Effect of a novel drug-eluted balloon coated with genistein before stent implantation in porcine coronary arteries

Paclitaxel-Coated Balloon for Femoropopliteal Artery Disease

PURPOSE OF THE REVIEW

Percutaneous transluminal angioplasty is an established form of therapy for femoropopliteal artery disease. Currently, percutaneous transluminal angioplasty (PTA) is carried out using standard balloon with or without deployment of a stent but is associated with a high rate of restenosis and stent-related complications. Treatment options for restenosis, especially in-stent restenosis, are limited. Drug-coated balloons promise to reduce the rates of restenosis by effective delivery of antiproliferative agent (paclitaxel) directly to vessel wall without the need for a permanent implant. In this review, we look at the technology and rationale behind drug-coated balloons and examine the evidence available so far.

RECENT FINDINGS

Recently, several studies tested the effectiveness of paclitaxel-coated balloon angioplasty compared to that of standard PTA in both de novo lesions and in-stent restenosis of femoropopliteal artery. Paclitaxel-coated balloon use resulted in reduced rates of restenosis and favourable clinical outcomes in both these lesion groups. However, in complex lesions, there is still lack of data to support the use of these balloons. Paclitaxel-coated balloon is a safe and effective therapeutic option in patients with both de novo lesions and in-stent restenosis involving femoropopliteal artery. In light of the new evidence, it is time to consider incorporation of this effective therapeutic option into clinical practice. However, further research is needed for the use of paclitaxel-coated balloons in complex femoropopliteal lesions like calcified lesions especially as adjuncts to cutting balloons and debulking strategies.

Current status, challenges and future directions of drug-eluting balloons

For the past 30 years, contemporary coronary and endovascular interventions utilized balloon catheters, bare metal- and drug-eluting stents (DES) to recanalize narrowed vessels. Despite this, the quest for outcome optimization is ongoing for specific lesions and patients. Drug-eluting balloons (DEBs) are among the latest technologies proposed to overcome the limitations of DES, such as stent thrombosis and the dependency on long-term dual antiplatelet therapy. In the large part, DEBs were introduced as a substitute for DES in the treatment of in-stent restenosis and perhaps in certain de novo lesion subsets. DEBs have been tested in several clinical scenarios with encouraging preliminary results. This article will discuss the rationale for developing DEBs, basic concepts and available DEB platforms, along with preclinical studies and clinical experience to support the use of this new technology for endovascular interventions.

Reduction of neointimal hyperplasia in porcine coronary arteries by 2-deoxy-D-glucose

BACKGROUND

The drug eluting stents have been shown to play a substantial role in preventing in-stent restenosis. This study was initiated to determine the efficacy of 2-deoxy-D-glucose (2-DG) in an in-stent restenosis model for reducing neointimal hyperplasia after coronary stent placement.

METHODS

In a porcine overstretch model, three kinds of stents were investigated (n = 12 per group): bare metal stents (BMS), rapamycin-eluted stents (RES), and BMS after intracoronary short-term application of 2-DG (DGS). After 42 days histomorphometric and histopathological analyses were performed.

RESULTS

Neointimal thickness (BMS: 0.38 +/- 0.08, RES: 0.24 +/- 0.11, DGS: 0.15 +/- 0.01), area stenosis (BMS: 47.39 +/- 2.76, RES: 32.2 +/- 2.08, DGS: 29.30 +/- 2.98) did not differ after 42 days between the RES and DGS but were significantly lower as compared to BMS only. Lumen area (BMS: 3.15 +/- 1.53, RES: 4.37 +/- 1.72, DGS: 4.77 +/- 2.14) was significantly higher in the DGS group in comparison to the BMS group. The calculated injury and inflammation scores were similar and re-endothelialization was confirmed in all groups.

CONCLUSIONS

This study could demonstrate that in porcine stent model neointimal hyperplasia and re-endothelialization after application of 2-DG are comparable to those seen in RES. Thus, 2-DG might be a promising clinical application for coronary stent coating.