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Elgendy IY, Mahmoud AN, Elgendy AY, Mojadidi MK, Elbadawi A, Eshtehardi P, Pérez-Vizcayno MJ, Wayangankar SA, Jneid H, David Anderson R, Alfonso F. Drug-Eluting Balloons Versus Everolimus-Eluting Stents for In-Stent Restenosis: A Meta-Analysis of Randomized Trials. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:612-618. [DOI: 10.1016/j.carrev.2018.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/01/2018] [Accepted: 08/13/2018] [Indexed: 01/27/2023]
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Venetsanos D, Lawesson SS, Panayi G, Tödt T, Berglund U, Swahn E, Alfredsson J. Long-term efficacy of drug coated balloons compared with new generation drug-eluting stents for the treatment of de novo coronary artery lesions. Catheter Cardiovasc Interv 2018; 92:E317-E326. [PMID: 29481718 DOI: 10.1002/ccd.27548] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 01/12/2018] [Accepted: 01/27/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Studies comparing drug coated balloons (DCB) with new generation drug-eluting stents (nDES) for the treatment of de novo coronary artery lesions are lacking. METHODS From 2009 to 2016, DCB or nDES used for treatment of de novo coronary lesions at our institution were included, in total 1,197 DEB and 6,458 nDES. We evaluated target lesions restenosis (TLR) and definite target lesion thrombosis (TLT). Propensity score modeling were utilized to study adjusted associations between treatment and outcomes. RESULTS Median follow-up was 901days. DCB patients were older, with higher cardiovascular risk profile. Bailout stenting after DCB was performed in 8% of lesions. The cumulative rate of TLR and TLT was 7.0 vs. 4.9% and 0.2 vs. 0.8% for DCB vs. nDES, respectively. Before adjustment, DCB was associated with a higher risk of TLR [hazard ratio (HR) 1.44; 95% confidence interval (CI) 1.07-1.94] and a non-significantly lower risk of TLT (HR 0.30; 95% CI 0.07-1.24), compared to nDES. In the propensity matched population consisted of 1,197 DCB and 1,197 nDES, treatment with DCB was associated with similar risk for TLR (adjusted HR 1.05; 95% CI 0.72-1.53) but significantly lower risk for TLT (adjusted HR 0.18; 95% CI 0.04-0.82) compared to nDES. CONCLUSIONS Treatment with DCB was associated with a similar risk of TLR and a lower risk of definite TLT compared with nDES. In selected cases, DCB appears as a good alternative to nDES for the treatment of de novo coronary lesions.
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Affiliation(s)
- Dimitrios Venetsanos
- Department of Cardiology, Linköping University, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Sofia Sederholm Lawesson
- Department of Cardiology, Linköping University, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Georgios Panayi
- Department of Cardiology, Linköping University, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Tim Tödt
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Ulf Berglund
- Department of Cardiology, Linköping University, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Eva Swahn
- Department of Cardiology, Linköping University, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Joakim Alfredsson
- Department of Cardiology, Linköping University, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Uskela S, Kärkkäinen JM, Eränen J, Siljander A, Mäntylä P, Mustonen J, Rissanen TT. Percutaneous coronary intervention with drug‐coated balloon‐only strategy in stable coronary artery disease and in acute coronary syndromes: An all‐comers registry study. Catheter Cardiovasc Interv 2018; 93:893-900. [DOI: 10.1002/ccd.27950] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 09/16/2018] [Accepted: 10/08/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Sanna Uskela
- Heart CenterCentral Hospital of North Karelia Joensuu Finland
| | | | - Jaakko Eränen
- Heart CenterCentral Hospital of North Karelia Joensuu Finland
| | | | - Pirjo Mäntylä
- Heart CenterCentral Hospital of North Karelia Joensuu Finland
| | - Juha Mustonen
- Heart CenterCentral Hospital of North Karelia Joensuu Finland
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Bukka M, Rednam PJ, Sinha M. Drug-eluting balloon: design, technology and clinical aspects. ACTA ACUST UNITED AC 2018; 13:032001. [PMID: 29227279 DOI: 10.1088/1748-605x/aaa0aa] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A drug-eluting balloon is a non-stent technology in which the effective homogenous delivery of anti-proliferative drugs is processed by the vessel wall through an inflated balloon. This is done to restore luminal vascularity in order to treat atherosclerosis, in-stent restenosis and reduce the risk of late thrombosis without implanting a permanent foreign object. The balloon technology relies on the concept of targeted drug delivery, which helps in the rapid healing of the vessel wall and prevents the proliferation of smooth muscle cells. Several drug eluting devices in the form of coated balloons are currently in clinical use, namely DIOR®, PACCOCATH®, SeQuent®Please and IN.PACT™. The device varies in terms of the material used for making the balloon, the coating techniques, the choice of coated drug and the release pattern of the drug at the site. This review gives an insight into the evolution, rationale and comparison of the marketed drug-eluting balloons. Here, different coating techniques have been analysed for the application and critical analysis of available DEB technologies, and a technical comparison has been done.
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Affiliation(s)
- Meenasree Bukka
- Department of Medical Devices, National Institute of Pharmaceutical Education and Research, Ahmedabad (NIPER-A) Palaj, Opp. Air Force Station, Gandhinagar-382355, Gujarat, India
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Kawashima H, Suzuki N, Katayama T, Takahashi S, Okabe R, Takamura S, Watanabe Y, Kyono H, Kozuma K. Quantified frequency-domain optical coherence tomography analysis for the thin-high signals on restenotic tissue after paclitaxel-coated balloon angioplasty. Heart Vessels 2017; 33:583-589. [PMID: 29249006 DOI: 10.1007/s00380-017-1103-3] [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: 06/27/2017] [Accepted: 12/08/2017] [Indexed: 11/24/2022]
Abstract
Thin-high signals (THS), detectable by optical coherence tomography (OCT), represent the paclitaxel coverage of in-stent restenotic tissue. This study was conducted to assess the relationship between THS and angiographic outcomes by means of quantified post-procedural frequency-domain OCT (FD-OCT) analysis. From January 2014 to July 2016, 41 patients underwent FD-OCT-guided percutaneous coronary intervention using paclitaxel-coated balloon (PCB) to prevent in-stent restenosis. Of these, we retrospectively enrolled 32 patients (38 lesions) who underwent a 6- to 9-month follow-up angiogram. THS were assessed quantitatively, as THS length and lumen perimeter length were measured using semi-automated software; %THS was calculated by the following formula; total THS area/lumen perimeter area × 100. THS were detected in all 38 lesions that had undergone PCB angioplasty. THS and %THS were significantly higher in lesions without binary restenosis (3.34 ± 2.11 vs. 11.48 ± 8.53 mm2, p = 0.001 and 1.49 ± 0.73 vs. 4.42 ± 2.71%, p = 0.001, respectively). Values for THS, which indicates the paclitaxel coverage on restenotic tissue, are associated with reducing restenosis after PCB for in-stent restenosis.
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Affiliation(s)
- Hideyuki Kawashima
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Nobuaki Suzuki
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan. .,Fourth Department of Internal Medicine, Teikyo University School of Medicine, 5-1-1 Futako, Takatsu-ku, Kawasaki, Japan.
| | - Taiga Katayama
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Shinji Takahashi
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Ryuta Okabe
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Shintaro Takamura
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yusuke Watanabe
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Hiroyuki Kyono
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Ken Kozuma
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
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6
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Tornyos A, Aradi D, Horváth IG, Kónyi A, Magyari B, Pintér T, Vorobcsuk A, Tornyos D, Komócsi A. Clinical outcomes in patients treated for coronary in-stent restenosis with drug-eluting balloons: Impact of high platelet reactivity. PLoS One 2017; 12:e0188493. [PMID: 29216314 PMCID: PMC5720717 DOI: 10.1371/journal.pone.0188493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 10/09/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The impact of high platelet reactivity (HPR) on clinical outcomes after elective percutaneous coronary interventions (PCI) with drug-eluting balloons (DEB) due to in-stent restenosis (ISR) is unknown. OBJECTIVE We sought to evaluate the prognostic importance of HPR together with conventional risk factors in patients treated with DEB. METHODS Patients treated with DEB due to ISR were enrolled in a single-centre, prospective registry between October 2009 and March 2015. Only patients with recent myocardial infarction (MI) received prasugrel, others were treated with clopidogrel. HPR was defined as an ADP-test >46U with the Multiplate assay and no adjustments were done based on results. The primary endpoint of the study was a composite of cardiovascular mortality, MI, any revascularization or stroke during one-year follow-up. RESULTS 194 stable angina patients were recruited of whom 90% were treated with clopidogrel. Clinical characteristics and procedural data were available for all patients; while platelet function testing was performed in 152 subjects of whom 32 (21%) had HPR. Patients with HPR had a higher risk for the primary endpoint (HR: 2.45; CI: 1.01-5.92; p = 0.03). The difference was primarily driven by a higher risk for revascularization and MI. According to the multivariate analysis, HPR remained a significant, independent predictor of the primary endpoint (HR: 2.88; CI: 1.02-8.14; p = 0.04), while total DEB length and statin treatment were other independent correlates of the primary outcome. CONCLUSION HPR was found to be an independent predictor of repeat revascularization and MI among elective patients with ISR undergoing PCI with DEB.
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Affiliation(s)
- Adrienn Tornyos
- Department of Interventional Cardiology, Heart Institute, University of Pécs, Pécs, Hungary
| | - Dániel Aradi
- Heart Centre Balatonfüred and Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Iván G. Horváth
- Department of Interventional Cardiology, Heart Institute, University of Pécs, Pécs, Hungary
| | - Attila Kónyi
- Department of Interventional Cardiology, Heart Institute, University of Pécs, Pécs, Hungary
| | - Balázs Magyari
- Department of Interventional Cardiology, Heart Institute, University of Pécs, Pécs, Hungary
| | - Tünde Pintér
- Department of Interventional Cardiology, Heart Institute, University of Pécs, Pécs, Hungary
| | - András Vorobcsuk
- Department of Interventional Cardiology, Heart Institute, University of Pécs, Pécs, Hungary
| | - Dániel Tornyos
- Department of Interventional Cardiology, Heart Institute, University of Pécs, Pécs, Hungary
| | - András Komócsi
- Department of Interventional Cardiology, Heart Institute, University of Pécs, Pécs, Hungary
- * E-mail:
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Pharmacokinetic Evaluation of Two Paclitaxel-Coated Balloons with Different Drug Load in a Short-Term Porcine Study. Cardiovasc Intervent Radiol 2016; 39:1152-8. [PMID: 27094691 DOI: 10.1007/s00270-016-1346-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 04/04/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of the study was to evaluate the pharmacokinetics and tissue absorption of 2 paclitaxel (PTX) drug-coated balloons (DCB) using different drug loads in a porcine-injured iliac artery model. MATERIALS AND METHODS Twenty-eight pigs were randomized into 2 groups. In group B1, angioplasty was performed with a 1.0 µg/mm(2) DCB with PTX and in group B3, with a 3.0 µg/mm(2) DCB with PTX. An overstretched model of the iliac artery was used for angioplasty under fluoroscopy. Blood and vessel wall PTX were measured with liquid-chromatography mass spectrometry at 1, 5, 30 min, 1, 7, and 28 days. Remaining drug in the balloon was analyzed. RESULTS Mean PTX in blood was significantly higher in the group B3 0.269 ± 0.085 µg/ml compared with the B1 0.218 ± 0.085 µg/ml; p = 0.01. Peak blood PTX concentration was detected at 1 min, and PTX was undetectable 24 h post-angioplasty. There were no statistically significant differences in the mean arterial wall concentration from the treated iliac artery between group-B1 (15.24 ± 21.29 ng/mg) and B3 (15.68 ± 16.33 ng/mg), or in the PTX wall concentration measured at different time points. Mean remaining drug in assayed balloons was lower for group-B1 and represented 8 % of the initial dose. CONCLUSIONS Blood PTX was higher when using 3.0 µg/mm(2) DCB, with a peak drug concentration at 1-min, although the drug was undetectable at 24 h, independently of the loading dose. This study demonstrates no difference in arterial wall uptake of a low dose DCB (1.0 µg/mm(2)), when compared to a common dose DCB (3.0 µg/mm(2)) suggesting that the dose of drug in the DCB could be reduced obtaining a similar clinical effect.
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8
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Kawashima H, Suzuki N, Kyono H, Mitsui M, Okabe S, Watanabe Y, Ishikawa S, Kozuma K. Incidence and distribution of thin-high signals detected by coronary optical coherence tomography in patients treated with paclitaxel-coated balloon angioplasty for in-stent restenosis. Int J Cardiol 2016; 202:892-3. [PMID: 26476988 DOI: 10.1016/j.ijcard.2015.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 10/03/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Hideyuki Kawashima
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Nobuaki Suzuki
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan.
| | - Hiroyuki Kyono
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Miho Mitsui
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Seiji Okabe
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yusuke Watanabe
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Shuichi Ishikawa
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Ken Kozuma
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
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Fernández-Parra R, Laborda A, Lahuerta C, Lostalé F, Aramayona J, de Blas I, de Gregorio MA. Pharmacokinetic Study of Paclitaxel Concentration after Drug-Eluting Balloon Angioplasty in the Iliac Artery of Healthy and Atherosclerotic Rabbit Models. J Vasc Interv Radiol 2015; 26:1380-7.e1. [PMID: 26190185 DOI: 10.1016/j.jvir.2015.05.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 05/18/2015] [Accepted: 05/18/2015] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To assess whether the presence of an atherosclerotic lesion may alter the deposition kinetics of paclitaxel on the arterial wall after drug-eluting balloon (DEB) angioplasty, as well as paclitaxel concentrations in serum and in the recovered balloons. MATERIALS AND METHODS Three New Zealand White rabbit models were created: an atheroma group (arterial mechanical injury and hyperlipidic diet; group A), a prelesional group (fat arterial infiltration, hyperlipidic diet; group B), and a control healthy group (group C). Forty-five animals underwent DEB angioplasty in the iliac artery. Arteries and serum samples were analyzed by liquid chromatography/tandem mass spectrometry at 1, 24, 48, 72, and 96 hours (arteries) and at 1, 6, 12, and 24 hours (serum). Recovered balloons were analyzed by UV chromatography. Histologic and statistical analyses were also performed. RESULTS Group A showed significantly higher arterial paclitaxel concentrations in the first hour after DEB angioplasty (632.05 ng/mg ± 125.75 in group A vs 179.55 ng/mg ± 45.64 and 168.54 ng/mg ± 83.48 in groups B and C, respectively; P < .05). Paclitaxel was undetectable in serum at 24 hours in all groups, but the amount was significantly higher (P < .05) in group B at 1, 6, and 12 hours. The paclitaxel amount in navigated balloons from group A was significantly lower than in other groups (P < .05). CONCLUSIONS Paclitaxel concentration in an atherosclerotic lesion model immediately after DEB angioplasty is nearly fourfold higher than in a healthy artery. Paclitaxel remains in the bloodstream longer when a universal state of fat arterial infiltration is achieved. These findings could have clinical implications, as studies testing commercial drug-eluting devices on healthy animals may be underestimating paclitaxel arterial uptake.
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Affiliation(s)
- Rocío Fernández-Parra
- Department of Animal Pathology, Universidad de Zaragoza, Zaragoza, Spain; Group Interventional Technics Minimal Invasive (GITMI), Zaragoza, Spain.
| | - Alicia Laborda
- Department of Animal Pathology, Universidad de Zaragoza, Zaragoza, Spain; Group Interventional Technics Minimal Invasive (GITMI), Zaragoza, Spain
| | - Celia Lahuerta
- Group Interventional Technics Minimal Invasive (GITMI), Zaragoza, Spain
| | - Fernando Lostalé
- Faculty of Veterinary Sciences, Universidad de Zaragoza, Zaragoza, Spain; Group Interventional Technics Minimal Invasive (GITMI), Zaragoza, Spain
| | - Jose Aramayona
- Department of Pharmacology, Faculty of Veterinary Sciences, Universidad de Zaragoza, Zaragoza, Spain
| | - Ignacio de Blas
- Department of Animal Pathology, Universidad de Zaragoza, Zaragoza, Spain
| | - Miguel A de Gregorio
- Faculty of Veterinary Sciences, Universidad de Zaragoza, Zaragoza, Spain; Group Interventional Technics Minimal Invasive (GITMI), Zaragoza, Spain; CIBER-BBN I3A, Zaragoza, Spain
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10
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Baerlocher MO, Kennedy SA, Rajebi MR, Baerlocher FJ, Misra S, Liu D, Nikolic B. Meta-analysis of drug-eluting balloon angioplasty and drug-eluting stent placement for infrainguinal peripheral arterial disease. J Vasc Interv Radiol 2015; 26:459-73.e4; quiz 474. [PMID: 25703839 DOI: 10.1016/j.jvir.2014.12.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/10/2014] [Accepted: 12/10/2014] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To perform a meta-analysis of randomized controlled trials (RCTs) of drug-eluting balloon (DEB) angioplasty and drug-eluting stents (DESs) for infrainguinal peripheral arterial disease. MATERIALS AND METHODS Systematic searches were performed for all relevant RCTs. RESULTS Eight RCTs for DEB angioplasty and 12 RCTs for a DES in peripheral arterial disease were identified. Meta-analysis demonstrated statistically significant superiority of DEB over plain balloon angioplasty of femoral-popliteal disease for late lumen loss, restenosis, and target lesion revascularization, with no benefit in major amputation or mortality. Statistically significant superiority of DEB over percutaneous transluminal angioplasty (PTA) was demonstrated for infrapopliteal disease for restenosis and target lesion revascularization. Drug-eluting stents showed statistically significant superiority over bare metal stents (BMSs) of femoral-popliteal disease for late lumen loss and restenosis, with no benefit in mortality or amputation. Drug-eluting stents showed statistically significant superiority over BMSs of infrapopliteal disease restenosis and target lesion revascularization, with no benefit in amputation or mortality. CONCLUSIONS Drug-eluting balloon angioplasty and DESs demonstrated superior outcomes compared to PTA and BMS, with no difference in amputation or mortality.
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Affiliation(s)
- Mark Otto Baerlocher
- Division of Vascular and Interventional Radiology, Department of Diagnostic Imaging, Royal Victoria Hospital, Barrie.
| | | | - Mohammad Reza Rajebi
- Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Felix J Baerlocher
- Department of Biology, Mount Allison University, Sackville, New Brunswick
| | - Sanjay Misra
- Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - David Liu
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Boris Nikolic
- Department of Radiology, Stratton Medical Center, Albany, New York
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11
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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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12
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Miyake T, Ihara S, Miyake T, Tsukada Y, Watanabe H, Matsuda H, Kiguchi H, Tsujimoto H, Nakagami H, Morishita R. Prevention of neointimal formation after angioplasty using nuclear factor-κB decoy oligodeoxynucleotide-coated balloon catheter in rabbit model. Circ Cardiovasc Interv 2014; 7:787-96. [PMID: 25406205 DOI: 10.1161/circinterventions.114.001522] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Despite the advent of drug-eluting stents, restenosis after endovascular intervention is still a major limitation in the treatment of cardiovascular disease. To regulate the multiple biological mechanisms underlying restenosis, we focused on inhibition of an important transcription factor, nuclear factor-kappaB (NFκB), using a decoy strategy. METHODS AND RESULTS For site-specific application of NFκB decoy oligodeoxynucleotides into target vessels during angioplasty, we developed a balloon catheter-based delivery system combined with biocompatible nanoparticles as oligodeoxynucleotides carriers. To clarify the therapeutic effect at the site of neointima, balloon angioplasty of the rabbit carotid arteries was performed at 4 weeks after initial endothelial denudation. This delivery system exhibited successful transfer of fluorescence-labeled nanospheres into the neointima in short-term contact with target vessels, and fluorescence could be detected ≥1 week after angioplasty. Consistently, local application of NFκB decoy oligodeoxynucleotides -loaded nanospheres resulted in significant inhibition of neointimal formation, associated with inhibition of NFκB binding activity in the injured arteries. The therapeutic effects were caused by inhibition of macrophage recruitment through the suppression of monocyte chemoattractant protein-1, vascular cell adhesion molecule-1, and CC chemokine ligand 4 expression and inhibition of vascular smooth muscle cell growth via a decrease in the expression of cyclin A and proliferating cell nuclear antigen. Importantly, application of NFκB nanospheres accelerated restoration of the endothelial cell monolayer, associated with enhanced expression of phosphorylated Bcl-2 in endothelial cells. CONCLUSIONS A drug-coated balloon catheter using NFκB decoy oligodeoxynucleotides significantly inhibited the development of neointimal hyperplasia in rabbits. The present study indicates the possibility of a novel therapeutic option to prevent restenosis after angioplasty.
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Affiliation(s)
- Takashi Miyake
- From the Department of Clinical Gene Therapy, Graduate School of Medicine, Osaka University, Osaka, Japan (T.M., T.M., R.M.); Division of Vascular Medicine and Epigenetics, Osaka University United Graduate School of Child Development, Osaka, Japan (T.M., H.N.); AnGes MG, Inc, Osaka, Japan (S.I., H.W.); Pharmaceutical and Beauty Science Research Center, Hosokawa Micron Corporation, Osaka, Japan (Y.T., H.T.); and Togo Medikit Co, Ltd, Miyazaki, Japan (H.M., H.K.)
| | - Shinya Ihara
- From the Department of Clinical Gene Therapy, Graduate School of Medicine, Osaka University, Osaka, Japan (T.M., T.M., R.M.); Division of Vascular Medicine and Epigenetics, Osaka University United Graduate School of Child Development, Osaka, Japan (T.M., H.N.); AnGes MG, Inc, Osaka, Japan (S.I., H.W.); Pharmaceutical and Beauty Science Research Center, Hosokawa Micron Corporation, Osaka, Japan (Y.T., H.T.); and Togo Medikit Co, Ltd, Miyazaki, Japan (H.M., H.K.)
| | - Tetsuo Miyake
- From the Department of Clinical Gene Therapy, Graduate School of Medicine, Osaka University, Osaka, Japan (T.M., T.M., R.M.); Division of Vascular Medicine and Epigenetics, Osaka University United Graduate School of Child Development, Osaka, Japan (T.M., H.N.); AnGes MG, Inc, Osaka, Japan (S.I., H.W.); Pharmaceutical and Beauty Science Research Center, Hosokawa Micron Corporation, Osaka, Japan (Y.T., H.T.); and Togo Medikit Co, Ltd, Miyazaki, Japan (H.M., H.K.)
| | - Yusuke Tsukada
- From the Department of Clinical Gene Therapy, Graduate School of Medicine, Osaka University, Osaka, Japan (T.M., T.M., R.M.); Division of Vascular Medicine and Epigenetics, Osaka University United Graduate School of Child Development, Osaka, Japan (T.M., H.N.); AnGes MG, Inc, Osaka, Japan (S.I., H.W.); Pharmaceutical and Beauty Science Research Center, Hosokawa Micron Corporation, Osaka, Japan (Y.T., H.T.); and Togo Medikit Co, Ltd, Miyazaki, Japan (H.M., H.K.)
| | - Hajime Watanabe
- From the Department of Clinical Gene Therapy, Graduate School of Medicine, Osaka University, Osaka, Japan (T.M., T.M., R.M.); Division of Vascular Medicine and Epigenetics, Osaka University United Graduate School of Child Development, Osaka, Japan (T.M., H.N.); AnGes MG, Inc, Osaka, Japan (S.I., H.W.); Pharmaceutical and Beauty Science Research Center, Hosokawa Micron Corporation, Osaka, Japan (Y.T., H.T.); and Togo Medikit Co, Ltd, Miyazaki, Japan (H.M., H.K.)
| | - Hiroaki Matsuda
- From the Department of Clinical Gene Therapy, Graduate School of Medicine, Osaka University, Osaka, Japan (T.M., T.M., R.M.); Division of Vascular Medicine and Epigenetics, Osaka University United Graduate School of Child Development, Osaka, Japan (T.M., H.N.); AnGes MG, Inc, Osaka, Japan (S.I., H.W.); Pharmaceutical and Beauty Science Research Center, Hosokawa Micron Corporation, Osaka, Japan (Y.T., H.T.); and Togo Medikit Co, Ltd, Miyazaki, Japan (H.M., H.K.)
| | - Hideki Kiguchi
- From the Department of Clinical Gene Therapy, Graduate School of Medicine, Osaka University, Osaka, Japan (T.M., T.M., R.M.); Division of Vascular Medicine and Epigenetics, Osaka University United Graduate School of Child Development, Osaka, Japan (T.M., H.N.); AnGes MG, Inc, Osaka, Japan (S.I., H.W.); Pharmaceutical and Beauty Science Research Center, Hosokawa Micron Corporation, Osaka, Japan (Y.T., H.T.); and Togo Medikit Co, Ltd, Miyazaki, Japan (H.M., H.K.)
| | - Hiroyuki Tsujimoto
- From the Department of Clinical Gene Therapy, Graduate School of Medicine, Osaka University, Osaka, Japan (T.M., T.M., R.M.); Division of Vascular Medicine and Epigenetics, Osaka University United Graduate School of Child Development, Osaka, Japan (T.M., H.N.); AnGes MG, Inc, Osaka, Japan (S.I., H.W.); Pharmaceutical and Beauty Science Research Center, Hosokawa Micron Corporation, Osaka, Japan (Y.T., H.T.); and Togo Medikit Co, Ltd, Miyazaki, Japan (H.M., H.K.)
| | - Hironori Nakagami
- From the Department of Clinical Gene Therapy, Graduate School of Medicine, Osaka University, Osaka, Japan (T.M., T.M., R.M.); Division of Vascular Medicine and Epigenetics, Osaka University United Graduate School of Child Development, Osaka, Japan (T.M., H.N.); AnGes MG, Inc, Osaka, Japan (S.I., H.W.); Pharmaceutical and Beauty Science Research Center, Hosokawa Micron Corporation, Osaka, Japan (Y.T., H.T.); and Togo Medikit Co, Ltd, Miyazaki, Japan (H.M., H.K.)
| | - Ryuichi Morishita
- From the Department of Clinical Gene Therapy, Graduate School of Medicine, Osaka University, Osaka, Japan (T.M., T.M., R.M.); Division of Vascular Medicine and Epigenetics, Osaka University United Graduate School of Child Development, Osaka, Japan (T.M., H.N.); AnGes MG, Inc, Osaka, Japan (S.I., H.W.); Pharmaceutical and Beauty Science Research Center, Hosokawa Micron Corporation, Osaka, Japan (Y.T., H.T.); and Togo Medikit Co, Ltd, Miyazaki, Japan (H.M., H.K.).
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Greer M, Fuehner T, Warnecke G, Noack H, Heilmann T, Haverich A, Welte T, Gottlieb J. Paclitaxel-coated balloons in refractory nonanastomostic airway stenosis following lung transplantation. Am J Transplant 2014; 14:2400-5. [PMID: 25055720 DOI: 10.1111/ajt.12845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 05/22/2014] [Accepted: 05/24/2014] [Indexed: 01/25/2023]
Abstract
Airway stenosis represents the commonest airway complication following lung transplantation, affecting between 7% and 18% of patients. Existing treatment options offer limited efficacy and can cause additional patient morbidity. Paclitaxel-coated balloons (PCB) have proved effective in managing postinterventional coronary artery re-stenosis. In a first-in-man study, we evaluated similar PCBs in refractory nonanastomotic airway stenosis in 12 patients. Following a single application, luminal patency was maintained in 50% at 270 days. No significant peri-interventional or early postinterventional complications occurred. Given these encouraging initial findings, further studies appear warranted.
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Affiliation(s)
- M Greer
- Department of Respiratory Medicine, Hanover Medical School, Hanover, Germany
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Coronary slow-flow phenomenon after paclitaxel-coated balloon angioplasty for neointimal plaque confirmed by optical coherence tomography. Int J Cardiol 2014; 176:1454-6. [DOI: 10.1016/j.ijcard.2014.08.066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 08/09/2014] [Indexed: 11/23/2022]
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Novel potential targets for prevention of arterial restenosis: insights from the pre-clinical research. Clin Sci (Lond) 2014; 127:615-34. [PMID: 25072327 DOI: 10.1042/cs20140131] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Restenosis is the pathophysiological process occurring in 10-15% of patients submitted to revascularization procedures of coronary, carotid and peripheral arteries. It can be considered as an excessive healing reaction of the vascular wall subjected to arterial/venous bypass graft interposition, endarterectomy or angioplasty. The advent of bare metal stents, drug-eluting stents and of the more recent drug-eluting balloons, have significantly reduced, but not eliminated, the incidence of restenosis, which remains a clinically relevant problem. Biomedical research in pre-clinical animal models of (re)stenosis, despite its limitations, has contributed enormously to the identification of processes involved in restenosis progression, going well beyond the initial dogma of a primarily proliferative disease. Although the main molecular and cellular mechanisms underlying restenosis have been well described, new signalling molecules and cell types controlling the progress of restenosis are continuously being discovered. In particular, microRNAs and vascular progenitor cells have recently been shown to play a key role in this pathophysiological process. In addition, the advanced highly sensitive high-throughput analyses of molecular alterations at the transcriptome, proteome and metabolome levels occurring in injured vessels in animal models of disease and in human specimens serve as a basis to identify novel potential therapeutic targets for restenosis. Molecular analyses are also contributing to the identification of reliable circulating biomarkers predictive of post-interventional restenosis in patients, which could be potentially helpful in the establishment of an early diagnosis and therapy. The present review summarizes the most recent and promising therapeutic strategies identified in experimental models of (re)stenosis and potentially translatable to patients subjected to revascularization procedures.
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