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Qian J, Wu Y, Li C, Yin J, Fu G, Wang J, He Y, Ma G, Chen Y, Xia Y, Li L, Ji F, Zeng H, Wei M, Nie S, Jin H, He B, Chen Y, Liu F, Wang H, Sun Y, Xu B, Ge J. Drug-coated balloon for the treatment of small vessel disease: 9 months of angiographic results and 12 months of clinical outcomes of the PEPCAD China SVD study. Catheter Cardiovasc Interv 2023; 101:33-43. [PMID: 36480798 DOI: 10.1002/ccd.30472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/20/2022] [Accepted: 10/24/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Whether the drug-coated balloons (DCBs)-alone strategy was superior to plain old balloon angioplasty (POBA) in treating SVD remains unknown. AIMS We aimed to evaluate the efficacy and safety of DCBs for the treatment of coronary de novo small vessel disease (SVD) and provide further evidence for extending the clinical indications of DCBs. (ChiCTR1800014966). METHODS Eligible patients were randomized at a 2:1 ratio to receive DCB treatment or POBA in this prospective, multicenter clinical trial. The reference vessel diameter of lesions was visually assessed to be 2.0 to 2.75 mm. The primary endpoint of the study was angiographic in-segment late luminal loss (LLL) at the 9-month follow-up to demonstrate the superiority of DCB treatment to POBA in SVD. The composite clinical endpoints included clinically driven target lesion revascularization (CD-TLR), target lesion failure (TLF), major adverse cardiac events (MACEs), and thrombosis at the 12-month follow-up. RESULTS A total of 270 patients were enrolled (181 for DCB, 89 for POBA) at 18 centers in China. The primary endpoint of 9-month in-segment LLL in the intention-to-treat population was 0.10 ± 0.33 mm with DCB and 0.25 ± 0.38 mm with POBA (p = 0.0027). This difference indicated significant superiority of DCB treatment (95% CI: -0.22, -0.04, psuperiority = 0.0068). The rates of the clinical endpoints-CD-TLR, TLF, and MACEs-were comparable between groups. No thrombosis events were reported. CONCLUSIONS DCB treatment of de novo SVD was superior to POBA with lower 9-month in-segment LLL. The rates of clinical events were comparable between the two devices.
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Affiliation(s)
- Juying Qian
- Department of Cardiology, Zhongshan Hospital Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yizhe Wu
- Department of Cardiology, Zhongshan Hospital Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Chenguang Li
- Department of Cardiology, Zhongshan Hospital Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Jiasheng Yin
- Department of Cardiology, Zhongshan Hospital Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Guosheng Fu
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhenjiang University School of Medicine, Hangzhou, China
| | - Jian'an Wang
- Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Yong He
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Genshan Ma
- Department of Cardiology, Zhongda Hospital Southeast University, Nanjing, China
| | - Yundai Chen
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Yong Xia
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Lang Li
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Fusui Ji
- Department of Cardiology, Beijing Hospital of the Ministry of Health, Beijing, China
| | - Hesong Zeng
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Meng Wei
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Shaoping Nie
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Huigen Jin
- Department of Cardiology, Central Hospital of Putuo District, Shanghai, China
| | - Ben He
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yuguo Chen
- Department of Cardiology, Qilu Hospital of Shandong University, Ji'nan, China
| | - Fan Liu
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hui Wang
- Department of Cardiology, Jiangsu Province Hospital, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yingxian Sun
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, China
| | - Bo Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
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Montelione N, Catanese V, Nenna A, Jawabra M, Verghi E, Loreni F, Nappi F, Lusini M, Mastroianni C, Jiritano F, Serraino GF, Mastroroberto P, Codispoti FA, Chello M, Spinelli F, Stilo F. The Diagnostic Value of Circulating Biomarkers and Role of Drug-Coated Balloons for In-Stent Restenosis in Patients with Peripheral Arterial Disease. Diagnostics (Basel) 2022; 12:diagnostics12092207. [PMID: 36140608 PMCID: PMC9498042 DOI: 10.3390/diagnostics12092207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022] Open
Abstract
Peripheral arterial disease (PAD) is an increasingly pathological condition that commonly affects the femoropopliteal arteries. The current fashionable treatment is percutaneous transluminal angioplasty (PTA), often with stenting. However, the in-stent restenosis (ISR) rate after the stenting of the femoropopliteal (FP) district remains high. Many techniques have been proposed for the treatment of femoropopliteal ISR, such as intravascular brachytherapy, laser atherectomy, second stenting and drug-coated balloons angioplasty (DCB). DCB showed a significantly lower rate of restenosis and target lesions revascularization (TLR) compared to conventional PTA. However, further studies and multi-center RCTs with dedicated long-term follow-up are needed to verify the true efficiency of this approach. Nowadays, the correlation between PAD and inflammation biomarkers is well known. Multiple studies have shown that proinflammatory markers (such as C-reactive proteins) and the high plasma levels of microRNA could predict the outcomes after stent placement. In particular, circulating microRNA-320a, microRNA-3937, microRNA-642a-3p and microRNA-572 appear to hold promise in diagnosing ISR in patients with PAD, but also as predictors of stent patency. This narrative review intends to summarize the current knowledge on the value of circulating biomarkers as predictors of ISR and to foster the scientific debate on the advantages of using DCB in the treatment of ISR in the FP district.
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Affiliation(s)
- Nunzio Montelione
- Vascular Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Vincenzo Catanese
- Vascular Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
- Correspondence:
| | - Antonio Nenna
- Cardiac Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Mohamad Jawabra
- Cardiac Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Emanuele Verghi
- Cardiac Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Francesco Loreni
- Cardiac Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Francesco Nappi
- Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, 93200 Paris, France
| | - Mario Lusini
- Cardiac Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Ciro Mastroianni
- Cardiac Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Federica Jiritano
- Cardiovascular Surgery, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | | | | | | | - Massimo Chello
- Cardiac Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Francesco Spinelli
- Vascular Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Francesco Stilo
- Vascular Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
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A randomized comparison of a novel iopromide-based paclitaxel-coated balloon Shenqi versus SeQuent Please for the treatment of in-stent restenosis. Coron Artery Dis 2021; 32:526-533. [PMID: 33229940 DOI: 10.1097/mca.0000000000000994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Treatment of coronary in-stent restenosis (ISR) remains challenging in contemporary clinical applications. Drug-coated balloon (DCB) angioplasty offers an effective treatment for ISR. Shenqi is a novel iopromide-based paclitaxel-coated balloon and its clinical safety, effectiveness and angiographic efficacy in patients with ISR have not been investigated. METHODS A total of 216 subjects with the first occurrence of ISR at 11 investigational sites in China were randomly allocated in a 1:1 fashion to treatment with DCB SeQuent Please or Shenqi. Clinical follow-up was planned at 1, 6, 9 and 12 months, and angiographic follow-up was planned at 9 months. The study was powered for the primary endpoint of 9-month in-segment late loss. RESULTS At 9-month follow-up, the in-segment late loss was 0.29 ± 0.43 mm with Shenqi versus 0.30 ± 0.46 mm with SeQuent Please, and the one-sided 97.5% upper confidence limit of the difference was 0.14 mm, achieving noninferiority of Shenqi compared with SeQuent Please (P = 0.002). In total, 12 patients developed target lesion failure (TLF) in the Shenqi group compared with 16 patients in the SeQuent Please group (10.91% versus 15.09%; P = 0.42) within 1 year. TLF was mainly driven by target lesion revascularization (9.09%) followed by target vessel-related myocardial infarction (1.82%) and cardiovascular death (0.91%) in the Shenqi group. CONCLUSIONS Shenqi DCB was noninferior to SeQuent Please DCB for the primary endpoint of 9-month in-segment late loss. Shenqi DCB may become an attractive alternative treatment for patients with coronary ISR, withholding the need for additional stent implantation.
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Gao JQ. A Case Summary of the Application of a Drug-Eluting Stent Combined with a Drug-Coated Balloon in Left Main Coronary Artery Disease. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2021. [DOI: 10.15212/cvia.2021.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective: To evaluate the clinical efficacy of a drug-eluting stent (DES) combined with a drug-coated balloon (DCB)in the treatment of left main coronary artery bifurcation lesions.Methods: A retrospective analysis was conducted on the clinical data of eight patients with left main coronary arterybifurcation lesions treated with a DES combined with a DCB who were admitted to our hospital from July 2016 to July2017. These eight patients all underwent DES treatment for their left main coronary artery and left anterior descendingcoronary artery lesions, and DCB treatment at the ostium of the left circumflex artery; six of the patients underwentsurgical procedures under the guidance of intravascular ultrasonography. Immediate postoperative angiography wasused to evaluate the patency of the diseased vessels, and the restenosis rate at the 6-month follow-up after the operationand the incidence of serious clinical events within 6 months were assessed as well.Results: The use of a DES combined with a DCB in the treatment of left main coronary artery bifurcation lesions hada low restenosis rate (left main coronary artery (8.4 ± 5.3)%, left anterior descending coronary artery (18.2 ± 5.0)%,left circumflex artery (30.5 ± 16.5)%). No serious clinical events occurred in any patients.Conclusion: A DES combined with a DCB is a safe and effective interventional treatment for left main artery coronarybifurcation lesions.
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