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drug coated balloon angioplasty

Philine J Köln, Bruno Scheller, Houng Bang Liew, Tuomas T Rissanen, Wan Azman Wan Ahmad, Ralf Weser, Telse Hauschild, Amin Ariff Nuruddin, Yvonne P Clever, Hee Hwa Ho, Franz X Kleber
BACKGROUND: Chronic total occlusions remain one of the biggest challenges for interventional cardiologists and the high risk of restenosis and stent thrombosis is still a major problem. Drug-coated balloons showed favorable results for the treatment of in-stent restenosis and other lesion types. The aim of this study was to evaluate the feasibility and outcome of a drug-coated balloon only approach for chronic total occlusion. METHODS: We included 34 patients with a native chronic total occlusion treated only by drug-coated balloons...
September 27, 2016: International Journal of Cardiology
Erik Debing, Dimitri Aerden, Alain Vanhulle, Sarah Gallala, Karl von Kemp
BACKGROUND: Several trials have shown that drug coated balloon (DCB) angioplasty reduce the rates of restenosis in the femoropopliteal artery. This controlled, prospective, multicenter study was designed to demonstrate the efficacy of DCB to inhibit restenosis of the infra- inguinal arteries in an exclusive diabetic population. METHODS: Between 2012 and 2014, 106 diabetic patients with symptomatic peripheral arterial disease (PAD) were enrolled at 11 sites in Belgium, 54 treated with DCB angioplasty and 52 treated with plain old balloon angioplasty (POBA)...
October 11, 2016: Journal of Cardiovascular Surgery
Konstantinos Katsanos, Panagiotis Kitrou, Stavros Spiliopoulos, Athanasios Diamantopoulos, Dimitris Karnabatidis
PURPOSE: To report a Bayesian network meta-analysis of randomized controlled trials (RCTs) comparing bare metal stents (BMS), paclitaxel-coated balloons (PCBs), and drug-eluting stents (DES) with balloon angioplasty (BA) or with each other in the infrapopliteal arteries. METHODS: Sixteen RCTs comprising 1805 patients with 1-year median follow-up were analyzed. Bayesian random effects binomial models were employed (WinBUGS). Relative treatment effects were expressed as odds ratios (ORs) with 95% credible intervals (CrI), and the cumulative rank probabilities were calculated to provide hierarchies of competing treatments...
October 5, 2016: Journal of Endovascular Therapy
Ciro Indolfi, Salvatore De Rosa, Antonio Colombo
The introduction of percutaneous treatment of coronary artery stenosis with balloon angioplasty was the first revolution in interventional cardiology; the advent of metallic coronary stents (bare and drug-eluting) marked the second and third revolutions. However, the latest generation of drug-eluting stents is limited by several factors. Permanent vessel caging impairs arterial physiology, and the incidence of very late stent thrombosis - although lower with the second generation than with the first generation of drug-eluting stents - remains a major concern...
September 29, 2016: Nature Reviews. Cardiology
Marc Bosiers, Koen Deloose, Joren Callaert, Patrick Peeters, Michel Bosiers
Endovascular techniques have improved markedly over the past several decades. Plain old balloon angioplasty can only reach patencies around 40% after 1 year. Scaffolding stents have resulted in improved short-term results but encountered limitations for longer-term durability. With the introduction of drug-eluting technologies the process of intimal hyperplasia might be slowed, resulting in improved long-term patency results. At first, limus-eluting technologies were not able to transfer the enthusiasm from the coronaries to the infrainguinal vascular bed...
December 2016: Journal of Cardiovascular Surgery
Frank D Kolodgie, Erica Pacheco, Kazuyuki Yahagi, Hiroyoshi Mori, Elena Ladich, Renu Virmani
PURPOSE: Different carrier excipients unique to individual drug-coated balloons (DCBs) may influence embolic safety characteristics in peripheral vascular territories through embolization of released particulates. A comparator study of IN.PACT Admiral vs Lutonix 035 balloons in healthy swine was therefore performed to assess which balloon produces more downstream emboli. MATERIALS AND METHODS: Single or overlapping 80-mm IN.PACT and Lutonix 035 DCBs were assessed in the femoral arteries of 21 swine with 28- and 90-day follow-up, with standard balloon angioplasty as a control...
September 15, 2016: Journal of Vascular and Interventional Radiology: JVIR
Monika Herten, Giovanni B Torsello, Eva Schönefeld, Stefan Stahlhoff
Peripheral arterial disease, particularly critical limb ischemia, is an area with urgent need for optimized therapies because, to date, vascular interventions often have limited life spans. In spite of initial encouraging technical success after femoropopliteal percutaneous transluminal angioplasty or stenting, postprocedural restenosis remains the major problem. The challenging idea behind the drug-coated balloon (DCB) concept is the biological modification of the injury response after balloon dilatation. Antiproliferative drugs administered via DCBs or drug-eluting stents are able to suppress neointimal hyperplasia, the main cause of restenosis...
2016: Vascular Health and Risk Management
Dasdo Antonius Sinaga, Hee Hwa Ho, Timothy James Watson, Alyssa Sim, Thuzar Tint Nyein, Fahim H Jafary, Jason K K Loh, Yau Wei Ooi, Julian K B Tan, Paul J L Ong
BACKGROUND: Drug-coated balloons (DCB) have been used to treat de novo small vessel coronary disease (SVD), with promising results and shorter dual antiplatelet therapy (DAPT) duration compared to drug-eluting stents (DES). We compared safety and effectiveness of the two treatments at 1 year. METHODS: We reviewed 3,613 angioplasty cases retrospectively from 2011 to 2013 and identified 335 patients with SVD treated with device diameter of ≤2.5 mm. DCB-only angioplasty was performed in 172 patients, whereas 163 patients were treated with second-generation DES...
October 2016: Journal of Interventional Cardiology
Daniele Giacoppo, Salvatore Cassese, Yukinori Harada, Roisin Colleran, Jonathan Michel, Massimiliano Fusaro, Adnan Kastrati, Robert A Byrne
OBJECTIVES: This study sought to assess the risk of target lesion revascularization (TLR) and all-cause death at 12 months and at the maximum available follow-up. Secondary objectives included the identification of factors which could have influenced general findings. BACKGROUND: Recently several randomized trials comparing drug-coated balloon (DCB) with conventional plain balloon (PB) for the treatment of femoropopliteal artery disease have been reported, but no updated meta-analyses are available and questions remain surrounding the long-term antirestenotic effectiveness of the 2 therapies...
August 22, 2016: JACC. Cardiovascular Interventions
Tobias A Rheude, Erion Xhepa, Robert A Byrne
The treatment of in-stent restenosis after drug-eluting stent (DES) implantation remains a major clinical challenge. Optical coherence tomography (OCT) imaging at the time of presentation can provide important information on mechanical factors contributing to stent failure as well as on tissue characteristics of the in-stent neointimal tissue. We report a case of markedly different tissue types-characterized by heterogeneous and homogeneous signal intensity-observed in a patient with multiple lesion DES in-stent restenosis...
August 16, 2016: Catheterization and Cardiovascular Interventions
Naoki Nishiyama, Takaaki Komatsu, Takanori Kuroyanagi, Akinori Fujikake, Sachiko Komatsu, Hidehiko Nakamura, Kota Yamada, Shiro Nakahara, Sayuki Kobayashi, Isao Taguchi
BACKGROUND: Despite the low restenosis rates of drug-eluting stents (DES), several problems remain, including stent thrombosis, stent fracture, and neo-atherosclerosis. 'Stent-less' (balloon alone) percutaneous coronary intervention (PCI) is still being used, and several clinical trials have supported the efficacy of DCB. The aim of this study was to investigate the efficacy of a drug-coated balloon (DCB) in the treatment of de novo coronary artery disease. METHODS: We enrolled 60 consecutive patients who had been given elective PCI between May 2014 and June 2015...
November 1, 2016: International Journal of Cardiology
Ahmed Kayssi, Talal Al-Atassi, George Oreopoulos, Graham Roche-Nagle, Kong Teng Tan, Dheeraj K Rajan
BACKGROUND: Atherosclerotic peripheral arterial disease (PAD) can lead to disabling ischemia and limb loss. Treatment modalities have included risk factor optimization through life-style modifications and medications, or operative approaches using both open and minimally invasive techniques, such as balloon angioplasty. Drug-eluting balloon (DEB) angioplasty has emerged as a promising alternative to uncoated balloon angioplasty for the treatment of this difficult disease process. By ballooning and coating the inside of atherosclerotic vessels with cytotoxic agents, such as paclitaxel, cellular mechanisms responsible for atherosclerosis and neointimal hyperplasia are inhibited and its devastating complications are prevented or postponed...
2016: Cochrane Database of Systematic Reviews
Ralf Langhoff, Andrea Behne, Eva Buschmann
In order to assess the role of drug-coated balloons (DCB) in below-the-knee (BTK) artery interventions, we analyzed randomized trials which compare coated to non-coated balloons and additionally a direct comparison of drug-eluting stents (DES) with DCB. As angioplasty with non-coated balloons is per guideline-recommendation still standard of care for below-the-knee artery endovascular treatment, we focused on the direct comparison of efficacy and clinical outcome data of both treatment modalities. Data from peer reviewed and published trials were consulted...
October 2016: Journal of Cardiovascular Surgery
Prashanta K Mandal, Sarifuddin, Vijaya B Kolachalama
Balloon angioplasty followed by local delivery of antiproliferative drugs to target tissue is increasingly being considered for the treatment of obstructive arterial disease, and yet there is much to appreciate regarding pharmacokinetics in arteries of non-uniform disease. We developed a computational model capable of simulating drug-coated balloon delivery to arteries of heterogeneous tissue composition comprising healthy tissue, as well as regions of fibrous, fibro-fatty, calcified and necrotic core lesions...
July 21, 2016: Cardiovascular Engineering and Technology
Sreekumar Madassery, Ulku C Turba, Bulent Arslan
Peripheral vascular disease (PVD) is a devastating medical problem that may lead to significant life alterations for patients, from simply limiting their daily activities to potential loss of limbs and eventual demise. Superficial femoral and popliteal arteries are significantly common locations for PVD sequelae to present itself, and owing to their length and mobile nature, treatment of these segments are quite challenging. Indications for PVD treatment include lifestyle-limiting claudication that is not responding to medical management, ischemic rest pain, nonhealing ulcers, and lower extremity gangrene...
June 2016: Techniques in Vascular and Interventional Radiology
Derek Mittleider, Erich Russell
Peripheral atherectomy is a class of procedures that is rapidly increasing in volume. Multiple classes of devices exist, and newer variants are added to the market annually. The devices see wide application for de novo lesions, in-stent restenosis, and adjunctive therapy for drug-coated balloons. The body of evidence supporting atherectomy is less robust than for many other peripheral therapies. The frequency and severity of complications from atherectomy can be significant compared with angioplasty and stenting, and familiarity with preventative and bailout techniques is essential for the interventionalist...
June 2016: Techniques in Vascular and Interventional Radiology
Jesse Naghi, Ethan A Yalvac, Ali Pourdjabbar, Lawrence Ang, John Bahadorani, Ryan R Reeves, Ehtisham Mahmud, Mitul Patel
Peripheral arterial disease (PAD) involving the lower extremity is a major source of morbidity and mortality. Clinical manifestations of PAD span the spectrum from lifestyle limiting claudication to ulceration and gangrene leading to amputation. Advancements including balloon angioplasty, self-expanding stents, drug-eluting stents, and atherectomy have resulted in high technical success rates for endovascular therapy in patients with PAD. However, these advances have been limited by somewhat high rates of clinical restenosis and clinically driven target lesion revascularization...
2016: Medical Devices: Evidence and Research
Tudor C Poerner, Corinna Duderstadt, Björn Goebel, Daniel Kretzschmar, Hans R Figulla, Sylvia Otto
BACKGROUND: Percutaneous coronary interventions (PCI) with drug-coated balloons (DCB) might be a promising trade-off between balloon angioplasty and drug-eluting stents, since DCB inhibit neointimal proliferation and limit duration of dual antiplatelet therapy. We investigated the safety, feasibility, and 6-month results of fractional flow reserve (FFR)-guided use of the paclitaxel-coated SeQuent Please(®) balloon without stenting for elective PCI of de novo lesions. METHODS AND RESULTS: In 46 patients (54 lesions) with stable symptomatic coronary artery disease (CAD), a FFR-guided POBA (plain old balloon angioplasty) was performed...
July 5, 2016: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Martin Werner
Restenosis or re-occlusion after femoropopliteal angioplasty or stent implantation is the main limitation of endovascular treatment strategies for peripheral artery disease. Within the last years, balloon catheters with anti-proliferative drug coating on the balloon surface have shown to be associated with higher patency rates compared to plain balloon angioplasty. Thus, drug-coated balloons were gradually adopted in many interventional centres for the treatment of femoropopliteal obstructions. The current review summarises the existing evidence for drug-coated balloons in the infrainguinal vessels and their indication in special lesion cohorts...
September 2016: VASA. Zeitschrift Für Gefässkrankheiten
Sanjum S Sethi, Michael S Lee
Revascularization of infrainguinal peripheral artery disease has traditionally been accomplished via percutaneous transluminal angioplasty. However, long-term results have been hampered by high rates of restenosis. Along with the advent of stents, paclitaxel-coated balloons are an emerging therapeutic option for the invasive management of infrainguinal peripheral artery disease. Paclitaxel has been successful in inhibiting neointimal hyperplasia, the main mechanism for in-stent restenosis. Technological advances have facilitated the development of paclitaxel-coated balloons, which show promise in early trials for femoropopliteal stenosis relative to uncoated balloons...
July 2016: Journal of Invasive Cardiology
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