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Nijhoff F, Agostoni P, Belkacemi A, Nathoe HM, Voskuil M, Samim M, Doevendans PA, Stella PR. Primary percutaneous coronary intervention by drug-eluting balloon angioplasty: the nonrandomized fourth arm of the DEB-AMI (drug-eluting balloon in ST-segment elevation myocardial infarction) trial. Catheter Cardiovasc Interv 2015; 86 Suppl 1:S34-44. [PMID: 26119971 DOI: 10.1002/ccd.26060] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 05/19/2015] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To evaluate a paclitaxel drug-eluting balloon (DEB) only strategy in primary percutaneous coronary intervention (PPCI), aiming at a comparison with bare metal stent (BMS) alone, DEB followed by BMS, and paclitaxel eluting stent (PES), as assessed in the randomized Drug Eluting Balloon in Acute ST-Segment Elevation Myocardial Infarction (DEB-AMI) trial. BACKGROUND DEB-only seems an attractive strategy in PPCI, as it obviates the risk of stent thrombosis. METHODS This study is a prospective registry with the same inclusion/exclusion criteria used in the DEB-AMI trial, as it constitutes the fourth, nonrandomized, treatment arm of this trial. Patients presenting with ST-elevation myocardial infarction were allocated to DEB-only (DIOR II, Eurocor GmbH, Bonn, Germany) after successful thrombus aspiration and predilatation. Primary endpoint was 6-month angiographic in-balloon/stent late-luminal loss (LLL). Secondary endpoints were in-balloon/stent binary restenosis and major adverse cardiac events (MACE: death, myocardial infarction, target-vessel revascularization). RESULTS Forty patients underwent PPCI by DEB-only. Procedural success was achieved in 97.5% with bail-out stenting required in 10.0% of procedures. In DEB-only, LLL was 0.51 ± 0.59 mm as compared to 0.74 ± 0.57 mm in BMS (P = 0.44), 0.64 ± 0.56 mm in DEB+BMS (P = 0.88) and 0.21 ± 0.32 mm in PES (P < 0.01); in-balloon/stent binary restenosis rates were 22.2%, 23.8% (P = 0.67), 28.6% (P = 0.97), and 4.5% (P = 0.07), respectively; and MACE rates were 17.5%, 23.5% (P = 0.20), 20.0% (P = 0.26), and 4.1% (P = 0.90), respectively. No acute or late thrombotic events occurred in the DEB-only group. CONCLUSIONS PPCI by DEB-only in selected patients yielded an angiographic outcome comparable to BMS alone and DEB followed by BMS. PES proved angiographic superiority to DEB-only. DEB-only is therefore a potential treatment alternative during PPCI in patients with contra-indications to drug-eluting stents.
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Affiliation(s)
- Freek Nijhoff
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Hendrik M Nathoe
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mariam Samim
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pieter A Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pieter R Stella
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
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Cannavale A, Tsetis D, Krokidis M. The endovascular approach for in-stent restenosis in femoropopliteal disease. Expert Rev Cardiovasc Ther 2015; 13:391-401. [DOI: 10.1586/14779072.2015.1023293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sgueglia GA, Scheller B. Learning from mistakes: The case of drug-coated balloons. Int J Cardiol 2015; 182:224-6. [DOI: 10.1016/j.ijcard.2014.11.139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 11/23/2014] [Indexed: 10/24/2022]
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Bandomir J, Kaule S, Schmitz KP, Sternberg K, Petersen S, Kragl U. Usage of different vessel models in a flow-through cell: in vitro study of a novel coated balloon catheter. RSC Adv 2015. [DOI: 10.1039/c4ra12524j] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Calcium alginate and polyacrylamide hydrogels were used as tissue models for the simulated anatomic implantation process.
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Affiliation(s)
- Jenny Bandomir
- University of Rostock
- Department of Chemistry
- 18059 Rostock
- Germany
| | - Sebastian Kaule
- University of Rostock
- Institute for Biomedical Engineering
- 18119 Rostock
- Germany
| | - Klaus-Peter Schmitz
- University of Rostock
- Institute for Biomedical Engineering
- 18119 Rostock
- Germany
| | - Katrin Sternberg
- University of Rostock
- Institute for Biomedical Engineering
- 18119 Rostock
- Germany
| | - Svea Petersen
- University of Rostock
- Institute for Biomedical Engineering
- 18119 Rostock
- Germany
| | - Udo Kragl
- University of Rostock
- Department of Chemistry
- 18059 Rostock
- Germany
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Rodriguez-Granillo GA, Rodriguez AE, Bruining N, Milei J, Aoki J, Tsuchida K, del Valle-Fernández R, Arampatzis CA, Ong ATL, Lemos PA, Ayala F, Garcia-Garcia HM, Saia F, Valgimigli M, Regar E, McFadden E, Biondi-Zoccai G, Barbenza E, Schoenhagen P, Serruys PW. Quantification of scientific output in cardiovascular medicine: a perspective based on global data. EUROINTERVENTION 2014; 9:975-8. [PMID: 24063871 DOI: 10.4244/eijv9i8a163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIMS We sought to explore whether global and regional scientific output in cardiovascular medicine is associated with economic variables and follows the same trend as medicine and as science overall. METHODS AND RESULTS We registered the number of documents, number of citations, citations per document and the h-index for the first 50 countries according to the h-index (a measure to evaluate both the productivity and impact of the publications) in cardiovascular medicine. Economic variables (gross domestic product [GDP] per capita, % expenditure of the GDP in research and development [R&D] and health) were obtained from the World Bank, the UNESCO, and the World Health Organization. In total, the scientific output in cardiology showed the same position as in medicine and science overall (mean difference vs. medicine -0.9±5.3º, p=0.25 vs. science -0.7±5.3º, p=0.39). We found significant correlations between the h-index and the % GDP expenditure in R&D (r=0.67, p<0.001), and the % GDP expenditure in health (r=0.71, p<0.0001). Overall, there was a 21.4% (interquartile range 3.7; 55.0) increase in the % GDP expenditure in R&D between 1996 and 2007. Emerging economies showed the larger growth in % GDP expenditure in health and R&D. CONCLUSIONS The global situation of scientific output in cardiovascular medicine is highly polarised and closely related to economic indicators. Emergent economies, with higher rates of GDP growth and increasingly larger expenditures for R&D and healthcare, are expected to show a visible escalation in the scientific global picture in the near future.
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Semmling B, Nagel S, Sternberg K, Weitschies W, Seidlitz A. Impact of different tissue-simulating hydrogel compartments on in vitro release and distribution from drug-eluting stents. Eur J Pharm Biopharm 2014; 87:570-8. [DOI: 10.1016/j.ejpb.2014.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 03/13/2014] [Accepted: 04/27/2014] [Indexed: 12/21/2022]
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Giannini F, Naim C, Costopoulos C, Latib A, Colombo A. Drug-coated balloons in interventional cardiology. Expert Rev Cardiovasc Ther 2014; 11:1379-91. [DOI: 10.1586/14779072.2013.837758] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Scheinert D, Duda S, Zeller T, Krankenberg H, Ricke J, Bosiers M, Tepe G, Naisbitt S, Rosenfield K. The LEVANT I (Lutonix Paclitaxel-Coated Balloon for the Prevention of Femoropopliteal Restenosis) Trial for Femoropopliteal Revascularization. JACC Cardiovasc Interv 2014; 7:10-9. [DOI: 10.1016/j.jcin.2013.05.022] [Citation(s) in RCA: 262] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 03/18/2013] [Accepted: 05/09/2013] [Indexed: 10/25/2022]
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Cremers B, Schmitmeier S, Clever YP, Gershony G, Speck U, Scheller B. Inhibition of neo-intimal hyperplasia in porcine coronary arteries utilizing a novel paclitaxel-coated scoring balloon catheter. Catheter Cardiovasc Interv 2013; 84:1089-98. [DOI: 10.1002/ccd.25296] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 10/30/2013] [Accepted: 11/16/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Bodo Cremers
- Department of Internal Medicine III; University of Saarland; Homburg/Saar Germany
| | | | - Yvonne P. Clever
- Department of Internal Medicine III; University of Saarland; Homburg/Saar Germany
| | - Gary Gershony
- John Muir Cardiovascular Institute; Concord California
| | - Ulrich Speck
- Department of Radiology; Campus Charité Mitte; Humboldt-University Berlin; Berlin Germany
| | - Bruno Scheller
- Department of Internal Medicine III; University of Saarland; Homburg/Saar Germany
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Belkacemi A, Stella PR, Chunlai S, Uiterwijk M, Ali D, Agostoni P. Angiographic fate of side branch dissections in bifurcation lesions treated with a provisional single stenting strategy: A post-hoc analysis of the international multicenter randomized DEBIUT study. Catheter Cardiovasc Interv 2013; 83:539-44. [DOI: 10.1002/ccd.25172] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 08/08/2013] [Accepted: 08/22/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Anouar Belkacemi
- Department of Cardiology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Pieter R. Stella
- Department of Cardiology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Shao Chunlai
- Department of Cardiology; University Medical Center Utrecht; Utrecht The Netherlands
- Department of Cardiology; The Second Affiliated Hospital of Soochow University; Suzhou People's Republic of China
| | - Marcelle Uiterwijk
- Department of Cardiology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Danish Ali
- Department of Cardiology; University Medical Center Utrecht; Utrecht The Netherlands
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Cortese B, Berti S, Biondi-Zoccai G, Colombo A, Limbruno U, Bedogni F, Cremonesi A, Silva PL, Sgueglia GA. Drug-coated balloon treatment of coronary artery disease: a position paper of the Italian Society of Interventional Cardiology. Catheter Cardiovasc Interv 2013; 83:427-35. [PMID: 23934956 DOI: 10.1002/ccd.25149] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 07/30/2013] [Indexed: 02/05/2023]
Abstract
Drug-coated balloons are a new tool for the treatment of patients with coronary artery disease. The main feature of this technology is a rapid and homogenous transfer of an antiproliferative drug (paclitaxel) to the vessel wall just at the time of balloon inflation, when neointimal proliferation, in response to angioplasty, is the highest. Moreover, drug-coated balloons share adjuntive advantages over stents: the absence of permanent scaffold and polymer, the respect of the original coronary anatomy, and limited inflammatory stimuli, thereby allowing for short-term dual antiplatelet therapy. To this day, a lot of devices are available in the market, with limited scientific data for the vast majority of them. Thus, the Italian scientific society of interventional cardiologists GISE decided to coordinate the efforts of a group of reknown experts on the field, in order to obtain a Position Paper on the correct use of drug-coated balloons in all the settings of coronary artery disease, giving a class of indication to each one, based on the clinical evidence. This Position Paper represents a quick reference for operators, investigators, and manufactures to promote the understanding and the correct use of the drug-coated balloon technology in everyday clinical practice.
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Late catch-up phenomenon after drug-eluting balloon angioplasty. Int J Cardiol 2013; 168:638-9. [DOI: 10.1016/j.ijcard.2013.04.175] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Accepted: 04/20/2013] [Indexed: 11/20/2022]
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Waksman R, Serra A, Loh JP, Malik FTN, Torguson R, Stahnke S, von Strandmann RP, Rodriguez AE. Drug-coated balloons for de novo coronary lesions: results from the Valentines II trial. EUROINTERVENTION 2013; 9:613-9. [DOI: 10.4244/eijv9i5a98] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Buszman PP, Tellez A, Afari ME, Peppas A, Conditt GB, Rousselle SD, McGregor JC, Stenoien M, Kaluza GL, Granada JF. Tissue Uptake, Distribution, and Healing Response After Delivery of Paclitaxel via Second-Generation Iopromide-Based Balloon Coating. JACC Cardiovasc Interv 2013; 6:883-90. [DOI: 10.1016/j.jcin.2013.04.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 04/12/2013] [Accepted: 04/25/2013] [Indexed: 10/26/2022]
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Fröhlich GM, Lansky AJ, Ko DT, Archangelidi O, De Palma R, Timmis A, Meier P. Drug eluting balloons for de novo coronary lesions - a systematic review and meta-analysis. BMC Med 2013; 11:123. [PMID: 23657123 PMCID: PMC3648374 DOI: 10.1186/1741-7015-11-123] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 04/17/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The role of drug-eluting balloons (DEB) is unclear. Increasing evidence has shown a benefit for the treatment of in-stent restenosis. Its effect on de novo coronary lesions is more controversial. Several smaller randomized trials found conflicting results. METHODS This is a systematic review and meta-analysis of randomized controlled trials (RCT) evaluating the effect of local Paclitaxel delivery/drug eluting balloons (DEB) (+/- bare metal stent) compared to current standard therapy (stenting) to treat de novo coronary lesions. Data sources for RCT were identified through a literature search from 2005 through 28 December 2012. The main endpoints of interest were target lesion revascularization (TLR), major adverse cardiac events (MACE), binary in-segment restenosis, stent thrombosis (ST), myocardial infarction (MI), late lumen loss (LLL) and mortality. A random effects model was used to calculate the pooled relative risks (RR) with 95% confidence intervals. RESULTS Eight studies (11 subgroups) and a total of 1,706 patients were included in this analysis. Follow-up duration ranged from 6 to 12 months. Overall, DEB showed similar results to the comparator treatment. The relative risk (RR) for MACE was 0.95 (0.64 to 1.39); P = 0.776, for mortality it was 0.79 (0.30 to 2.11), P = 0.644, for stent thrombosis it was 1.45 (0.42 to 5.01), P = 0.560, for MI it was 1.26 (0.49 to 3.21), P = 0.629, for TLR it was 1.09 (0.71 to 1.68); P = 0.700 and for binary in-stent restenosis it was 0.96 (0.48 to 1.93), P = 0.918. Compared to bare metal stents (BMS), DEB showed a lower LLL (- 0.26 mm (-0.51 to 0.01)) and a trend towards a lower MACE risk (RR 0.66 (0.43 to 1.02)). CONCLUSION Overall, drug-eluting balloons (+/- bare metal stent) are not superior to current standard therapies (BMS or drug eluting stent (DES)) in treating de novo coronary lesions. However, the performance of DEB seems to lie in between DES and BMS with a trend towards superiority over BMS alone. Therefore, DEB may be considered in patients with contraindications for DES. The heterogeneity between the included studies is a limitation of this meta-analysis; different drug-eluting balloons have been used.
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Affiliation(s)
- Georg M Fröhlich
- The Heart Hospital, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
| | - Alexandra J Lansky
- Division of Cardiology, Yale Medical School, 333 Cedar Street, New Haven, CT, 06510, USA
| | - Dennis T Ko
- Institute for Clinical Evaluative Sciences, 2075 Bayview Ave., Toronto, ON, M4N 3M5, Canada
| | - Olga Archangelidi
- Department of Epidemiology and Public Health, University College London UCL, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Rodney De Palma
- The Heart Hospital, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
| | - Adam Timmis
- Department of Cardiology, London Chest Hospital, Bethnal Green, London, E2 9JX, UK
| | - Pascal Meier
- The Heart Hospital, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
- Division of Cardiology, Yale Medical School, 333 Cedar Street, New Haven, CT, 06510, USA
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Krokidis M, Spiliopoulos S, Katsanos K, Sabharwal T. Peripheral applications of drug-coated balloons: past, present and future. Cardiovasc Intervent Radiol 2013; 36:281-91. [PMID: 22915325 DOI: 10.1007/s00270-012-0467-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 07/31/2012] [Indexed: 02/08/2023]
Abstract
Drug-coated balloon (DCB) technologies represent the latest and hottest development in the field of endovascular treatment of peripheral arterial disease. Initial experience with paclitaxel-coated balloon use in the femoral artery has demonstrated lower mid-term restenosis and superior mid-term clinical outcomes in terms of improved wound healing and reduced repeat angioplasty rates compared with standard balloon angioplasty. Many companies are presently developing and/or improving DCB catheters and therefore ongoing, technical improvements of the already existing platforms, new drugs, and innovative carriers are expected. The ongoing basic research studies and various multicenter randomized, controlled trials that are currently in progress will offer valuable scientific insights regarding the long-term effectiveness and other crucial issues, such as efficacy in various vascular beds, optimal balloon dosage, and post angioplasty antiplatelet therapy. Future applications of these devices also could include in-stent restenosis, anastomotic stenosis of surgical bypass, and benign stenoses of the central venous system. The authors envision that DCB angioplasty will evolve to a major paradigm shift in the endovascular treatment of occlusive vascular diseases.
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Affiliation(s)
- Miltiadis Krokidis
- Department of Radiology, Guy's and St. Thomas' Hospitals, NHS Foundation Trust, 1st Floor Lambeth Wing, Lambeth Palace Road, London, SE1 7EH, UK.
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Karimi A, de Boer SW, van den Heuvel DAF, Fioole B, Vroegindeweij D, Heyligers JMM, Lohle PNM, Elgersma O, Nolthenius RPT, Vos JA, de Vries JPPM. Randomized trial of Legflow(®) paclitaxel eluting balloon and stenting versus standard percutaneous transluminal angioplasty and stenting for the treatment of intermediate and long lesions of the superficial femoral artery (RAPID trial): study protocol for a randomized controlled trial. Trials 2013; 14:87. [PMID: 23537403 PMCID: PMC3651710 DOI: 10.1186/1745-6215-14-87] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 02/13/2013] [Indexed: 11/29/2022] Open
Abstract
Background Restenosis after percutaneous transluminal angioplasty (PTA) of the superficial femoral artery (SFA) may occur in 45% of patients at 2 years follow-up. Paclitaxel-coated balloons have been found to reduce neointimal hyperplasia, and thus reduce restenosis. Recently, the Legflow® paclitaxel-coated balloon (Cardionovum Sp.z.o.o., Warsaw, Poland) (LPEB) has been introduced. This balloon is covered with shellac, a Food and Drug Administration (FDA) approved natural resin, to obtain an equally distributed tissue concentration of paclitaxel. The RAPID trial is designed to assess restenosis after PTA using the Legflow balloon combined with nitinol stenting versus uncoated balloons with nitinol stenting in SFA lesions >5 cm. Methods/Design A total of 176 adult patients with Rutherford class 2 to class 6 symptoms due to intermediate (5–15 cm) or long (>15 cm) atherosclerotic lesions in the SFA will be randomly allocated for treatment with LPEB with nitinol stenting or uncoated balloon angioplasty with stenting. Stenting will be performed using the Supera® stent in both groups (IDEV Technologies Inc., Webster, TX). The primary endpoint is the absence of binary restenosis of the treated SFA segment. Secondary outcomes are target lesion revascularization (TLR), clinical and hemodynamic outcome, amputation rate, mortality rate, adverse events, and device-specific adverse events. Follow up consists of four visits in which ankle-brachial indices (ABI), toe pressure measurements, and duplex ultrasound (DUS) will be performed. Furthermore, a peripheral artery questionnaire (PAQ) will be completed by the patients at each follow-up. In the event that DUS reveals a symptomatic >50% restenosis, or a >75% asymptomatic restenosis, additional digital subtraction angiography will be performed with any necessary re-intervention. Discussion The RAPID trial is a multicenter randomized controlled patient blind trial that will provide evidence concerning whether the use of the Legflow paclitaxel/shellac coated balloons with nitinol stenting significantly reduces the frequency of restenosis in intermediate and long SFA lesions compared to standard PTA and stenting. Trial registration ISRCTN47846578
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Affiliation(s)
- Amine Karimi
- Department of Vascular Surgery, St. Antonius Hospital, PO box 2500, Nieuwegein, EM 3430, The Netherlands.
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Schmehl J, von der Ruhr J, Dobratz M, Kehlbach R, Braun I, Greiner TO, Claussen CD, Behnisch B. Balloon coating with rapamycin using an on-site coating device. Cardiovasc Intervent Radiol 2013; 36:756-63. [PMID: 23435745 DOI: 10.1007/s00270-013-0583-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 01/07/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE The efficacy of drug-eluting balloons has been demonstrated in clinical trials. The drug predominantly used is paclitaxel because of its lipophilic properties and the rapid onset of action. The aim of the investigation was to evaluate the feasibility and efficacy of an alternative balloon coating with rapamycin that can be applied on site. METHODS The balloon coating (3.0/18 and 3.0/12 mm, Cathy No. 4, Translumina GmbH) with rapamycin was conducted with a coating machine (Translumina GmbH). Concentrations were 2, 2 × 2, 3, and 4 %. Measurements regarding the amount of substance released to the vessel wall were carried out on explanted porcine coronaries by means of ultraviolet and visible-light spectroscopy. Inflation time varied between 30 and 120 s. The biological effect of the coating was evaluated in a porcine peripheral overstretch and stent implantation model. RESULTS The amount of rapamycin on the balloon surface ranged from 558 ± 108 μg for the 2 % solution to 1,441 ± 228 μg in the 4 % solution. An amount of 95 ± 63-193 ± 113 μg was released into the vessel wall. The quantitative measurements of the angiographic examinations 4 weeks after treatment revealed a reduction of diameter stenosis from 20.6 ± 17.4 % in the control group to 11.6 ± 5.5 % in the drug-eluting balloon group. CONCLUSION A balloon coating with rapamycin omitting an excipient is possible with a dose-adjustable coating machine. However, the biological effects are moderate, which make further optimization of the coating process and evaluation of appropriate excipients necessary.
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Affiliation(s)
- Jörg Schmehl
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany.
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Plass CA, Sabdyusheva-Litschauer I, Bernhart A, Samaha E, Petnehazy O, Szentirmai E, Petrási Z, Lamin V, Pavo N, Nyolczas N, Jakab A, Murlasits Z, Bergler-Klein J, Maurer G, Gyöngyösi M. Time course of endothelium-dependent and -independent coronary vasomotor response to coronary balloons and stents. Comparison of plain and drug-eluting balloons and stents. JACC Cardiovasc Interv 2012; 5:741-51. [PMID: 22814779 DOI: 10.1016/j.jcin.2012.03.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Revised: 03/07/2012] [Accepted: 03/29/2012] [Indexed: 02/05/2023]
Abstract
OBJECTIVES This study sought to determine the time dependency of the endothelium-dependent and -independent vascular responses after percutaneous coronary intervention (PCI) with drug-eluting (DEB) or plain balloons, bare-metal (BMS), and drug-eluting (DES) stents, or controls. BACKGROUND Long-term endothelial dysfunction after DES implantation is associated with delayed healing and late thrombosis. METHODS Domestic pigs underwent PCI using DEB or plain balloon, BMS, or DES. The dilated and stented segments, and the proximal reference segments of stents and control arteries were explanted at 5-h, 24-h, 1-week, and 1-month follow-up (FUP). Endothelin-induced vasoconstriction and endothelium-dependent and -independent vasodilation of the arterial segments were determined in vitro and were related to histological results. RESULTS DES- and BMS-treated arteries showed proneness to vasoconstriction 5 h post-PCI. The endothelium-dependent vasodilation was profoundly (p < 0.05) impaired early after PCI (9.8 ± 3.7%, 13.4 ± 9.2%, 5.7 ± 5.3%, and 7.6 ± 4.7% using plain balloon, DEB, BMS, and DES, respectively), as compared with controls (49.6 ± 9.5%), with slow recovery. In contrast to DES, the endothelium-related vasodilation of vessels treated with plain balloon, DEB, and BMS was increased at 1 month, suggesting enhanced endogenous nitric oxide production of the neointima. The endothelium-independent (vascular smooth muscle-related) vasodilation decreased significantly at 1 day, with slow normalization during FUP. All PCI-treated vessels exhibited imbalance between vasoconstriction-vasodilation, which was more pronounced in DES- and BMS-treated vessels. No correlation between histological parameters and vasomotor function was found, indicating complex interactions between the healing neoendothelium and smooth muscle post-PCI. CONCLUSIONS Coronary arteries treated with plain balloon, DEB, BMS, and DES showed time-dependent loss of endothelial-dependent and -independent vasomotor function, with imbalanced contraction/dilation capacity.
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Affiliation(s)
- Christian A Plass
- Department of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, Austria
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Sangiorgi G, Romagnoli E, Biondi-Zoccai G. Commentary: drug-eluting balloons for carotid in-stent restenosis: can this technology deliver the goods? J Endovasc Ther 2012; 19:743-8. [PMID: 23210871 DOI: 10.1583/jevt-12-3942c.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Giuseppe Sangiorgi
- Department of Cardiology, University of Rome Tor Vergata, Cardiac Cath Lab, Policlinico Casilino, Rome, Italy.
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71
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Mieres J, Fernandez-Pereira C, Risau G, Solorzano L, Pauletto R, Rodriguez-Granillo AM, Rubilar B, Stella P, Rodriguez AE. One-year outcome of patients with diabetes mellitus after percutaneous coronary intervention with three different revascularization strategies: Results from the DiabEtic Argentina Registry (DEAR). CARDIOVASCULAR REVASCULARIZATION MEDICINE 2012; 13:265-71. [DOI: 10.1016/j.carrev.2012.06.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 06/01/2012] [Accepted: 06/14/2012] [Indexed: 11/16/2022]
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Coronary angiography and percutaneous coronary intervention in the porcine model: a practical guide to the procedure. Animal 2012; 6:311-20. [PMID: 22436190 DOI: 10.1017/s1751731111001650] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Assessment of safety and efficacy within the porcine coronary artery model remains a standard requirement for new therapies delivered to the coronary arteries before proceeding to clinical testing. Human coronary procedures carry a very low mortality rate; however, procedural mortality for porcine experiments is often high, despite these animals being young and free of atherosclerosis. Some of these deaths are due to poor technique, and therefore avoidable. However, despite the wide use of this model, a systematic description of the procedure has never been published. This article will detail how porcine angiography and stent implantation is performed in our institution and will discuss the relevant differences between humans and pigs with regard to anaesthesia, pharmacotherapy, vascular access, catheter selection and angiographic views. Important variations to the technique that have been reported are also covered.
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73
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Belkacemi A, Agostoni P, Nathoe HM, Voskuil M, Shao C, Van Belle E, Wildbergh T, Politi L, Doevendans PA, Sangiorgi GM, Stella PR. First Results of the DEB-AMI (Drug Eluting Balloon in Acute ST-Segment Elevation Myocardial Infarction) Trial. J Am Coll Cardiol 2012; 59:2327-37. [DOI: 10.1016/j.jacc.2012.02.027] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 02/06/2012] [Accepted: 02/07/2012] [Indexed: 11/28/2022]
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Speck U, Cremers B, Kelsch B, Biedermann M, Clever YP, Schaffner S, Mahnkopf D, Hanisch U, Böhm M, Scheller B. Do pharmacokinetics explain persistent restenosis inhibition by a single dose of paclitaxel? Circ Cardiovasc Interv 2012; 5:392-400. [PMID: 22619258 DOI: 10.1161/circinterventions.111.967794] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of this study was to investigate the elimination of paclitaxel from the arterial wall after a single short administration with a coated balloon. METHODS AND RESULTS Slightly oversized paclitaxel-coated balloons (dose 3 or 9 μg/mm(2)) without or with premounted stents were inflated in nonatherosclerotic coronary arteries of either young domestic pigs or adult Goettingen minipigs. The paclitaxel content of plasma, arterial segments, and residual hearts (without treated arteries) was measured for up to 180 days using high-performance liquid chromatography/ultraviolet detection or mass spectrometry. Angiograms were evaluated for lumen narrowing. The paclitaxel concentration in plasma remained <10 ng/mL. In arteries of domestic pigs and minipigs treated with paclitaxel-coated balloons with premounted stents, 10%±5% or 21%±8% of dose, respectively, was initially detected and decreased to 3.5%±3.1% of dose (domestic pig) by Day 7. Within 6 months it fell with a half-life of 1.9 months to 0.40%±0.35%. After 3 months the concentration in the arterial wall was 17±11 μmol/L. Without a stent, drug transfer to the vessel wall was somewhat reduced and elimination faster. Immediately after treatment up to 26%±4% of dose was detected in the residual whole hearts. It dropped with a half-life of 45 days to 1.5%±0.6% of dose (0.3 μmol/L) within 6 months. CONCLUSIONS After a single local administration with coated balloons, paclitaxel stays in the vessel wall of pigs long enough to explain persistent inhibition of neointimal proliferation. The pharmacokinetics of paclitaxel does, however, not exclude other reasons for sustained efficacy such as early blocking of processes initiating excessive and prolonged neointimal proliferation.
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Affiliation(s)
- Ulrich Speck
- Department of Radiology, Charité, Humboldt University Berlin, Berlin, Germany.
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75
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Zago AC, Raudales JC, Attizzani G, Matte BS, Yamamoto GI, Balvedi JA, Nascimento L, Kosachenco BG, Centeno PR, Zago AJ. Local delivery of sirolimus nanoparticles for the treatment of in-stent restenosis. Catheter Cardiovasc Interv 2012; 81:E124-9. [DOI: 10.1002/ccd.24331] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 01/07/2012] [Indexed: 11/06/2022]
Affiliation(s)
- Alexandre C. Zago
- Cardiovascular Research Center; Universidade Luterana do Brasil (ULBRA); Canoas; Rio Grande do Sul; Brazil
| | - José C. Raudales
- Cardiovascular Research Center; Universidade Luterana do Brasil (ULBRA); Canoas; Rio Grande do Sul; Brazil
| | - Guilherme Attizzani
- Cardiovascular Research Center; Universidade Luterana do Brasil (ULBRA); Canoas; Rio Grande do Sul; Brazil
| | - Bruno S. Matte
- Cardiovascular Research Center; Universidade Luterana do Brasil (ULBRA); Canoas; Rio Grande do Sul; Brazil
| | - German I. Yamamoto
- Cardiovascular Research Center; Universidade Luterana do Brasil (ULBRA); Canoas; Rio Grande do Sul; Brazil
| | - Julise A. Balvedi
- Cardiovascular Research Center; Universidade Luterana do Brasil (ULBRA); Canoas; Rio Grande do Sul; Brazil
| | - Ludmila Nascimento
- Cardiovascular Research Center; Universidade Luterana do Brasil (ULBRA); Canoas; Rio Grande do Sul; Brazil
| | - Beatriz G. Kosachenco
- Cardiovascular Research Center; Universidade Luterana do Brasil (ULBRA); Canoas; Rio Grande do Sul; Brazil
| | - Paulo R. Centeno
- Cardiovascular Research Center; Universidade Luterana do Brasil (ULBRA); Canoas; Rio Grande do Sul; Brazil
| | - Alcides J. Zago
- Cardiovascular Research Center; Universidade Luterana do Brasil (ULBRA); Canoas; Rio Grande do Sul; Brazil
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Stella PR, Belkacemi A, Dubois C, Nathoe H, Dens J, Naber C, Adriaenssens T, van Belle E, Doevendans P, Agostoni P. A multicenter randomized comparison of drug-eluting balloon plus bare-metal stent versus bare-metal stent versus drug-eluting stent in bifurcation lesions treated with a single-stenting technique: Six-month angiographic and 12-month clinical results of th. Catheter Cardiovasc Interv 2012; 80:1138-46. [DOI: 10.1002/ccd.23499] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 11/21/2011] [Indexed: 11/09/2022]
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77
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Vassilev D, Hazan M, Dean L. Aneurysm formation after drug-eluting balloon treatment of drug-eluting in-stent restenosis: First case report. Catheter Cardiovasc Interv 2012; 80:1223-6. [DOI: 10.1002/ccd.23460] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Accepted: 10/31/2012] [Indexed: 11/09/2022]
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Stella PR, Belkacemi A, Waksman R, Stahnke S, Torguson R, von Strandmann RP, Agostoni P, Sangiorgi G, Silber S. The Valentines Trial: results of the first one week worldwide multicentre enrolment trial, evaluating the real world usage of the second generation DIOR paclitaxel drug-eluting balloon for in-stent restenosis treatment. EUROINTERVENTION 2012; 7:705-10. [PMID: 21959672 DOI: 10.4244/eijv7i6a113] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIM To assess the safety and efficacy of the second generation DIOR paclitaxel drug-eluting balloon (DEB) for in-stent restenosis in a real world setting in a prospective single-arm registry with 8-month clinical outcomes. METHODS AND RESULTS In this "real world", international prospective registry, patients with in-stent restenosis (bare-metal stent and drug-eluting stent) were enrolled- in a unique study design- with a one week enrolment period, spread over 104 centres worldwide. Patients underwent predilatation with a regular balloon, with subsequent DEB inflation in the target lesion. Additional stenting of the target lesion was left to the operators discretion in case of suboptimal angiographic success (TIMI flow <3 and/or residual stenosis >30%). The primary endpoint was 6-9-month major adverse cardiac events (MACE: all cause death, myocardial infarction, and target vessel revascularisation). A total of 250 evaluable patients were enrolled in a large web-based clinical research form and treated with the second generation DIOR DEB. Of these, 244 had 6-9 month clinical follow-up, with a mean follow-up time of 7.5 months. The cumulative MACE rate at follow-up was 11.1%, with 3 (1.2%) cardiac deaths, 1 (0.4%) non-cardiac death, 5 (2.0%) myocardial infarctions of which 2 (0.8%) periprocedural, 21 (8.6%) target vessel revascularisations, of which 18 (7.4%) target lesion revascularisations. CONCLUSIONS In-stent restenosis treatment with the second generation DIOR DEB is safe and feasible, with high angiographic success and low target lesion revascularisation and overall MACE rates. Moreover this new and unique method of high speed and short duration multicentre study enrolment was very successful.
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Affiliation(s)
- Pieter R Stella
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
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Abstract
AIMS After the excellent results of the PACCOCATH ISR and PEPCAD II trials in in-stent restenosis, paclitaxel-coated balloon (PCB) still has to prove its efficacy in native coronary disease. METHODS AND RESULTS In the PICCOLETO randomised trial, patients with stable or unstable angina undergoing PCI of small coronary vessels (≤ 2.75 mm) were randomised to the Dior PCB (28 patients) or the Taxus DES (29 patients). The primary study endpoint was percent diameter stenosis at 6-month angiographic follow-up (non-inferiority); secondary endpoints were angiographic binary restenosis and major adverse cardiac events (MACE: death, Q-wave myocardial infarction, TLR) at 9-month follow-up (non-inferiority). The two groups were not dissimilar for clinical and angiographic data. The study was interrupted after enrolment of two-thirds of the patients due to a clear superiority of one study group. The primary endpoint was not met: the PCB group had higher percent diameter stenosis (43.6% vs. 24.3%, p=0.029), angiographic restenosis (32.1 vs. 10.3%, p=0.043), and higher occurrence of MACE (35.7% vs. 13.8%, p=0.054). CONCLUSIONS Dior PCB failed to show equivalence to Taxus DES regarding angiographic endpoints during PCI of small coronary arteries. We hypothesise that it concerned the lack of efficacy of the device used (which has since been replaced by its second generation) rather than a class-effect in native coronary vessels.
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Affiliation(s)
- Bernardo Cortese
- Interventional Cardiology, Cliniche Humanitas Gavazzeni, Bergamo, Italy.
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Karnabatidis D, Spiliopoulos S, Katsanos K, Siablis D. Below-the-knee drug-eluting stents and drug-coated balloons. Expert Rev Med Devices 2012; 9:85-94. [PMID: 22145843 DOI: 10.1586/erd.11.67] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Endovascular procedures have evolved to the mainstream treatment of choice for revascularization of infrapopliteal obstructive disease, especially in patients suffering from critical limb ischemia and multiple comorbidities. However, standard balloon angioplasty is limited by the potential of a suboptimal acute outcome due to elastic recoil and/or flow-limiting dissection, followed by neointimal hyperplasia and progressive vascular restenosis even in the case of bare-metal stent use. Drug-eluting stents and drug-coated balloons are emerging endovascular technologies with the promise of significant inhibition of vessel restenosis and improved clinical outcomes. The current review outlines the drug-eluting properties of those instruments and summarizes the currently available clinical data. The authors critically appraise the current status and also provide a glimpse of the near future of endovascular below-the-knee treatments.
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Affiliation(s)
- Dimitris Karnabatidis
- Department of Radiology, Angiography Suite, Patras University Hospital, Rion, Greece.
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81
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Radke P, Joner M, Joost A, Byrne R, Hartwig S, Bayer G, Steigerwald K, Wittchow E. Vascular effects of paclitaxel following drug-eluting balloon angioplasty in a porcine coronary model: the importance of excipients. EUROINTERVENTION 2011; 7:730-7. [DOI: 10.4244/eijv7i6a116] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Cortese B, Bertoletti A. Paclitaxel coated balloons for coronary artery interventions: a comprehensive review of preclinical and clinical data. Int J Cardiol 2011; 161:4-12. [PMID: 21955612 DOI: 10.1016/j.ijcard.2011.08.855] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Revised: 08/25/2011] [Accepted: 08/30/2011] [Indexed: 10/17/2022]
Abstract
After the "mechanical era" in interventional cardiology (represented by balloon angioplasty and bare metal stent implantation), arrived the "local dispensing" era, began with the intracoronary delivery of antithrombotic or antirestenotic drugs. However, even drug eluting stents have some pitfalls and cannot be used in all clinical subsets. In this article we will review the significant data on the paclitaxel-coated balloons for the treatment of coronary artery disease. Particularly, we will review the rationale of this new treatment strategy, the preclinical data and will focus on available clinical studies in humans. After the initial boost of the paclitaxel coated balloons with the Paccocath technology in in-stent restenotic lesions, the experimentation of newer devices in native coronary arteries raised some concerns on their efficacy and safety. We will comment on this topic trying to understand the reasons of this failure, and will discuss on possible future developments and applications for these devices for the treatment of coronary artery disease.
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Affiliation(s)
- Bernardo Cortese
- Interventional Cardiology, Cliniche Humanitas Gavazzeni, Bergamo, Italy.
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VAQUERIZO BEATRIZ, SERRA ANTONIO, MIRANDA-GUARDIOLA FAUSTINO, MARTÍNEZ VANESA, ANTONI GÓMEZ-HOSPITAL JOAN, IÑIGUEZ ANDRÉS, FERNÁNDEZ EDUARDO, RAMÓN RUMOROSO JOSÉ, BOSA FRANCISCO, OTAEGUI IMANOL. One-year Outcomes with Angiographic Follow-Up of Paclitaxel-Eluting Balloon for the Treatment of In-Stent Restenosis: Insights from Spanish Multicenter Registry. J Interv Cardiol 2011; 24:518-28. [DOI: 10.1111/j.1540-8183.2011.00667.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Fiorella DJ, Turk AS, Levy EI, Pride GL, Woo HH, Albuquerque FC, Welch BG, Niemann DB, Aagaard-Kienitz B, Rasmussen PA, Hopkins LN, Masaryk TJ, McDougall CG. U.S. Wingspan Registry: 12-month follow-up results. Stroke 2011; 42:1976-81. [PMID: 21636812 DOI: 10.1161/strokeaha.111.613877] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study is to present 12-month follow-up results for a series of patients undergoing percutaneous transluminal angioplasty and stenting with the Gateway-Wingspan stenting system (Boston Scientific) for the treatment of symptomatic intracranial atherostenosis. METHODS Clinical and angiographic follow-up results were recorded for patients from 5 participating institutions. Primary end points were stroke or death within 30 days of the stenting procedure or ipsilateral stroke after 30 days. RESULTS During a 21-month study period, 158 patients with 168 intracranial atherostenotic lesions (50% to 99%) were treated with the Gateway-Wingspan system. The average follow-up duration was 14.2 months with 143 patients having at least 3 months of clinical follow-up and 110 having at least 12 months. The cumulative rate of the primary end point was 15.7% for all patients and 13.9% for patients with high-grade (70% to 99%) stenosis. Of 13 ipsilateral strokes occurring after 30 days, 3 resulted in death. Of these strokes, 76.9% (10 of 13) occurred within the first 6 months of the stenting procedure and no events were recorded after 12 months. An additional 9 patients experienced ipsilateral transient ischemic attack after 30 days. Most postprocedural events (86%) could be attributed to interruption of antiplatelet medications (n=6), in-stent restenosis (n=12), or both (n=1). In 3 patients, the events were of uncertain etiology. CONCLUSIONS After successful Wingspan percutaneous transluminal angioplasty and stenting, some patients continued to experience ipsilateral ischemic events. Most of these ischemic events occurred within 6 months of the procedure and were associated with the interruption of antiplatelet therapy or in-stent restenosis.
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Affiliation(s)
- David J Fiorella
- Stony Brook University Medical Center, Department of Neurological Surgery, Health Sciences Center T-12 080, Stony Brook, NY 11794, USA.
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Schmitmeier S, Cremers B, Clever YP, Speck U, Scheller B. The SeQuent™ Please drug-coated balloon system for percutaneous transluminal coronary angioplasty. Interv Cardiol 2011. [DOI: 10.2217/ica.11.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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87
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Stella P, Belkacemi A, Agostoni P. Drug-eluting balloons and bifurcations, a new future? EUROINTERVENTION 2010; 6 Suppl J:J161-4. [DOI: 10.4244/eijv6supja28] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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