-62] versus 56 [46-66] mm; P<0.001) and a higher rate of large vessels were treated (76.2% versus 83.5%; P=0.036) in the DES cohort. The cumulative 2-year target lesion failure incidence was not significantly different between the 2 groups (DCB, 4.1% versus DES, 9.8%; hazard ratio, 0.51 [95% CI, 0.20-1.27]; P=0.15). After a 1:1 propensity score matching resulting in 139 matched pairs, the DCB-based treatment was associated with a lower risk for target lesion failure at 2 years compared with DES-only PCI (hazard ratio, 0.2 [95% CI, 0.07-0.58]; P=0.003), mainly driven by less target lesion revascularization. CONCLUSIONS A DCB-based treatment approach for left anterior descending revascularization allows a significantly reduced stent burden, thereby potentially limiting target lesion failure risk at midterm follow-up.
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Affiliation(s)
- Mauro Gitto
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Alessandro Sticchi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Mauro Chiarito
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Laura Novelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Pier Pasquale Leone
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Gianluca Mincione
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Angelo Oliva
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Francesco Condello
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | | | - Damiano Regazzoli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Gabriele Gasparini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Ottavia Cozzi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Giulio G Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Gianluigi Condorelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Bernhard Reimers
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- EMO-GVM Centro Cuore Columbus, Milan, Italy (M.L.R., A.C.)
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Kleber FX. Commentary: Dissection still a sticking point in the widespread use of DCB in PCI. Catheter Cardiovasc Interv 2023; 102:772-773. [PMID: 37483067 DOI: 10.1002/ccd.30778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/09/2023] [Indexed: 07/25/2023]
Abstract
Key Points
Dissection is judged as a major hurdle for a more widespread use of DCB
Vessel stretching by either overdilatation or by straightening of very tortuous vessel segments are the predominant avoidable or modifiable risk factors for major dissection during predilatation or during DCB application.
While aggressive (pre‐)dilatation reduces the risk of elastic recoil, it increases the number of severe dissections. The known effects of positive vessel remodeling (1,2) might allow a more gentle angioplasty with residual stenosis of up to 30 % after DCB application without negative effects on long term results (3).
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Affiliation(s)
- Franz X Kleber
- Academic Teaching Hospital, University Halle-Wittenberg, Halle, Germany
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Yamamoto T, Kawamori H, Toba T, Kakizaki S, Nakamura K, Fujimoto D, Sasaki S, Fujii H, Hamana T, Osumi Y, Iwane S, Naniwa S, Sakamoto Y, Matsuhama K, Fukuishi Y, Kozuki A, Shite J, Iwasaki M, Ishida A, Hirata KI, Otake H. Clinical impact of optical coherence tomography findings after drug-coated balloon treatment for patients with acute coronary syndromes. Int J Cardiol 2023; 387:131149. [PMID: 37423566 DOI: 10.1016/j.ijcard.2023.131149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/06/2023] [Accepted: 07/05/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Drug-coated balloon (DCB) became a potential treatment option for patients with acute coronary syndrome (ACS); however, factors associated with target lesion failure (TLF) remain uncertain. METHODS This retrospective, multicentre, observational study included consecutive ACS patients who underwent optical coherence tomography (OCT)-guided DCB treatment. Patients were divided into two groups according to the occurrence of TLF, a composite of cardiac death, target vessel-related myocardial infarction, and ischemia-driven target lesion revascularisation. RESULTS We enrolled 127 patients in this study. During the median follow-up period of 562 (IQR: 342-1164) days, 24 patients (18.9%) experienced TLF, and 103 patients (81.1%) did not. The cumulative 3-year incidence of TLF was 22.0%. The cumulative 3-year incidence of TLF was the lowest in patients with plaque erosion (PE) (7.5%), followed by those with rupture (PR) (26.1%) and calcified nodule (CN) (43.5%). Multivariable Cox regression analysis revealed that plaque morphology was independently associated with TLF on pre-PCI (percutaneous coronary intervention) OCT, and residual thrombus burden (TB) was positively associated with TLF on post-PCI OCT. Further stratification by post-PCI TB revealed a comparable incidence of TLF in patients with PR (4.2%) to that of PE if the culprit lesion had a smaller post-PCI TB than the cut-off value (8.4%). TLF incidence was high in patients with CN, regardless of TB size on post-PCI OCT. CONCLUSIONS Plaque morphology was strongly associated with TLF for ACS patients after DCB treatment. Residual TB post-PCI might be a key determinant for TLF, especially in patients with PR.
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Affiliation(s)
- Tetsuya Yamamoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroyuki Kawamori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takayoshi Toba
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shunsuke Kakizaki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koichi Nakamura
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daichi Fujimoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Satoru Sasaki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroyuki Fujii
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyo Hamana
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuto Osumi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Seigo Iwane
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shota Naniwa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuki Sakamoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koshi Matsuhama
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuta Fukuishi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Amane Kozuki
- Division of Cardiovascular Medicine, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Junya Shite
- Division of Cardiovascular Medicine, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Masamichi Iwasaki
- Department of Cardiology, Hyogo Prefectural Awaji Medical Center, Sumoto, Japan
| | - Akihiko Ishida
- Department of Cardiology, Toyooka Public Hospital, Toyooka, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
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Merinopoulos I, Gunawardena T, Corballis N, Bhalraam U, Gilbert T, Maart C, Richardson P, Ryding A, Sarev T, Sawh C, Sulfi S, Wickramarachchi U, Wistow T, Mohamed MO, Mamas MA, Vassiliou VS, Eccleshall SC. Paclitaxel drug-coated balloon-only angioplasty for de novo coronary artery disease in elective clinical practice. Clin Res Cardiol 2023; 112:1186-1193. [PMID: 36104455 PMCID: PMC10449668 DOI: 10.1007/s00392-022-02106-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/06/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE We aimed to investigate the safety of drug-coated balloon (DCB)-only angioplasty compared to drug-eluting stent (DES), as part of routine clinical practice. BACKGROUND The recent BASKETSMALL2 trial demonstrated the safety and efficacy of DCB angioplasty for de novo small vessel disease. Registry data have also demonstrated that DCB angioplasty is safe; however, most of these studies are limited due to long recruitment time and a small number of patients with DCB compared to DES. Therefore, it is unclear if DCB-only strategy is safe to incorporate in routine elective clinical practice. METHODS We compared all-cause mortality and major cardiovascular endpoints (MACE), including unplanned target lesion revascularisation (TLR) of all patients treated with DCB or DES for first presentation of stable angina due to de novo coronary artery disease between 1st January 2015 and 15th November 2019. Data were analysed with Cox regression models and cumulative hazard plots. RESULTS We present 1237 patients; 544 treated with DCB and 693 treated with DES for de novo, mainly large-vessel coronary artery disease. On multivariable Cox regression analysis, only age and frailty remained significant adverse predictors of all-cause mortality. Univariable, cumulative hazard plots showed no difference between DCB and DES for either all-cause mortality or any of the major cardiovascular endpoints, including unplanned TLR. The results remained unchanged following propensity score-matched analysis. CONCLUSION DCB-only angioplasty, for stable angina and predominantly large vessels, is safe compared to DES as part of routine clinical practice, in terms of all-cause mortality and MACE, including unplanned TLR.
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Affiliation(s)
- Ioannis Merinopoulos
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, 2.06 Bob Champion Research and Education Building, Norwich, NR4 7TJ, UK
| | - Tharusha Gunawardena
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, 2.06 Bob Champion Research and Education Building, Norwich, NR4 7TJ, UK
| | - Natasha Corballis
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, 2.06 Bob Champion Research and Education Building, Norwich, NR4 7TJ, UK
| | - U Bhalraam
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Tim Gilbert
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Clint Maart
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Paul Richardson
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Alisdair Ryding
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Toomas Sarev
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Chris Sawh
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Sreekumar Sulfi
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Upul Wickramarachchi
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, 2.06 Bob Champion Research and Education Building, Norwich, NR4 7TJ, UK
| | - Trevor Wistow
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
| | | | | | - Vassilios S Vassiliou
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK.
- Norwich Medical School, University of East Anglia, 2.06 Bob Champion Research and Education Building, Norwich, NR4 7TJ, UK.
| | - Simon C Eccleshall
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
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Zilio F, Verdoia M, De Angelis MC, Zucchelli F, Borghesi M, Rognoni A, Bonmassari R. Drug Coated Balloon in the Treatment of De Novo Coronary Artery Disease: A Narrative Review. J Clin Med 2023; 12:jcm12113662. [PMID: 37297857 DOI: 10.3390/jcm12113662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/08/2023] [Accepted: 05/17/2023] [Indexed: 06/12/2023] Open
Abstract
Drug coated balloons (DCBs) are currently indicated in guidelines as a first choice option in the management of instant restenosis, whereas their use in de novo lesions is still debated. The concerns raised after the contrasting results of the initial trials with DCBs in de novo lesions have been more recently overcome by a larger amount of data confirming their safety and effectiveness as compared to drug-eluting stents (DES), with potentially greater benefits being achieved, especially in particular anatomical settings, as in very small or large vessels and bifurcations, but also in selected subsets of higher-risk patients, where a 'leave nothing behind' strategy could offer a reduction of the inflammatory stimulus and thrombotic risk. The present review aims at providing an overview of current available DCB devices and their indications of use based on the results of data achieved so far.
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Affiliation(s)
- Filippo Zilio
- Department of Cardiology, Santa Chiara Hospital, 38122 Trento, Italy
| | | | | | | | - Marco Borghesi
- Department of Cardiology, Santa Chiara Hospital, 38122 Trento, Italy
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Murphy G, Naughton A, Durand R, Heron E, McCaughey C, Murphy RT, Pearson I. Long-term Outcomes for Drug-eluting Balloons versus Drug-eluting Stents in the Treatment of Small Vessel Coronary Artery Disease: A Systematic Review and Meta-analysis. Interv Cardiol 2023; 18:e14. [PMID: 37398872 PMCID: PMC10311399 DOI: 10.15420/icr.2022.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/27/2022] [Indexed: 07/04/2023] Open
Abstract
Background: This systematic review and meta-analysis compares long-term outcomes follow-up data comparing drug-eluting balloons (DEBs) and drug-eluting stents (DESs) in interventional treatment of small coronary artery disease (<3 mm). Methods: A systematic review was undertaken along with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The primary outcome was 1-3-year performance of DEB versus DES in major adverse cardiac events. Secondary outcomes include all-cause mortality, MI, cardiac death, vessel thrombosis, major bleeding, target vessel revascularisation and target lesion revascularisation. Two independent reviewers extracted data. All outcomes used the Mantel-Haenszel and random effects models. ORs are presented with a 95% CI. Results: Of 4,661 articles, four randomised control trials were included (1,414 patients). DEBs demonstrated reduced rates of non-fatal MI at 1 year (OR 0.44; 95% CI [0.2-0.94]), and BASKET-SMALL 2 reported a significant reduction in 2-year bleeding rates (OR 0.3; 95% CI [0.1-0.91]). There was no significant difference in all other outcomes. Conclusion: Long-term follow-up of DEB and DES use in small coronary arteries demonstrates DEBs be comparable with DESs in all outcomes at 1, 2 and 3 years of follow-up. A significant reduction was found in rates of non-fatal MI at 1 year in the DEB arm, and a reduction in major bleeding episodes at 2 years in the BASKET-SMALL 2 trial. These data highlight the potential long-term utility of novel DEBs in small coronary artery disease revascularisation.
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Affiliation(s)
- Greg Murphy
- Cardiology Department, St James' Hospital Dublin, Ireland
| | | | - Rory Durand
- Cardiology Department, St James' Hospital Dublin, Ireland
| | | | | | - Ross T Murphy
- Cardiology Department, St James' Hospital Dublin, Ireland
| | - Ian Pearson
- Cardiology Department, St James' Hospital Dublin, Ireland
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Spaulding C, Krackhardt F, Bogaerts K, Urban P, Meis S, Morice MC, Eccleshall S. Comparing a strategy of sirolimus-eluting balloon treatment to drug-eluting stent implantation in de novo coronary lesions in all-comers: Design and rationale of the SELUTION DeNovo Trial. Am Heart J 2023; 258:77-84. [PMID: 36642225 DOI: 10.1016/j.ahj.2023.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/05/2023] [Accepted: 01/08/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Drug eluting stents (DES) are associated with a 2% to 4% annual rate of target lesion failure through 5-to-10-year follow-up. The presence of a metallic protheses is a trigger for neo-atherosclerosis and very late stent thrombosis. A "leave nothing behind" strategy using Drug Coated Balloons has been suggested; however, paclitaxel coated balloons are only recommended in selected indications. Recently a novel sirolimus eluting balloon, the SELUTION SLR TM 014 PTCA balloon (SEB) (M.A. MedAlliance SA, Nyon, Switzerland) has been developed. HYPOTHESIS A strategy of percutaneous coronary intervention (PCI) with SEB and provisional DES is non-inferior to a strategy of systematic DES on target vessel failure (TVF) at one and five years. If non-inferiority is met at 5 years, superiority will be tested. DESIGN SELUTION DeNovo is a multi-center international open-label randomized trial. Subjects meeting eligibility criteria are randomized 1:1 to treatment of all lesions with either SEB and provisional DES or systematic DES. Major inclusion criteria are PCI indicated for ≥1 lesion considered suitable for treatment by either SEB or DES and clinical presentation with chronic coronary syndrome, unstable angina or non-ST segment elevation myocardial infarction (NSTEMI). There is no limitation in the number of lesions to be treated. Target lesions diameters are between 2 and 5 mm. Major exclusion criteria are lesions in the left main artery, chronic total occlusions, ST segment elevation myocardial infarction and unstable non-ST segment elevation myocardial infarction. Three thousand three hundred twenty six patients will be included in 50 sites in Europe and Asia. TVF rates and their components will be determined at 30 days, 6 months and annually up to 5 years post-intervention. Among secondary endpoints, bleeding events, cost-effectiveness data and net clinical benefits will be assessed. SUMMARY SELUTION DeNovo trial is an open-label, multi-center international randomized trial comparing a strategy of PCI with SEB and provisional DES to a strategy of PCI with systematic DES on TVF at one and five years. Non-inferiority will be tested at one and five years. If non-inferiority is met at five years, superiority will be tested.
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Affiliation(s)
- Christian Spaulding
- Département de Cardiologie, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Université Paris Cité and INSERM U 970, Paris, France.
| | | | - Kris Bogaerts
- Department of public health and critical care, I-BioStat, KU Leuven, Leuven, Belgium; UHasselt, I-BioStat, Hasselt, Belgium
| | | | - Susanne Meis
- MedAlliance CardioVascular SA, Nyon, Switzerland
| | - Marie-Claude Morice
- Cardiovascular European Research Centre (CERC) and Ramsay Générale de Santé, Massy, France
| | - Simon Eccleshall
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
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Räsänen A, Kärkkäinen JM, Eranti A, Eränen J, Rissanen TT. Percutaneous coronary intervention with drug-coated balloon-only strategy combined with single antiplatelet treatment in patients at high bleeding risk: Single center experience of a novel concept. Catheter Cardiovasc Interv 2023; 101:569-578. [PMID: 36682076 DOI: 10.1002/ccd.30558] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 01/01/2023] [Accepted: 01/02/2023] [Indexed: 01/23/2023]
Abstract
OBJECTIVES At least 1 month of dual antiplatelet therapy is required after coronary stenting. The aim of this all-comers retrospective registry study was to assess the efficacy and safety of percutaneous coronary intervention (PCI) using drug-coated balloon (DCB) with single antiplatelet treatment (SAPT). METHODS Between 2011 and 2020, 232 PCIs were performed in 172 patients using the DCB-only strategy and discharged with SAPT. RESULTS The mean age of the patients was 75 ± 11 years and 59% were male. The clinical presentation was stable coronary artery disease (CAD) in 42% of the patients and acute coronary syndrome (ACS) in 58%. The lesions were mainly de novo (96%). The majority (58%) of treated lesions were in large coronary arteries (≥3.0 mm). Most (87%) of the patients were at high bleeding risk (HBR) with at least one major or two minor Academic Research Consortium (ARC) risk factors for bleeding. Periprocedural DAPT was used in 49% of the patients. The 12-month major adverse cardiac events (MACE, the composition of cardiovascular death, nonfatal myocardial infarction, and target-lesion revascularization) rate was 1.4% in stable CAD and 7.1% in ACS. The 12-month all-cause mortality after DBC only + SAPT strategy was 4.1% in stable CAD and 12.1% in ACS. The rate of ischemia-driven target lesion revascularisation (TLR) was 0% in stable CAD and 3.0% in ACS at 12 months. The 12-month rate of significant bleeding (BARC type 2-5) was 10.5%. There were no acute or subacute vessel closures. CONCLUSIONS Despite the aged patient population with comorbidities, the TLR, MACE, and bleeding rates were low with DCB-only PCI combined with SAPT. This novel approach could reduce the post-PCI bleeding risk in patients with CAD and HBR compared to stenting.
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Affiliation(s)
- Alma Räsänen
- Heart Center, Central Hospital of North Karelia, Siun Sote, Joensuu, Finland
| | | | - Antti Eranti
- Heart Center, Central Hospital of North Karelia, Siun Sote, Joensuu, Finland
| | - Jaakko Eränen
- Heart Center, Central Hospital of North Karelia, Siun Sote, Joensuu, Finland
| | - Tuomas T Rissanen
- Heart Center, Central Hospital of North Karelia, Siun Sote, Joensuu, Finland
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Funayama N, Muratsubaki S, Ito R, Tobisawa T, Konishi T. Drug-coated balloons versus drug-eluting stents for coronary de novo lesions in dialysis patients. Heart Vessels 2023; 38:300-308. [PMID: 36045267 PMCID: PMC9898424 DOI: 10.1007/s00380-022-02169-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/24/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this study was to compare the efficacy of drug-coated balloon (DCB) angioplasty with drug-eluting stent (DES) angioplasty in the treatment of de novo coronary artery lesions in dialysis patients. METHOD We retrospectively enrolled 400 consecutive dialysis patients with 464 coronary de novo lesions treated by DCB or DES from five participating institutions in Japan. The primary endpoint was target lesion revascularization (TLR) at 12 months. We performed serial coronary angiographic analysis. RESULTS There were no significant differences in the rate of TLR between the groups in either crude or propensity score-matched analysis (DES 14.1% vs. DCB 14.7%, P = 0.864, DES 12.1% vs. 12.1%, P = 1.00). Target lesion thrombosis was not observed in the DCB group; however, stent thrombosis was observed in 7 patients (2.2%) in the DES group. The rate of binary restenosis was similar in both groups (DES, 20.9% vs. DCB, 22.8%; P = 0.749). The late lumen loss at follow-up was significantly greater in the DES group than in the DCB group (0.61 ± 0.76 mm vs 0.22 ± 0.48 mm; P < 0.001). Late lumen enlargement was observed in 38.6% of patients in the DCB group. CONCLUSION The efficacy of DCB angioplasty for de novo coronary artery lesions in dialysis patients was similar to that of DES angioplasty in the real world. Drug-coated balloon angioplasty can be an acceptable treatment for de novo coronary artery lesions in dialysis patients.
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Affiliation(s)
- Naohiro Funayama
- Division of Cardiovascular Medicine, Hokkaido Cardiovascular Hospital, West 13, South 27, Chuou-ku, Sapporo, Hokkaido, 064-8622, Japan.
| | - Shingo Muratsubaki
- Division of Cardiovascular Medicine, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Hokkaido, 040-8611, Japan
| | - Ryuta Ito
- Division of Cardiovascular Medicine, Nagoya Kyoritsu Hospital, 1-172, Hokke, Nakagawa-ku, Nagoya, Aichi, 454-0933, Japan
| | - Toshiyuki Tobisawa
- Division of Cardiovascular Medicine, Asahikawa Red Cross Hospital, 1-1, Akebono, Asahikawa, Hokkaido, 070-8530, Japan
| | - Takao Konishi
- Division of Cardiovascular Medicine, Hokkaido University Hospital, West 5, North 14, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
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Yamada K, Ishikawa T, Nakamura H, Mizutani Y, Ukaji T, Shimura M, Kondo Y, Aoki H, Hisauchi I, Itabashi Y, Nakahara S, Kobayashi S, Taguchi I. Midterm safety and efficacy of elective drug-coated balloon angioplasty in comparison to drug-eluting stents for unrestrictive de novo coronary lesions: A single center retrospective study. J Cardiol 2022; 81:537-543. [PMID: 36481299 DOI: 10.1016/j.jjcc.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/05/2022] [Accepted: 11/08/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The safety and efficacy of elective drug-coated balloon (DCB) angioplasty for unrestrictive de novo coronary stenosis in daily practice is not fully understood, especially in comparison to those of drug-eluting stents (DESs). METHODS A total of 588 consecutive de novo coronary stenotic lesions electively and successfully treated with either DCB (n = 275) or DESs (n = 313) between January 2016 and December 2019 at our medical center were included. The primary safety endpoint was the incidence of target lesion failure (TLF), comprising cardiac death, non-fatal myocardial infarction, and target vessel revascularization. The secondary angiographic efficacy endpoint was angiographic restenosis frequency, defined as a follow-up percent diameter stenosis of >50. The endpoints were compared after baseline adjustment using propensity score matching. In addition, the frequency and predictors of late lumen enlargement (LLE), defined as minus late luminal loss, were examined in 201 crude angiographic follow-up lesions after DCB angioplasty. RESULTS A total of 31 baseline parameters were adjusted to analyze 177 lesions in each group. The TLF frequencies (DCB group: 9.6 % during a mean observational interval of 789 ± 488 days vs. DES group: 10.2 %, 846 ± 484 days, p = 0.202) and cumulative TLF-free ratios of both groups were not significantly different (p = 0.892, log-rank test). The angiographic restenosis frequency in the DCB group (6.3 %, n = 128) was not significantly different from that of the DES group (10.1 %, n = 100, p = 0.593). LLE was observed in 45.3 % of entire lesions, and a type-A dissection was a significant predictor of LLE among 23 variables (odds ratio: 3.02, 95 % CI: 1.31-6.95, p = 0.010). CONCLUSIONS The present single-center retrospective study revealed statistically equivalent midterm clinical safety and angiographic efficacy among both elective DCB angioplasty and DESs placements in the treatment of unrestrictive de novo coronary lesions. In our daily practice environment, LLE was achieved in approximately half after DCB angioplasty.
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Affiliation(s)
- Kota Yamada
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Tetsuya Ishikawa
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Saitama, Japan.
| | - Hidehiko Nakamura
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Yukiko Mizutani
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Tomoaki Ukaji
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Masatoshi Shimura
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Yuki Kondo
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Hidehiko Aoki
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Itaru Hisauchi
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Yuji Itabashi
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Shiro Nakahara
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Sayuki Kobayashi
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Isao Taguchi
- Department of Cardiology, Dokkyo Medical University, Saitama Medical Center, Koshigaya, Saitama, Japan
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Ma WR, Chandrasekharan KH, Nai CS, Zhu YX, Iqbal J, Chang S, Cheng YW, Wang XY, Bourantas CV, Zhang YJ. Clinical outcomes of percutaneous coronary intervention for de novo lesions in small coronary arteries: A systematic review and network meta-analysis. Front Cardiovasc Med 2022; 9:1017833. [DOI: 10.3389/fcvm.2022.1017833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/31/2022] [Indexed: 11/15/2022] Open
Abstract
BackgroundPercutaneous coronary intervention (PCI) has a well-established role in revascularization for coronary artery disease. We performed network meta-analysis to provide evidence on optimal intervention strategies for de novo lesions in small coronary arteries.Materials and methodsEnrolled studies were randomized clinical trials that compared different intervention strategies [balloon angioplasty (BA), biolimus-coated balloon (BCB), bare-metal stent (BMS), new-generation drug-eluting stent (New-DES), older generation sirolimus-eluting stent (Old-SES), paclitaxel-coated balloon (PCB), and paclitaxel-eluting stent (PES)] for de novo lesions in small coronary arteries. The primary outcome was major adverse cardiac events (MACE).ResultsA total of 23 randomized clinical trials comparing seven intervention devices were analyzed. In terms of the primary outcome, New-DES was the intervention device with the best efficacy [surface under the cumulative ranking curve (SUCRA), 89.1%; mean rank, 1.7], and the Old-SES [risk ratio (RR), 1.09; 95% confidence interval (CI), 0.45–2.64] and PCB (RR, 1.40; 95% CI, 0.72–2.74) secondary to New-DES, but there was no statistically significant difference between these three intervention devices. All DES and PCB were superior to BMS and BA for MACE in both primary and sensitivity analysis. For secondary outcomes, there was no association between all-cause mortality and myocardial infarction (MI) with any intervention strategy, and additionally, the findings of target lesion revascularization (TLR) were similar to the primary outcomes.ConclusionPaclitaxel-coated balloon yielded similar outcomes to New-DES for de novo lesions in small coronary arteries. Therefore, this network meta-analysis may provide potential support for PCB as a feasible, effective, and safe alternative intervention strategy for the revascularization of small coronary arteries.Systematic review registration[https://www.crd.york.ac.uk/PROSPERO/#recordDetails], identifier [CRD42022338433].
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Tervo J, Kärkkäinen JM, Rissanen TT. Technical success, clinical efficacy, and insight into the causes of restenosis after the percutaneous coronary intervention of de novo coronary artery lesions using a paclitaxel-coated balloon with citrate ester excipient. Front Cardiovasc Med 2022; 9:1012473. [PMID: 36386336 PMCID: PMC9662788 DOI: 10.3389/fcvm.2022.1012473] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/03/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives The aim of this all-comers registry study was to investigate the technical success, clinical efficacy, and safety of a drug-coated balloon (DCB) with paclitaxel combined with citrate ester excipient (CEE) in percutaneous coronary intervention (PCI) of de novo coronary lesions in an all-comers population. Materials and methods A total of 338 consecutive PCIs using the DCB (CEE)-only approach comprising 406 de novo lesions were included in the study. Technical success was determined by the successful delivery of the device and no need for bailout stenting. Results The mean follow-up time was 25 ± 12 months. The mean age of patients was 71 ± 11 years, and 48% had the acute coronary syndrome. A total of 55% of the patients were at risk of factor bleeding. The delivery of DCB was successful in 98% of cases. The overall technical success rate was 83%. Bailout stenting was used in 9% of lesions. Rotational atherectomy was used in 11% of cases before the DCB-only approach. The mean diameter of the DCBs used was 2.7 ± 0.5 mm and 38% of DCBs were large (≥3.0 mm). The 12-month MACE rates were 5.4 ± 1.7 and 18.3 ± 3.1% in stable CAD and in ACS, respectively. The respective target lesion revascularization (TLR) rates were 3.0 ± 1.3 and 8.5 ± 2.3%. Unacceptable acute recoil (>30%) was found in 74% of cases that needed repeat revascularization. No acute vessel closures occurred after DCB treatment. Conclusion The DCB-only strategy using a paclitaxel-coated (CEE) device was technically feasible, safe, and effective in an all-comers population. Acute recoil was found as a significant cause of restenosis after the DCB-only strategy.
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Affiliation(s)
- Jerry Tervo
- Heart Center, North Karelia Central Hospital, Joensuu, Finland
| | | | - Tuomas T. Rissanen
- Heart Center, North Karelia Central Hospital, Joensuu, Finland
- *Correspondence: Tuomas T. Rissanen,
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Sella G, Gandelman G, Tuvali O, Volodarsky I, Cuciuc V, Haberman D, Ayyad O, Poles L, Welt M, Kracoff OH, George J. Utilization of Drug-Coated Balloons for the Treatment of Coronary Lesions in the Elderly Population. J Clin Med 2022; 11. [PMID: 35566739 DOI: 10.3390/jcm11092616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 04/25/2022] [Accepted: 05/03/2022] [Indexed: 01/27/2023] Open
Abstract
Introduction: The use of drug-coated balloons (DCBs) has become more prevalent in the past few years for the treatment of in-stent restenosis (ISR) and de novo lesions. The absence of foreign polymer implantations potentially shortens the duration of dual anti-platelet therapy (DAPT), which can be beneficial for the elderly population. We aimed to investigate the safety and efficacy of the use of DCBs for the treatment of coronary lesions in elderly patients as compared to the younger population. Materials and methods: A database of 446 consecutive patients who underwent a procedure of DCB inflation in our institution was divided into two groups, below 70 years old and above 80 years old. We compared and analyzed the endpoints of total major adverse cardiovascular events (MACE), cardiovascular (CV) death, and all-cause mortality in both groups. Results: The difference in MACE between the two age groups was non-significant (p = 0.225); the difference in cardiovascular death was also non-significant (p = 0.086). All-cause mortality was significantly different (p < 0.0001) and can be attributed to the age of the patients. Conclusion: The utilization of DCBs for the treatment of coronary lesions may be as safe and effective for the elderly population as for the younger population and may allow a shorter period of DAPT therapy, which can lower the risk of bleeding.
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Mangner N, Farah A, Ohlow MA, Möbius-Winkler S, Weilenmann D, Wöhrle J, Linke A, Stachel G, Markovic S, Leibundgut G, Rickenbacher P, Cattaneo M, Gilgen N, Kaiser C, Scheller B, Jeger RV. Safety and Efficacy of Drug-Coated Balloons Versus Drug-Eluting Stents in Acute Coronary Syndromes: A Prespecified Analysis of BASKET-SMALL 2. Circ Cardiovasc Interv 2022; 15:e011325. [PMID: 35000455 DOI: 10.1161/circinterventions.121.011325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Drug-coated balloons (DCBs) are an established treatment strategy for coronary artery disease. Randomized data on the application of DCBs in patients with an acute coronary syndrome (ACS) are limited. We evaluated the impact of clinical presentation (ACS versus chronic coronary syndrome) on clinical outcomes in patients undergoing DCB or drug-eluting stent (DES) treatment in a prespecified analysis of the BASKET-SMALL 2 trial (Basel Kosten Effektivitäts Trial-Drug-Coated Balloons Versus Drug-Eluting Stents in Small Vessel Interventions). METHODS BASKET-SMALL 2 randomized 758 patients with small vessel coronary artery disease to DCB or DES treatment and followed them for 3 years regarding major adverse cardiac events (cardiac death, nonfatal myocardial infarction, and target vessel revascularization). RESULTS Among 758 patients, 214 patients (28.2%) presented with an ACS (15 patients [7%], ST-segment-elevation myocardial infarction; 109 patients [50.9%], non-ST-segment-elevation myocardial infarction; 90 patients [42.1%], unstable angina pectoris). At 1-year follow-up, there was no significant difference in the incidence of the primary end point by randomized treatment in patients with ACS (hazard ratio, 0.50 [95% CI, 0.19-1.26] for DCB versus DES) or chronic coronary syndrome (hazard ratio, 1.29 [95% CI, 0.67-2.47] for DCB versus DES). There was no significant interaction between clinical presentation and treatment effect (P for interaction, 0.088). For cardiac death (P for interaction, 0.049) and nonfatal myocardial infarction (P for interaction, 0.010), a significant interaction between clinical presentation and treatment was seen at 1 year with lower rates of these secondary end points in patients with ACS treated by DCB. At 3 years, there were similar major adverse cardiac event rates throughout groups without significant interaction between clinical presentation and treatment (P for interaction, 0.301). All-cause mortality was higher in ACS compared with chronic coronary syndrome; however, there was no difference between DCB and DES irrespective of clinical presentation. CONCLUSIONS In this subgroup analysis of the BASKET-SMALL 2 trial, there was no interaction between indication for percutaneous coronary intervention (acute versus chronic coronary syndrome) and treatment effect of DCB versus DES in patients with small vessel coronary artery disease. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01574534.
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Affiliation(s)
- Norman Mangner
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Germany (N.M., A.L.)
| | - Ahmed Farah
- Department of Internal Medicine III, Knappschaftskrankenhaus, Klinikum Westfalen, Dortmund, Germany (A.F.)
| | - Marc-Alexander Ohlow
- Department of Cardiology and Intensive Care, SRH Wald-Klinikum, Gera, Germany (M.-A.O.)
| | | | - Daniel Weilenmann
- Department of Cardiology, Cantonal Hospital St. Gallen, Switzerland (D.W.)
| | - Jochen Wöhrle
- Department of Cardiology and Intensive Care, Medizin Campus Bodensee, Friedrichshafen, Germany (J.W.)
| | - Axel Linke
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Germany (N.M., A.L.).,Dresden Cardiovascular Research Institute and Core Laboratories GmbH, Germany (A.L.)
| | - Georg Stachel
- Department of Cardiology, Heart Center Leipzig, University Hospital, Germany (G.S.)
| | - Sinisa Markovic
- Department of Internal Medicine II, University Hospital Ulm, Germany (S.M.)
| | - Gregor Leibundgut
- Department of Cardiology, Cantonal Hospital Baselland, Liestal, Switzerland (G.L.)
| | - Peter Rickenbacher
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (P.R., N.G., C.K., R.V.J.)
| | - Marco Cattaneo
- Department of Clinical Research, University Hospital Basel, University of Basel, Switzerland (M.C.)
| | - Nicole Gilgen
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (P.R., N.G., C.K., R.V.J.)
| | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (P.R., N.G., C.K., R.V.J.)
| | - Bruno Scheller
- Department of Cardiology, Angiology and Intensive Care, University of Saarland, Homburg, Germany (B.S.)
| | - Raban V Jeger
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (P.R., N.G., C.K., R.V.J.)
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Abstract
PURPOSE OF REVIEW In the interventional treatment of coronary artery disease, new-generation drug-eluting stents (DES) currently are the standard treatment. In addition, drug-coated balloons (DCB) are a well-established option for the treatment of in-stent restenosis in both bare-metal stents (BMS) and DES, where DCBs deliver an antiproliferative drug without the necessity of re-implanting a stent. Since the field of use for DCB has increasingly been extended to other indications such as de novo lesions in small vessel disease (SVD), a review of literature may be useful. RECENT FINDINGS Recent randomized trial data show good efficacy and safety for DCB in de novo lesions, especially in small coronary arteries, and confirm long-term clinical efficacy and safety up to three years. DCB are an attractive and safe option in the treatment of de novo lesions in SVD.
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Affiliation(s)
- Ketina Arslani
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Raban Jeger
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
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Ito R, Ishii H, Oshima S, Nakayama T, Sakakibara T, Kakuno M, Murohara T. Outcomes after drug-coated balloon interventions for de novo coronary lesions in the patients on chronic hemodialysis. Heart Vessels 2021; 36:1646-1652. [PMID: 33895872 DOI: 10.1007/s00380-021-01858-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
The impact of drug-coated balloon (DCB) on hemodialysis (HD) patients with coronary lesions remains unclear. This study aimed to compare outcomes after DCB treatment between HD and non-HD patients with de novo coronary lesions. A total of 235 consecutive patients who electively underwent DCB treatment for de novo coronary lesions were included (HD group: n = 100; non-HD group: n = 135). Angiographic follow-up was performed 6 months after the procedure. Patients were clinically followed up for 2 years. The incidence rates of target lesion revascularization (TLR) and major adverse cardiac events (MACE) were investigated. Diabetes and a history of coronary bypass grafting were more frequent in the HD group than in the non-HD group (69.0% vs. 50.7%, p = 0.007, and 24.0% vs 9.1%, p = 0.013, respectively). The reference diameter and pre-procedural diameter stenosis were greater in the HD group than in the non-HD group (2.49 mm vs. 2.24 mm, p = 0.007, and 65.9% vs. 59.6%, p = 0.015, respectively). Calcification was observed in 65.5% of all lesions, and rotational atherectomy was performed in 30.2% patients. The average diameter of the DCB was 2.51 mm (2.57 mm, HD group vs. 2.47 mm, non-HD group, p = 0.14). Although post-procedural diameter stenosis was similar between the groups, late lumen loss on follow-up angiography was larger in HD patients than in non-HD patients (0.27 mm vs. - 0.03 mm, p = 0.0009). The 2-year rates of freedom from TLR and MACE were lower in HD patients than in non-HD patients [79.3% vs. 91.7%, hazard ratio (HR) 2.76, 95% confidence interval (CI) 1.23-6.77, p = 0.014; and 61.6% vs. 89.4%, HR 4.60, 95% CI 2.30-10.2, p < 0.001, respectively]. In conclusion, the rates of TLR and MACE after DCB treatment were higher in HD patients than in non-HD patients.
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Affiliation(s)
- Ryuta Ito
- Department of Cardiology, Nagoya Kyoritsu Hospital, 1-172 Hokke, Nakagawa-ku, Nagoya, Aichi, 454-0933, Japan.
| | - Hideki Ishii
- Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan.,Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoru Oshima
- Department of Cardiology, Nagoya Kyoritsu Hospital, 1-172 Hokke, Nakagawa-ku, Nagoya, Aichi, 454-0933, Japan
| | - Takuya Nakayama
- Department of Cardiovascular Surgery, Nagoya Kyoritsu Hospital, Nagoya, Japan
| | - Takashi Sakakibara
- Department of Cardiology, Nagoya Kyoritsu Hospital, 1-172 Hokke, Nakagawa-ku, Nagoya, Aichi, 454-0933, Japan
| | - Motohiko Kakuno
- Department of Cardiology, Nagoya Kyoritsu Hospital, 1-172 Hokke, Nakagawa-ku, Nagoya, Aichi, 454-0933, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Abstract
Drug-eluting stents are the standard revascularization strategy for the treatment of symptomatic coronary artery disease. However, in-stent restenosis (ISR), stent thrombosis and reinfarction of target lesions following stent implantation present challenges. Drug-coated balloons (DCBs), which deliver antiproliferative drugs into the vessel wall without stent implantation, are a novel treatment option for percutaneous coronary intervention and have been proven to act as a promising strategy in the treatment of ISR and coronary small vessel disease. However, their role in acute myocardial infarction (AMI) remains unclear. The present review discusses current evidence for the treatment of AMI with DCBs.
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Affiliation(s)
- Huilin Hu
- Department of Cardiology, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang 314000, P.R. China
| | - Liang Shen
- Department of Cardiology, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang 314000, P.R. China
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Ueno K, Morita N, Kojima Y, Kondo H, Takahashi H, Minatoguchi S, Higuchi S, Ando Y, Esaki M. Efficacy of Low-Pressure Inflation of Oversized Drug-Coated Balloon for Coronary Artery Disease. J Interv Cardiol 2020; 2020:6615988. [PMID: 33447166 DOI: 10.1155/2020/6615988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/02/2020] [Accepted: 12/07/2020] [Indexed: 11/18/2022] Open
Abstract
Objectives This study sought to assess the efficacy of oversized drug-coated balloon (DCB) inflation at low pressure for the prevention of acute dissections and late restenosis. Background The major limitation of DCB coronary angioplasty is the occurrence of severe dissection after inflation of DCB. Methods Between 2014 and 2018, 273 consecutive patients were retrospectively studied. 191 lesions (154 patients) treated by oversized DCB inflation at low pressure (<4 atm, 2.4 ± 1.2 atm, DCB/artery ratio 1.14 ± 0.22; LP group) were compared with 135 lesions (119 patients) treated by the standard DCB technique (7.1 ± 2.2 atm, DCB/artery ratio 1.03 ± 0.16; SP group). Results Although the lesions in the LP group were more complex than those in the SP group (smaller reference diameter (2.38 mm vs. 2.57 mm, P=0.011), longer lesions (11.7 mm vs. 10.5 mm, P=0.10), and more frequent use of rotational atherectomy (45.0% vs. 28.1%, P=0.003), there was no significant difference in the NHLBI type of dissections between the two groups (11.5%, 12.0%, 5.2% vs. 12.6%, 12.6%, 2.2% in type A, B, and C, P=0.61), and no bailout stenting was required. In 125 well-matched lesion pairs after propensity score analysis, the cumulative incidence of target lesion revascularization at 3 years was 4.5% vs. 7.0%, respectively (P=0.60). Late lumen loss (−0.00 mm vs. −0.01 mm, P=0.94) and restenosis rates (7.4% vs. 7.1%, P=1.0) were similar in both of the groups. Conclusion The application of oversized DCB at low pressure is effective and feasible for preventing late restenosis comparative to the standard technique of DCB.
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Venetsanos D, Omerovic E, Sarno G, Pagonis C, Witt N, Calais F, Böhm F, Jurga J, Völz S, Koul S, Olivercrona G, James S, Alfredsson J. Long term outcome after treatment of de novo coronary artery lesions using three different drug coated balloons. Int J Cardiol 2021; 325:30-6. [PMID: 32980433 DOI: 10.1016/j.ijcard.2020.09.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [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.
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Liu W, Zhang M, Chen G, Li Z, Wei F. Drug-Coated Balloon for De Novo Coronary Artery Lesions: A Systematic Review and Trial Sequential Meta-analysis of Randomized Controlled Trials. Cardiovasc Ther. 2020;2020:4158363. [PMID: 32934664 DOI: 10.1155/2020/4158363] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/25/2020] [Indexed: 12/20/2022] Open
Abstract
Objective To investigate the efficacy of drug-coated balloon (DCB) treatment for de novo coronary artery lesions in randomized controlled trials (RCTs). Background DCB was an effective therapy for patients with in-stent restenosis. However, the efficacy of DCB in patients with de novo coronary artery lesions is still unknown. Methods Eligible studies were searched on PubMed, Web of Science, EMBASE, and Cochrane Library Database. Systematic review and meta-analyses of RCTs were performed comparing DCB with non-DCB devices (such as plain old balloon angioplasty (POBA), bare-metal stents (BMS), or drug-eluting stents (DES)) for the treatment of de novo lesions. Trial sequential meta-analysis (TSA) was performed to assess the false positive and false negative errors. Results A total of 2,137 patients enrolled in 12 RCTs were analyzed. Overall, no significant difference in target lesion revascularization (TLR) was found, but there were numerically lower rates after DCB treatment at 6 to 12 months follow-up (RR: 0.69; 95% CI: 0.47 to 1.01; P = 0.06; TSA-adjusted CI: 0.41 to 1.16). TSA showed that at least 1,000 more randomized patients are needed to conclude the effect on TLR. A subgroup analysis from high bleeding risk patients revealed that DCB treatment was associated with lower rate of TLR (RR: 0.10; 95% CI: 0.01 to 0.78; P = 0.03). The systematic review illustrated that the rate of bailout stenting was lower and decreased gradually. Conclusions DCB treatment was associated with a trend toward lower TLR when compared with controls. For patients at bleeding risk, DCB treatment was superior to BMS in TLR.
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Jeger RV, Eccleshall S, Wan Ahmad WA, Ge J, Poerner TC, Shin ES, Alfonso F, Latib A, Ong PJ, Rissanen TT, Saucedo J, Scheller B, Kleber FX. Drug-Coated Balloons for Coronary Artery Disease. JACC Cardiovasc Interv 2020; 13:1391-1402. [DOI: 10.1016/j.jcin.2020.02.043] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 12/19/2022]
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Silverio A, Buccheri S, Venetsanos D, Alfredsson J, Lagerqvist B, Persson J, Witt N, James S, Sarno G. Percutaneous Treatment and Outcomes of Small Coronary Vessels. JACC Cardiovasc Interv 2020; 13:793-804. [DOI: 10.1016/j.jcin.2019.10.062] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/25/2019] [Accepted: 10/15/2019] [Indexed: 10/25/2022]
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Scheller B, Ohlow MA, Ewen S, Kische S, Rudolph TK, Clever YP, Wagner A, Richter S, El-Garhy M, Böhm M, Degenhardt R, Mahfoud F, Lauer B. Bare metal or drug-eluting stent versus drug-coated balloon in non-ST-elevation myocardial infarction: the randomised PEPCAD NSTEMI trial. EUROINTERVENTION 2020; 15:1527-1533. [DOI: 10.4244/eij-d-19-00723] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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25
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Scheller B, Vukadinovic D, Jeger R, Rissanen TT, Scholz SS, Byrne R, Kleber FX, Latib A, Clever YP, Ewen S, Böhm M, Yang Y, Lansky A, Mahfoud F. Survival After Coronary Revascularization With Paclitaxel-Coated Balloons. J Am Coll Cardiol 2020; 75:1017-1028. [DOI: 10.1016/j.jacc.2019.11.065] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/14/2019] [Accepted: 11/24/2019] [Indexed: 10/24/2022]
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Fahrni G, Scheller B, Coslovsky M, Gilgen N, Farah A, Ohlow MA, Mangner N, Weilenmann D, Wöhrle J, Cuculi F, Leibundgut G, Möbius-Winkler S, Zweiker R, Twerenbold R, Kaiser C, Jeger R; BASKET-SMALL 2 Investigators. Drug-coated balloon versus drug-eluting stent in small coronary artery lesions: angiographic analysis from the BASKET-SMALL 2 trial. Clin Res Cardiol 2020; 109:1114-24. [PMID: 31993736 DOI: 10.1007/s00392-020-01603-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 01/16/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The randomized BASKET-SMALL 2 trial showed non-inferiority for treatment with drug-coated balloon (DCB) compared with drug-eluting stents (DES) in patients undergoing percutaneous coronary intervention (PCI) for de novo lesions in small coronary arteries regarding clinical endpoints at 1 year. In this predefined substudy, we investigated the angiographic findings in patients undergoing a clinically indicated follow-up angiography during the study phase. METHODS Eight-hundred and eighty-three patients underwent PCI with either DES or DCB in a culprit vessel < 3 mm in diameter for stable coronary artery disease or acute coronary syndrome. Event-driven re-angiographies and the corresponding images at baseline were analyzed for angiographic endpoints. RESULTS One-hundred and eleven patients (117 lesions, 66 DES versus 51 DCB) presented for an unscheduled re-angiography at median 5.7 months after the index procedure. At baseline, mean reference vessel diameter was 2.05 mm and the residual in-segment stenosis after the index procedure was less in DES compared to DCB (23.7% vs 33.8%, p = 0.001). At follow-up angiography, diameter stenosis in the DES group (29.0%) was still somewhat smaller than after DCB angioplasty (35.8%) when adjusting for time since PCI (p = 0.047), whereas lumen loss (LL) did not differ between the two treatment arms (LL-DES 0.06 mm vs LL-DCB 0.10 mm, p = 0.20). Eight patients following DES implantation presented with a complete occlusion of the target lesion compared to no occlusion in the DCB group (p = 0.009). CONCLUSIONS The clinically indicated follow-up angiography within 1 year showed no difference in LL. Complete thrombotic vessel occlusions were found only in the DES group. CLINICAL TRIAL REGISTRATION www.clinicaltrials.gov ; number, NCT01574534.
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Nestelberger T, Kaiser C, Jeger R. Drug-coated balloons in cardiovascular disease: benefits, challenges, and clinical applications. Expert Opin Drug Deliv 2020; 17:201-211. [DOI: 10.1080/17425247.2020.1714590] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Thomas Nestelberger
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christoph Kaiser
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Raban Jeger
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
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Ybarra LF, Dandona S, Daneault B, Rinfret S. Drug‐coated balloon after subintimal plaque modification in failed coronary chronic total occlusion percutaneous coronary intervention: A novel concept. Catheter Cardiovasc Interv 2019; 96:609-613. [DOI: 10.1002/ccd.28663] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 11/06/2019] [Accepted: 12/08/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Luiz F. Ybarra
- London Health Sciences Centre, Schulich School of Medicine & DentistryWestern University London Ontario Canada
- McGill University Health CentreMcGill University Montreal Quebec Canada
| | - Sonny Dandona
- McGill University Health CentreMcGill University Montreal Quebec Canada
| | - Benoit Daneault
- Centre Hospitalier Universitaire de Sherbrooke Sherbrooke Quebec Canada
| | - Stéphane Rinfret
- McGill University Health CentreMcGill University Montreal Quebec Canada
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Nestelberger T, Jeger R. Drug-coated Balloons for Small Coronary Vessel Interventions: A Literature Review. ACTA ACUST UNITED AC 2019; 14:131-136. [PMID: 31867057 PMCID: PMC6918480 DOI: 10.15420/icr.2019.06.r3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 09/30/2019] [Indexed: 12/13/2022]
Abstract
Newer-generation drug-eluting stents (DES) are the standard of care for the treatment of symptomatic coronary artery disease. However, some lack of efficacy has been reported in small coronary arteries based on higher rates of target lesion restenosis, thrombosis and MI resulting in repeated interventions. Drug-coated balloons (DCBs) are an established treatment option for in-stent restenosis in both bare metal stents and DES and they can deliver an anti-proliferative drug into the vessel wall without implanting a stent. DCBs are a promising technique for selected de novo coronary lesions, especially in small vessel disease. In this article, the current evidence for the treatment of small vessel disease with DCBs will be reviewed.
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Affiliation(s)
- Thomas Nestelberger
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel University of Basel, Switzerland
| | - Raban Jeger
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel University of Basel, Switzerland
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Funayama N, Muratsubaki S, Kawahatsu K, Miyata M, Katou Y, Oikawa T. Clinical outcomes of SeQuent Please paclitaxel-coated balloons for de novo small coronary artery lesion in a Japanese multicenter post-approval registry. Coron Artery Dis 2020; 31:35-9. [PMID: 31524670 DOI: 10.1097/MCA.0000000000000782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Drug-coated balloon (DCB) angioplasty has emerged as an effective management strategy worldwide. In June 2016, DCB became available for the treatment of de novo small coronary lesions in Japan; however, there has been no multicenter analysis in a post-approval real-world clinical setting to date. The aim of this study was to evaluate the efficacy of DCB for de novo small coronary lesions based on a Japanese multicenter registry. METHODS AND RESULTS From June 2016 to July 2017, a total of 111 lesions (102 patients) treated with DCB for de novo small coronary lesions were enrolled at six Japanese institutions. The primary endpoint was the rate of target lesion revascularization (TLR) at 12 months. Angiographic follow-up endpoints were binary restenosis and late lumen loss (LLL). Clinical follow-up data at 12 months were available for 106 lesions, excluding five lesions that required bailout stenting. The TLR rate was 5.7% (6/106 lesions). No cardiac death or target lesion thrombosis was observed. The binary restenosis rate was 14.4% and LLL was 0.0017 ± 0.37 mm. CONCLUSIONS DCB angioplasty for de novo small coronary lesions in the real-world environment in Japan is effective with acceptable 12-month outcomes.
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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: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Scheller B. Drug-coated balloons for patients with increased risk of bleeding. Lancet 2019; 394:190-192. [PMID: 31204111 DOI: 10.1016/s0140-6736(19)31144-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 05/01/2019] [Indexed: 11/22/2022]
Affiliation(s)
- Bruno Scheller
- Clinical and Experimental Interventional Cardiology, University of Saarland, 66421 Homburg, Germany.
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Liu Y, Zhang YJ, Deng LX, Yin ZY, Hu T, Wang Q, Li Y, Li JY, Guo WY, Mou FJ, Tao L. 12-Month clinical results of drug-coated balloons for de novo coronary lesion in vessels exceeding 3.0 mm. Int J Cardiovasc Imaging 2019; 35:579-586. [PMID: 30929102 DOI: 10.1007/s10554-018-1505-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 11/15/2018] [Indexed: 01/30/2023]
Abstract
The purpose of this observational study was to investigate the feasibility, initial safety, and efficacy of the SeQuent® Please DCB (B. Braun Melsungen, Germany) for patients with de novo coronary lesions in vessels exceeding 3.0 mm in a consecutive series of all comer percutaneous coronary intervention. A total of 120 patients (135 lesions) with de novo coronary lesions in vessels ≥ 3.0 mm treated with DCB were enrolled in this single-centre prospective observational study. The primary endpoint was target lesion failure (TLF), a composite endpoint of cardiac death, target vessel-myocardial infarction (TV-MI), and clinically driven target vessel revascularization (TLR) at 12 months. Safety endpoints included cardiac death, TV-MI, and definite target vessel thrombosis. 45.9% of the lesions were classified as complex (type B2/C). The reference vessel diameter was 3.09 ± 0.31 mm measured via quantitative coronary angiography analysis. Coronary dissections occurred in 42 patients (35.0%; Type A-B 14.1%; Type C 19.1%; Type D: 1.6%), two of which [1.6%; (type D dissection)] underwent bail-out stent implantation. 12-month follow-up was completed in 100% patients. The 12-month incidence of TLF was 3.4%. The clinically driven TLR occurred in four patients (3.4%). The incidence of TLR was low in patients without any detectable dissections, similar to those with dissections (3.8% vs. 2.5%; p = 0.146). No patient suffered cardiac death, TV-MI, or target vessel thrombosis. The study shows the feasibility, initial safety, and efficacy of coronary intervention using SeQuent® Please DCB for the treatment of patients with de novo lesion in vessels exceeding 3 mm. The study highlights that the coronary dissection (Type A-C) post DCB treatment occurs frequently but is safe at follow up.
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Affiliation(s)
- Yi Liu
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, No. 15 Changle West Road, Xi'an, 710032, China
| | - Yao-Jun Zhang
- Department of Cardiology, Xuzhou Third People's Hospital, Xuzhou, China
| | - Long-Xiang Deng
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, No. 15 Changle West Road, Xi'an, 710032, China
| | - Zhi-Yong Yin
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, No. 15 Changle West Road, Xi'an, 710032, China
| | - Tao Hu
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, No. 15 Changle West Road, Xi'an, 710032, China
| | - Qiong Wang
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, No. 15 Changle West Road, Xi'an, 710032, China
| | - Yan Li
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, No. 15 Changle West Road, Xi'an, 710032, China
| | - Jia-Yi Li
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, No. 15 Changle West Road, Xi'an, 710032, China
| | - Wen-Yi Guo
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, No. 15 Changle West Road, Xi'an, 710032, China
| | - Fang-Jun Mou
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, No. 15 Changle West Road, Xi'an, 710032, China
| | - Ling Tao
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, No. 15 Changle West Road, Xi'an, 710032, China.
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Ueno K, Morita N, Kojima Y, Takahashi H, Kawasaki M, Ito R, Kondo H, Minatoguchi S, Yoshida T, Hashimoto Y, Tatsumi T, Kitamura T. Safety and Long-Term Efficacy of Drug-Coated Balloon Angioplasty following Rotational Atherectomy for Severely Calcified Coronary Lesions Compared with New Generation Drug-Eluting Stents. J Interv Cardiol 2019; 2019:9094178. [PMID: 31772551 DOI: 10.1155/2019/9094178] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 02/11/2019] [Indexed: 01/15/2023] Open
Abstract
Objectives This study sought to assess the safety and long-term efficacy of drug-coated balloons (DCB) following aggressive intracoronary image-guided rotational atherectomy (iRA) for severe coronary artery calcification (CAC), and to compare this strategy with new generation drug-eluting stents (nDES) following iRA. Background Ischemic events following the treatment of CAC is still relatively high. Thus, more innovative strategies are required. Methods We evaluated 123 consecutive patients (166 lesions) with de novo CAC undergoing an iRA (burr size; 0.7 of the mean reference diameter by intracoronary imaging) followed by DCB (DCB-iRA; 54 patients, 68 lesions) or nDES (nDES-iRA; 69 patients, 98 lesions). Follow-up angiography was obtained at > 6 months. Results The target vessels (right coronary and circumflex), bifurcation (67.6% versus 47.9%), reference diameter (2.28mm versus 2.49mm), and lesion length (11.89mm versus 18.78mm) were significantly different between the two groups. The median follow-up was 732 days. TLR and TVR in DCB-iRA and nDES-iRA at 3 years were similar: 15.6% versus 16.3% (P=0.99) and 15.6% versus 23.3% (P=0.38). In 41 well-matched lesion pairs after propensity score analysis, the cumulative incidence of TLR and TVR in DCB-iRA and nDES-iRA at 3 years was 12.9% versus 16.3% (P=0.70) and 12.9% versus 26.1% (P=0.17), respectively. On QCA analysis, although the acute gain was smaller in DCB-iRA (0.85 mm versus 1.53 mm, P<0.001), the minimum lumen diameter at follow-up was similar (1.69 mm versus 1.87 mm, P=0.29). The late lumen loss was lower (0.09 mm versus 0.52 mm, P=0.009) in DCB-iRA. Conclusions DCB-iRA is feasible for CAC.
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Hashikata T, Matsushita M, Shindo A, Kakuda N, Tojo T, Ohnishi S, Yamasaki M. Stent Recoil in Overlapping Stent 18 Years After Wiktor Stent Implantation. Int Heart J 2019; 60:178-180. [DOI: 10.1536/ihj.18-261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | | | - Akito Shindo
- Department of Cardiology, NTT Medical Center Tokyo
| | | | - Taiki Tojo
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
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Mohiaddin H, Wong TDFK, Burke-Gaffney A, Bogle RG. Drug-Coated Balloon-Only Percutaneous Coronary Intervention for the Treatment of De Novo Coronary Artery Disease: A Systematic Review. Cardiol Ther 2018; 7:127-149. [PMID: 30368735 PMCID: PMC6251821 DOI: 10.1007/s40119-018-0121-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Indexed: 02/06/2023] Open
Abstract
Percutaneous coronary intervention (PCI) with a drug coated balloon (DCB) is a novel treatment which seeks to acutely dilate a coronary stenosis and deliver an anti-proliferative drug to the vessel wall (reducing the risk of re-stenosis), without implanting a drug eluting stent (DES). In this study, we performed a systematic review of stentless DCB-only angioplasty in de novo coronary artery disease. We identified 41 studies examining the effects of DCB-only PCI in a variety of clinical scenarios including small vessels, bifurcations, calcified lesions, and primary PCI. DCB-only PCI appears to be associated with comparable clinical outcomes to DESs and superior angiographic outcomes to plain-old balloon angioplasty. Although current data are promising, there is still a need for further long-term randomized control trial data comparing a DCB-only approach specifically against a second- or third-generation DES. A 4-week period of dual antiplatelet therapy provides a real advantage for the DCB-only PCI approach, which is not possible with most DESs. Since rates of adverse clinical outcomes are very low for all PCI procedures attention should be turned to the development of robust endpoints with which to compare DCB-only PCI approaches to the standard treatment with a DES.
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Affiliation(s)
| | | | - Anne Burke-Gaffney
- Vascular Biology, National Heart & Lung Institute (NHLI), Faculty of Medicine, Imperial College London, London, UK
| | - Richard G Bogle
- Clinical Academic Group, St George's University Foundation Hospitals NHS Trust, London, UK
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Jeger RV, Farah A, Ohlow MA, Mangner N, Möbius-Winkler S, Leibundgut G, Weilenmann D, Wöhrle J, Richter S, Schreiber M, Mahfoud F, Linke A, Stephan FP, Mueller C, Rickenbacher P, Coslovsky M, Gilgen N, Osswald S, Kaiser C, Scheller B. Drug-coated balloons for small coronary artery disease (BASKET-SMALL 2): an open-label randomised non-inferiority trial. Lancet 2018; 392:849-856. [PMID: 30170854 DOI: 10.1016/s0140-6736(18)31719-7] [Citation(s) in RCA: 228] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 07/18/2018] [Accepted: 07/23/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Drug-coated balloons (DCB) are a novel therapeutic strategy for small native coronary artery disease. However, their safety and efficacy is poorly defined in comparison with drug-eluting stents (DES). METHODS BASKET-SMALL 2 was a multicentre, open-label, randomised non-inferiority trial. 758 patients with de-novo lesions (<3 mm in diameter) in coronary vessels and an indication for percutaneous coronary intervention were randomly allocated (1:1) to receive angioplasty with DCB versus implantation of a second-generation DES after successful predilatation via an interactive internet-based response system. Dual antiplatelet therapy was given according to current guidelines. The primary objective was to show non-inferiority of DCB versus DES regarding major adverse cardiac events (MACE; ie, cardiac death, non-fatal myocardial infarction, and target-vessel revascularisation) after 12 months. The non-inferiority margin was an absolute difference of 4% in MACE. This trial is registered with ClinicalTrials.gov, number NCT01574534. FINDINGS Between April 10, 2012, and February 1, 2017, 382 patients were randomly assigned to the DCB group and 376 to DES group. Non-inferiority of DCB versus DES was shown because the 95% CI of the absolute difference in MACE in the per-protocol population was below the predefined margin (-3·83 to 3·93%, p=0·0217). After 12 months, the proportions of MACE were similar in both groups of the full-analysis population (MACE was 7·5% for the DCB group vs 7·3% for the DES group; hazard ratio [HR] 0·97 [95% CI 0·58-1·64], p=0·9180). There were five (1·3%) cardiac-related deaths in the DES group and 12 (3·1%) in the DCB group (full analysis population). Probable or definite stent thrombosis (three [0·8%] in the DCB group vs four [1·1%] in the DES group; HR 0·73 [0·16-3·26]) and major bleeding (four [1·1%] in the DCB group vs nine [2·4%] in the DES group; HR 0·45 [0·14-1·46]) were the most common adverse events. INTERPRETATION In small native coronary artery disease, DCB was non-inferior to DES regarding MACE up to 12 months, with similar event rates for both treatment groups. FUNDING Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung, Basel Cardiovascular Research Foundation, and B Braun Medical AG.
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Affiliation(s)
- Raban V Jeger
- University Hospital Basel, University of Basel, Basel, Switzerland.
| | - Ahmed Farah
- Knappschaftskrankhenhaus, Klinikum Westfalen, Dortmund, Germany
| | | | - Norman Mangner
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany; Heart Center Leipzig, University Hospital, Leipzig, Germany
| | | | | | | | | | | | | | | | - Axel Linke
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany; Heart Center Leipzig, University Hospital, Leipzig, Germany
| | | | | | | | | | - Nicole Gilgen
- University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefan Osswald
- University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christoph Kaiser
- University Hospital Basel, University of Basel, Basel, Switzerland
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