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Cortese B, Malakouti S, Mazhar W, Leontin Lazar F, Munjal A, Ketchanji Mougang Y. Long-term benefits of drug-coated balloons for coronary artery revascularization. Minerva Cardiol Angiol 2024; 72:506-516. [PMID: 38127439 DOI: 10.23736/s2724-5683.23.06425-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) represents the treatment of choice for the majority of patients with coronary artery disease. While currently available DES, in addition to physiological support, has failed to show the non-inferiority to coronary artery bypass grafting (CABG) in terms of cumulative incidence of clinical events over the short-term follow-up. Studies have also shown that DES is associated with an increased risk of target vessel revascularization compared to CABG after long-term follow-up. Drug-coated balloons (DCB) have been shown to provide clinically significant benefits in the management of in-stent restenosis and diffuse coronary artery disease, as well as small coronary artery lesions. The aim of this review was to describe the inherent technical limitations of DES and highlight the potential advantages of PCI with DCB for long-term outcomes and potentially demonstrate its non-inferiority to CABG. Currently, ongoing studies will provide more information and help to understand if a blended therapy of DCB+DES can match the performance of CABG in the need for revascularization in more complex patients.
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Affiliation(s)
- Bernardo Cortese
- Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy -
- DCB Academy, Milan, Italy -
| | | | - Waqas Mazhar
- DCB Academy, Milan, Italy
- Institute of Cardiology of Rawalpindi, Rawalpindi, Pakistan
| | - Florin Leontin Lazar
- Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Clinicilor, Cluj-Napoca, Romania
| | - Amit Munjal
- DCB Academy, Milan, Italy
- Maharaja Agresan Medical College, Agroha, India
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Fezzi S, Ding D, Mahfoud F, Huang J, Lansky AJ, Tu S, Wijns W. Illusion of revascularization: does anyone achieve optimal revascularization during percutaneous coronary intervention? Nat Rev Cardiol 2024; 21:652-662. [PMID: 38710772 DOI: 10.1038/s41569-024-01014-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 05/08/2024]
Abstract
This Perspective article is a form of 'pastiche', inspired by the 1993 review by Lincoff and Topol entitled 'Illusion of reperfusion', and explores how their concept continues to apply to percutaneous revascularization in patients with coronary artery disease and ischaemia. Just as Lincoff and Topol argued that reperfusion of acute myocardial infarction was facing unresolved obstacles that hampered clinical success in 1993, we propose that challenging issues are similarly jeopardizing the potential benefits of stent-based angioplasty today. By analysing the appropriateness and efficacy of percutaneous coronary intervention (PCI), we emphasize the limitations of relying solely on visual angiographic guidance, which frequently leads to inappropriate stenting and overtreatment in up to one-third of patients and the associated increased risk of periprocedural myocardial infarction. The lack of optimal revascularization observed in half of patients undergoing PCI confers risks such as suboptimal physiology after PCI, residual angina and long-term stent-related events, leaving an estimated 76% of patients with an 'illusion of revascularization'. These outcomes highlight the need to refine our diagnostic tools by integrating physiological assessments with targeted intracoronary imaging and emerging strategies, such as co-registration systems and angiography-based computational methods enhanced by artificial intelligence, to achieve optimal revascularization outcomes.
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Affiliation(s)
- Simone Fezzi
- The Lambe Institute for Translational Medicine, the Smart Sensors Laboratory and Curam, University of Galway, Galway, Ireland
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Daixin Ding
- The Lambe Institute for Translational Medicine, the Smart Sensors Laboratory and Curam, University of Galway, Galway, Ireland
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Felix Mahfoud
- Saarland University Hospital, Internal Medicine III, Cardiology, Angiology, Intensive Care Medicine, Homburg/Saar, Germany
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- University Heart Center Basel, Department of Cardiology, University Basel, Basel, Switzerland
| | - Jiayue Huang
- The Lambe Institute for Translational Medicine, the Smart Sensors Laboratory and Curam, University of Galway, Galway, Ireland
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Alexandra J Lansky
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Shengxian Tu
- Department of Cardiology, Ren Ji Hospital, School of Medicine, and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
| | - William Wijns
- The Lambe Institute for Translational Medicine, the Smart Sensors Laboratory and Curam, University of Galway, Galway, Ireland.
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3
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Kamada K, Joko K, Otaka N, Matsusaka H, Morishige K. Successful treatment of acute left main coronary artery disease with a drug-coated balloon under left ventricular unloading using Impella: a case report. Eur Heart J Case Rep 2024; 8:ytae443. [PMID: 39258016 PMCID: PMC11384888 DOI: 10.1093/ehjcr/ytae443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/10/2024] [Accepted: 08/19/2024] [Indexed: 09/12/2024]
Abstract
Background Although the efficacy and safety of drug-coated balloons (DCBs) for acute left main coronary artery (LMCA) disease have not yet been proven, stentless percutaneous coronary intervention with a DCB is preferred for patients with high bleeding risk requiring a shorter duration of dual antiplatelet therapy. Mechanical circulatory support may improve haemodynamics in patients with cardiogenic shock caused by acute LMCA disease. Case summary A 74-year-old man diagnosed with acute congestive heart failure underwent emergency coronary angiography (CAG) at our hospital owing to ischaemic changes on the electrocardiogram (ECG), indicating acute LMCA disease. Coronary angiography revealed severe LMCA ostial stenosis. Immediately after CAG, mechanical circulatory support was initiated using Impella CP® for haemodynamic collapse with abrupt ST-segment elevation in the precordial leads. The haemodynamics stabilized with a dramatic improvement in the ECG. We treated the culprit ostial lesion with inflation of a cutting balloon followed by DCB delivery because of an episode of haematochezia. Subsequently, his cardiac function recovered fully. Discussion A case of acute LMCA disease was successfully treated with a DCB under haemodynamic support using Impella CP. The left ventricular (LV) unloading with Impella was indicated to contribute to stable haemodynamics, even during long inflation with the DCB, and the immediate recovery of LV function. Haemodynamic support using Impella may be effective, especially in cases requiring repeated and longer inflation of balloon catheters accompanied by extensive myocardial ischaemia.
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Affiliation(s)
- Kazuhiro Kamada
- Department of Cardiovascular Medicine, Matsuyama Red Cross Hospital, 1 Bunkyocho, Matsuyama-city, Ehime 790-8524, Japan
| | - Kensuke Joko
- Department of Cardiovascular Medicine, Matsuyama Red Cross Hospital, 1 Bunkyocho, Matsuyama-city, Ehime 790-8524, Japan
| | - Naoya Otaka
- Department of Cardiovascular Medicine, Matsuyama Red Cross Hospital, 1 Bunkyocho, Matsuyama-city, Ehime 790-8524, Japan
| | - Hidenori Matsusaka
- Department of Cardiovascular Medicine, Matsuyama Red Cross Hospital, 1 Bunkyocho, Matsuyama-city, Ehime 790-8524, Japan
| | - Kunio Morishige
- Department of Cardiovascular Medicine, Matsuyama Red Cross Hospital, 1 Bunkyocho, Matsuyama-city, Ehime 790-8524, Japan
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Her AY, Shin ES. Drug-Coated Balloon Treatment for De Novo Coronary Lesions: Current Status and Future Perspectives. Korean Circ J 2024; 54:519-533. [PMID: 38956941 PMCID: PMC11361769 DOI: 10.4070/kcj.2024.0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 05/22/2024] [Indexed: 07/04/2024] Open
Abstract
The outstanding development in contemporary medicine, highlighted by percutaneous coronary intervention (PCI), was achieved through the adoption of drug-eluting stents (DESs). Although DES is the established therapy for patients undergoing PCI for de novo coronary artery disease (CAD), their drawbacks include restenosis, stent thrombosis, and the requirement for dual antiplatelet therapy (DAPT) with an uncertain duration regarding its optimality. Drug-coated balloon (DCB) treatment leaves nothing behind on the vessel wall, providing the benefit of avoiding stent thrombosis and not necessitating obligatory extended DAPT. After optimizing coronary blood flow, DCB treatment delivers an anti-proliferative drug directly coated on a balloon. Although more evidence is needed for the application of DCB treatment in de novo coronary lesions, recent studies suggest the safety and effectiveness of DCB treatment for diverse conditions including small and large vessel diseases, complex lesions like bifurcation lesions or diffuse or multivessel diseases, chronic total occlusion lesions, acute myocardial infarctions, patients at high risk of bleeding, and beyond. Consequently, we will review the current therapeutic choices for managing de novo CAD using DCB and assess the evidence supporting their concurrent application. Additionally, it aims to discuss future important perspectives.
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Affiliation(s)
- Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University College of Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
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Mukheja Y, Sarkar A, Arora R, Pal K, Ahuja A, Vashishth A, Kuhad A, Chopra K, Jain M. Unravelling the progress and potential of drug-eluting stents and drug-coated balloons in cardiological insurgencies. Life Sci 2024; 352:122908. [PMID: 39004270 DOI: 10.1016/j.lfs.2024.122908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 07/01/2024] [Accepted: 07/08/2024] [Indexed: 07/16/2024]
Abstract
AIM Coronary artery disease (CAD) is the leading cause of mortality. Though percutaneous transluminal angioplasty followed by stenting is still the default treatment of choice for revascularization of obstructive CAD, the high rate of restenosis compromises the outcomes of endovascular procedures. To overcome restenosis, drug-eluting stents (DES) and drug-coated balloons (DCB) are designed that release antiproliferative drugs like sirolimus, paclitaxel, everolimus, etc., over time to inhibit cell growth and proliferation. Our review aims to summarize the challenges and progress of DES/DCBs in clinical settings. MATERIAL AND METHODS The comprehensive review, search and selection encompasses in relevant articles through Google Scholar, Springer online, Cochrane library and PubMed that includes research articles, reviews, letters and communications, various viewpoints, meta-analyses, randomized trials and quasi-randomized trials. Several preclinical and clinical data have been included from National Institutes of Health and clinicaltrials.gov websites. KEY FINDINGS Challenges like delayed endothelialization, stent thrombosis (ST), and inflammation was prominent in first-generation DES. Second-generation DES with improved designs and drug coatings enhanced biocompatibility with fewer complications. Gradual absorption of bioresorbable DES over time mitigated long-term issues associated with permanent implants. Polymer-free DES addressed the inflammation concerns but still, they leave behind metallic stents in the vasculature. As an alternative therapeutic strategy, DCB were developed to minimize inflammation in the vessel. Although both DES and DCBs have shown considerable progress, challenges persist. SIGNIFICANCE This review illustrates the advancements in the designs, preparation technologies, biodegradable materials, and drugs used as well as challenges associated with DES and DCBs in clinical settings.
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Affiliation(s)
- Yashdeep Mukheja
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
| | - Ankan Sarkar
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
| | - Rubal Arora
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
| | - Kashish Pal
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
| | - Akanksha Ahuja
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
| | - Anushka Vashishth
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
| | - Anurag Kuhad
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
| | - Kanwaljit Chopra
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
| | - Manish Jain
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India.
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Shin D, Singh M, Shlofmitz E, Scheller B, Latib A, Kandzari DE, Zaman A, Mylotte D, Dakroub A, Malik S, Sakai K, Jeremias A, Moses JW, Shlofmitz RA, Stone GW, Ali ZA. Paclitaxel-coated versus sirolimus-coated balloon angioplasty for coronary artery disease: A systematic review and meta-analysis. Catheter Cardiovasc Interv 2024. [PMID: 39044661 DOI: 10.1002/ccd.31154] [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: 04/23/2024] [Revised: 06/12/2024] [Accepted: 07/12/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Although use of sirolimus-based analogs has shown superiority over paclitaxel in drug-eluting stents, the relative efficacy of these two agents released from drug-coated balloons (DCB) is unclear. The present meta-analysis is aimed to compare outcomes after percutaneous coronary intervention (PCI) with paclitaxel-coated balloons (PCB) versus sirolimus-coated balloons (SCB) for either in-stent restenosis or native de novo lesions. METHODS The study outcomes were 1) target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction, or target lesion revascularization, and 2) follow-up angiographic parameters including late lumen loss (LLL), diameter stenosis, and minimal lumen diameter (MLD). Pooled odds ratios (OR) and weighted mean differences (WMD) with 95% confidence intervals (CI) were calculated by using random-effects models. RESULTS A search of PubMed, EMBASE, and Cochrane Library from their inception to January 2024 identified five randomized clinical trials and three observational studies with a total of 1861 patients (889 in PCB and 972 in SCB groups). During 9-12 months of follow-up, there was no significant difference in TLF (OR 1.01, 95% CI 0.75-1.35) between the two groups. On follow-up angiography at 6-9 months, MLD (WMD 0.10, 95% CI 0.02-0.17) was larger in PCB but there was no statistically significant difference in LLL (WMD -0.11, 95% CI -0.23-0.02) and diameter stenosis (WMD -3.33, 95% CI -8.11-1.45). CONCLUSIONS Among patients undergoing DCB-only PCI, the risk of TLF was similar during 9-12 months of follow-up after PCB and SCB treatment. However, the MLD was larger favoring PCB over SCB on follow-up angiography.
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Affiliation(s)
- Doosup Shin
- Department of Cardiology, St Francis Hospital and Heart Center, Roslyn, New York, USA
| | - Mandeep Singh
- Department of Cardiology, St Francis Hospital and Heart Center, Roslyn, New York, USA
| | - Evan Shlofmitz
- Department of Cardiology, St Francis Hospital and Heart Center, Roslyn, New York, USA
| | - Bruno Scheller
- Clinical and Experimental Interventional Cardiology, University of Saarland, Homburg/Saar, Germany
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Azfar Zaman
- Department of Cardiology, Freeman Hospital and Newcastle University, Newcastle upon Tyne, UK
| | - Darren Mylotte
- Department of Cardiology, University Hospital Galway, Galway, Ireland
| | - Ali Dakroub
- Department of Cardiology, St Francis Hospital and Heart Center, Roslyn, New York, USA
| | - Sarah Malik
- Department of Cardiology, St Francis Hospital and Heart Center, Roslyn, New York, USA
| | - Koshiro Sakai
- Department of Cardiology, St Francis Hospital and Heart Center, Roslyn, New York, USA
| | - Allen Jeremias
- Department of Cardiology, St Francis Hospital and Heart Center, Roslyn, New York, USA
- Cardiovascular Research Foundation, New York, New York, USA
| | - Jeffrey W Moses
- Department of Cardiology, St Francis Hospital and Heart Center, Roslyn, New York, USA
- Cardiovascular Research Foundation, New York, New York, USA
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Richard A Shlofmitz
- Department of Cardiology, St Francis Hospital and Heart Center, Roslyn, New York, USA
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ziad A Ali
- Department of Cardiology, St Francis Hospital and Heart Center, Roslyn, New York, USA
- Cardiovascular Research Foundation, New York, New York, USA
- New York Institute of Technology, Old Westbury, New York, USA
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7
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Sedhom R, Hamed M, Elbadawi A, Mohsen A, Swamy P, Athar A, Bharadwaj AS, Prasad V, Elgendy IY, Alfonso F. Outcomes With Limus- vs Paclitaxel-Coated Balloons for Percutaneous Coronary Intervention: Meta-Analysis of Randomized Controlled Trials. JACC Cardiovasc Interv 2024; 17:1533-1543. [PMID: 38986653 DOI: 10.1016/j.jcin.2024.04.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/08/2024] [Accepted: 04/24/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Randomized controlled trials (RCTs) examining the outcomes with limus drug-coated balloons (DCBs) vs paclitaxel DCBs were small and underpowered for clinical endpoints. OBJECTIVES This study sought to compare the angiographic and clinical outcomes with limus DCBs vs paclitaxel DCBs for percutaneous coronary intervention (PCI). METHODS An electronic search of Medline, EMBASE, and Cochrane databases was performed through January 2024 for RCTs comparing limus DCBs vs paclitaxel DCBs for PCI. The primary endpoint was clinically driven target lesion revascularization (TLR). The secondary endpoints were late angiographic findings. Summary estimates were constructed using a random effects model. RESULTS Six RCTs with 821 patients were included; 446 patients received a limus DCB, and 375 patients received a paclitaxel DCB. There was no difference between limus DCBs and paclitaxel DCBs in the incidence of TLR at a mean of 13.4 months (10.3% vs 7.8%; risk ratio [RR]: 1.32; 95% CI: 0.84-2.08). Subgroup analysis suggested no significant interaction among studies for de novo coronary lesions vs in-stent restenosis (Pinteraction = 0.58). There were no differences in the risk of major adverse cardiovascular events, cardiac mortality, or target vessel myocardial infarction between groups. However, limus DCBs were associated with a higher risk of binary restenosis (RR: 1.89; 95% CI: 1.14-3.12), late lumen loss (mean difference = 0.16; 95% CI: 0.03-0.28), and a smaller minimum lumen diameter (mean difference = -0.12; 95% CI: -0.22 to -0.02) at late follow-up. In addition, late lumen enlargement occurred more frequently (50% vs 27.5%; RR: 0.59; 95% CI: 0.45-0.77) with paclitaxel DCBs. CONCLUSIONS Among patients undergoing DCB-only PCI, there were no differences in the risk of clinically driven TLR and other clinical outcomes between limus DCBs and paclitaxel DCBs. However, paclitaxel DCBs were associated with better late angiographic outcomes. These findings support the need for future trials to establish the role of new-generation limus DCBs for PCI.
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Affiliation(s)
- Ramy Sedhom
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Mohamed Hamed
- Division of Cardiology, Florida Atlantic University, Boca Raton, Florida, USA
| | - Ayman Elbadawi
- Division of Cardiology, Christus Good Shepherd Medical Center, Longview, Texas, USA; Texas A&M School of Medicine, Bryan, Texas, USA
| | - Amr Mohsen
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Pooja Swamy
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Ahmed Athar
- Cardiology Section, Jerry L. Pettis Memorial Veteran's Hospital, Loma Linda, California, USA
| | - Aditya S Bharadwaj
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Vinoy Prasad
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, Kentucky, USA.
| | - Fernando Alfonso
- Cardiology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, IIS-IP, CIBER-CV, Madrid, Spain
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Jeger RV, Fahrni G. Rest in PEACE? REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:537-538. [PMID: 38316356 DOI: 10.1016/j.rec.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/17/2024] [Indexed: 02/07/2024]
Affiliation(s)
- Raban V Jeger
- Cardiology Triemli Hospital Zürich and University of Basel, Basel, Switzerland.
| | - Gregor Fahrni
- Cardiology Triemli Hospital Zürich and University of Basel, Basel, Switzerland
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Cortese B, Sanchez-Jimenez E, Lazar L. Coronary stent failure: role of a blended approach with drug-coated balloons for complex lesions. Minerva Cardiol Angiol 2024; 72:266-280. [PMID: 36939731 DOI: 10.23736/s2724-5683.22.06172-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
The management of coronary artery disease by means of percutaneous approach have been focused initially to overcome the recoil and acute occlusion after vessel ballooning; therefore, to develop and improve metallic stent platforms, and later drug-eluting technologies. Contemporarily, the necessity emerged to optimize interventional procedures using functional physiologic tests and intravascular imaging guidance, but still stent failures, especially in the complex lesion setting, continue to be not negligible. This comprehensive review is focused on the technology of drug-coated balloons as a tool to treat coronary artery disease without the need for metal implantation but still eluting antirestenotic drugs such as paclitaxel or sirolimus. We delve into these technologies, the drugs, the technical aspects of the deployment and the most updated evidence also proposing a dedicated interventional algorithm. There is solid data to support the use of drug-coated balloons in patients with in-stent restenosis and de-novo small coronary artery disease but also new evidence with promising results from recent studies indicate the feasibility of this approach in complex coronary interventions, bifurcation lesions and larger coronary vessels. In this state-of-the-art review, we also propose a blended approach based on the combination of drug-eluting stents and drug-coated balloons, keeping in mind the necessity to reduce the total stent length in order to reduce the long-term risk of complications.
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Affiliation(s)
- Bernardo Cortese
- Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy -
| | | | - Leontin Lazar
- Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy
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10
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Aihara K, Torii S, Ito M, Koseki K, Shiozaki M, Sato Y, Nakamura N, Yoshikawa A, Ikari Y, Nakazawa G. Biological differences of three paclitaxel- and sirolimus-coated balloons on coronary lesions in a rabbit model. EUROINTERVENTION 2024; 20:e389-e398. [PMID: 38506736 PMCID: PMC10941670 DOI: 10.4244/eij-d-23-00425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/12/2023] [Indexed: 03/21/2024]
Abstract
BACKGROUND Drug-coated balloons (DCBs) are important treatment options for coronary artery disease; however, randomised controlled trials comparing various DCB technologies are sparse, and further investigations are needed. AIMS This preclinical study aimed to histologically and biologically compare the drug effects and safety of a low-dose paclitaxel-coated DCB (PCB; AGENT), a regular-dose PCB (SeQuent Please NEO) and a sirolimus-coated DCB (SCB; MagicTouch). METHODS The DCBs were inflated in the healthy iliac arteries of 18 rabbits, which were euthanised after 28 days. The treated iliac arteries and distal skeletal muscles were histopathologically evaluated, and drug concentrations were measured. RESULTS In the histopathological evaluation, the medial smooth muscle cell loss score regarding depth, an indicator of drug efficacy, was significantly higher with AGENT and SeQuent Please NEO than with MagicTouch (4.0 [3.6-4.0] vs 3.7 [3.7-4.0] vs 2.2 [2.0-2.4]), with significant differences in comparisons between AGENT and MagicTouch (p<0.01) and between SeQuent Please NEO and MagicTouch (p<0.01). AGENT and SeQuent Please NEO showed comparable drug concentrations in the treated artery (p=0.61). In contrast, the drug concentrations in distal skeletal muscles were the highest for MagicTouch, followed by SeQuent Please NEO and AGENT (28.07 [13.19-52.46] ng/mg vs 0.66 [0.22-3.76] ng/mg vs 0.25 [0.04-3.23] ng/mg, respectively). CONCLUSIONS This study demonstrated that PCBs might have higher efficacy and lower drug concentrations in distal skeletal muscles than the MagicTouch SCB. The efficacy of the AGENT low-dose PCB and the SeQuent Please NEO regular-dose PCB was comparable.
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Affiliation(s)
- Kazuki Aihara
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Sho Torii
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Masatoshi Ito
- Support Center for Medical Research and Education, Tokai University, Isehara, Japan
| | - Kaito Koseki
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Manabu Shiozaki
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Yu Sato
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Norihito Nakamura
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Ayako Yoshikawa
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Gaku Nakazawa
- Department of Cardiology, Kindai University Faculty of Medicine, Osaka, Japan
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11
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Sciahbasi A, Salvi N, Heang TM, Perez IS, Geraci S, Vaccaro G, Benincasa S, Nuruddin AA, Ocaranza R, Giannini F, Greco A, Cortese B. Long term clinical outcome of sirolimus drug coated balloons in large coronary vessels. Catheter Cardiovasc Interv 2024; 103:532-538. [PMID: 38415895 DOI: 10.1002/ccd.30996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/10/2024] [Accepted: 02/16/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Studies evaluating the safety and efficacy of drug coating balloons (DCB) for the treatment of lesions in large coronary vessel are limited. AIMS Our study aimed to evaluate the performance of a sirolimus DCB in large coronary arteries. METHODS We analyzed all the procedures included in the EASTBOURNE Registry (NCT03085823) enrolling patients with a clinical indication to percutaneous coronary intervention performed by a sirolimus DCB according to investigator judgment. In the present analysis, a cut-off of 2.75 mm was used to define large coronary arteries. Primary endpoint of the study was clinically driven target lesion revascularization (TLR) at 24 months whereas secondary endpoint included procedural success, myocardial infarction (MI), cardiac death and total mortality. RESULTS Among the 2123 patients and 2440 lesions enrolled in the EASTBOURNE study between 2016 and 2020, 757 patients/810 lesions fulfilled the criteria for the present analysis. Mean reference vessel diameter was 3.2 ± 0.3 mm with mean lesion length of 22 ± 7 mm. Procedural success was high (96%) and at 2-year follow up the device showed a good efficacy with a TLR rate of 9%. There were 34 deaths (4.5%), 30 MIs (4%) and 8 BARC type 3-5 bleedings (1.1%). In-stent restenosis (629 lesions) and de novo lesions (181) were associated with 11% and 4% rates of TLR at 2 years, respectively (p = 0.003). CONCLUSIONS Clinical performance of a sirolimus DCB in large coronary artery vessels shows promising signals at 2-year follow up, both in de novo and in-stent restenosis lesions.
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Affiliation(s)
- Alessandro Sciahbasi
- Department of Cardiac, Interventional Cardiology, Sandro Pertini Hospital, Rome, Italy
| | - Nicolò Salvi
- Department of Cardiac, Interventional Cardiology, Sandro Pertini Hospital, Rome, Italy
| | - Tay M Heang
- Department of Cardiac, Pantai Hospital Ayer Keroh, Melaka, Malaysia
| | - Ignacio S Perez
- Department of Cardiac, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | | | | | - Amin A Nuruddin
- Department of Cardiac, Institute Jantung Negara, Kuala Lumpur, Malaysia
| | | | | | - Antonio Greco
- Department of Cardiac, A.O.U. Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Bernardo Cortese
- Cardiovascular Research Team, Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy
- Research Group, DCB Academy, Milano, Italy
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12
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Camaj A, Leone PP, Kini A, Sharma SK. Sirolimus- vs Paclitaxel-Coated Balloons: It Is Only the Start. JACC Cardiovasc Interv 2024; 17:580. [PMID: 38418060 DOI: 10.1016/j.jcin.2023.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/06/2023] [Accepted: 12/12/2023] [Indexed: 03/01/2024]
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13
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Madanchi M, Attinger-Toller A, Gjergjizi V, Majcen I, Cioffi GM, Epper A, Gnan E, Koch T, Zhi Y, Cuculi F, Bossard M. Treatment of coronary lesions with a novel crystalline sirolimus-coated balloon. Front Cardiovasc Med 2024; 11:1316580. [PMID: 38414923 PMCID: PMC10896972 DOI: 10.3389/fcvm.2024.1316580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/31/2024] [Indexed: 02/29/2024] Open
Abstract
Background There is mounting data supporting the use of drug-coated balloons (DCB) not only for treatment of in-stent restenosis (ISR), but also in native coronary artery disease. So far, paclitaxel-coated balloons represented the mainstay DCBs. The SeQuent® crystalline sirolimus-coated balloon (SCB) (B.Braun Medical Inc, Germany) represents a novel DCB, which allows a sustained release of the limus-drug. We evaluated its performance in an all-comer cohort, including complex coronary lesions. Methods Consecutive patients treated with the SeQuent® SCB were analyzed from the prospective SIROOP registry (NCT04988685). We assessed clinical outcomes, including major adverse cardiovascular events (MACE), target lesion revascularization (TLR), target vessel myocardial infarction (TV-MI) and cardiovascular death. Angiograms and outcomes were independently adjudicated. Results From March 2021 to March 2023, we enrolled 126 patients and lesions, of which 100 (79%) treated using a "DCB-only" strategy and 26 (21%) with a hybrid approach (DES + DCB). The mean age was 68 ± 10 years, 48 (38%) patients had an acute coronary syndrome. Regarding lesion characteristics, ISR was treated in 27 (21%), 11 (9%) underwent CTO-PCI and 59 (47%) of the vessels were moderate to severe calcified. Procedural success rate was 100%. At a median follow-up time of 12.7 (IQR 12; 14.2) months, MACE occurred in 5 patients (4.3%). No acute vessel closure was observed. Conclusions Our data indicates promising outcomes following treatment with this novel crystalline SCB in an all-comer cohort with complex coronary lesions. These results require further investigation with randomized trials.
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Affiliation(s)
- Mehdi Madanchi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | - Varis Gjergjizi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Irena Majcen
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Giacomo M. Cioffi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
- McMaster University, Hamilton, ON, Canada
- Hamilton Health Sciences, Hamilton, ON, Canada
| | - Angelika Epper
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Eleonora Gnan
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Milan, Italy
| | - Tanja Koch
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Yuan Zhi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Florim Cuculi
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Matthias Bossard
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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14
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Lazar FL, Onea HL, Olinic DM, Cortese B. A 2024 scientific update on the clinical performance of drug-coated balloons. ASIAINTERVENTION 2024; 10:15-25. [PMID: 38425817 PMCID: PMC10900242 DOI: 10.4244/aij-d-23-00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 10/12/2023] [Indexed: 03/02/2024]
Abstract
Continuous advances in the field of interventional cardiology have led to the development of drug-coated balloons (DCB). These represent a promising device for overcoming the well-known limitations of traditional metallic stents, which are associated with a persistent yearly increased risk of adverse events. This technology has the ability to homogeneously transfer the drug into the vessel wall in the absence of a permanent prosthesis implanted in the coronary vessel. Robust data support the use of DCB for the treatment of in-stent restenosis, but there is also currently growing evidence from long-term follow-up of large randomised clinical trials regarding the use of these devices in other scenarios, such as de novo small and large vessel disease, complex bifurcations, and diffuse coronary disease. Other critical clinical settings such as diabetes mellitus, high bleeding risk patients and acute coronary syndromes could be approached in the upcoming future by using DCB, alone or as part of a blended strategy in combination with drug-eluting stents. There have been important scientific and technical advances in the DCB field in recent years. The purpose of this paper is to review the most current data regarding the use of DCB, including the mid- and long-term follow-up reports on the safety and efficacy of this novel strategy in different clinical and angiographic scenarios.
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Affiliation(s)
- Florin-Leontin Lazar
- Iuiliu Hatieganu University of Medicine and Pharmacy, 5th Department, Internal Medicine, Medical Clinic No. 1, Cluj-Napoca, Romania
| | - Horea-Laurentiu Onea
- Iuiliu Hatieganu University of Medicine and Pharmacy, 5th Department, Internal Medicine, Medical Clinic No. 1, Cluj-Napoca, Romania
| | - Dan-Mircea Olinic
- Iuiliu Hatieganu University of Medicine and Pharmacy, 5th Department, Internal Medicine, Medical Clinic No. 1, Cluj-Napoca, Romania
| | - Bernardo Cortese
- Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy
- DCB Academy, Milan, Italy
- CardioParc, Lyon, France
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15
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Fan J, Li T, Pu F, Guo N, Wang J, Gao Y, Zhao H, Wang X, Zhu H. Comparative efficacy of different Chinese patent medicines in preventing restenosis after percutaneous coronary intervention: a systematic review and Bayesian network meta-analysis of randomized clinical trials. Front Pharmacol 2024; 14:1265766. [PMID: 38249344 PMCID: PMC10796822 DOI: 10.3389/fphar.2023.1265766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/21/2023] [Indexed: 01/23/2024] Open
Abstract
Background: Chinese patent medicines (CMPs) have curative effectiveness in preventing coronary restenosis. However, the relative efficacy between different CPMs has not been sufficiently investigated. Methods: Randomized clinical trials were searched from electronic databases including PubMed, Web of Science, Cochrane Library, Embase, CNKI, VIP, WanFang, SinoMed, Chinese Clinical Trial Registry, and ClinicalTrials.gov. Bayesian network meta-analysis was performed to analyze CPMs' efficacy in preventing angiographic restenosis, recurrence angina, acute myocardial infarction, and target lesion revascularization after percutaneous coronary intervention. Results: This network meta-analysis included 47 trials with 5,077 patients evaluating 11 interventions. Regarding angiographic restenosis, the efficacy of CPMs (except Xuezhikang capsule) combined with standard treatment (Std) was superior to Std alone, and Guanxin Shutong capsule plus Std reduced the risk of angiographic restenosis by 76% (relative risk 0.24, 95% confidence interval 0.11-0.45, and very low to moderate certainty of evidence), most likely the best intervention. Fufang Danshen dripping pill combined with Std showed superiority over other interventions for relieving recurrence angina, which can reduce the risk by 83% (RR 0.17, 95% CI 0.04-0.51, very low to moderate certainty of evidence) compared to Std alone. In acute myocardial infarction after percutaneous coronary intervention, compared with Std alone, Danhong injection plus Std displayed a significant effect (RR 0.11, 95% CI 0.00-0.69, very low to moderate certainty of evidence) and was the best treatment probably. Chuanxiongqin tablet plus Std was the most effective treatment for reducing target lesion revascularization by 90% (RR 0.10, 95% CI 0.00-0.60, very low to moderate certainty of evidence) compared with Std alone. Conclusion: The results indicated that CPMs combined with Std reduced the risk of coronary restenosis after percutaneous coronary intervention. However, the results should be interpreted cautiously due to significant data limitations.
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Affiliation(s)
- Jiasai Fan
- Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Tianli Li
- National Integrated Traditional and Western Medicine Center for Cardiovascular Disease, China-Japan Friendship Hospital, Beijing, China
| | - Fenglan Pu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Nan Guo
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jing Wang
- Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yuqian Gao
- Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hongbing Zhao
- Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xian Wang
- Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Institute of Cardiovascular Diseases, Beijing University of Chinese Medicine, Beijing, China
| | - Haiyan Zhu
- Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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16
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Byrne RA, Durand R. Sirolimus-Coated Balloon Angioplasty for Coronary Artery Disease: One Step Forward, Two Steps Back. JACC Cardiovasc Interv 2023; 16:2897-2899. [PMID: 38092495 DOI: 10.1016/j.jcin.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/07/2023] [Indexed: 12/18/2023]
Affiliation(s)
- Robert A Byrne
- Cardiovascular Research Institute Dublin and Dept. of Cardiology, Mater Private Network, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - Rory Durand
- Cardiovascular Research Institute Dublin and Dept. of Cardiology, Mater Private Network, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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17
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Ninomiya K, Serruys PW, Colombo A, Reimers B, Basavarajaiah S, Sharif F, Testa L, Di Mario C, Nerla R, Ding D, Huang J, Kotoku N, Kageyama S, Kageyama M, Sevestre E, Fezzi S, Dijkstra J, O'Leary N, Morel MA, Garg S, Cortese B, Onuma Y. A Prospective Randomized Trial Comparing Sirolimus-Coated Balloon With Paclitaxel-Coated Balloon in De Novo Small Vessels. JACC Cardiovasc Interv 2023; 16:2884-2896. [PMID: 37877914 DOI: 10.1016/j.jcin.2023.09.026] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND There are no data comparing sirolimus-coated balloons (SCBs [MagicTouch, Concept Medical]) to paclitaxel-coated balloons (PCBs [SeQuent Please Neo, B. Braun]) for the treatment of de novo small vessel disease (SVD). OBJECTIVES This study sought to compare quantitative coronary angiographic outcomes at 6 months after treatment of de novo SVD with a PCB or SCB. METHODS This prospective, multicenter, noninferiority trial randomized 121 patients (129 SVD lesions) to treatment with an SCB or PCB, with balloon sizing determined using optical coherence tomography. The primary endpoint was noninferiority for the 6-month angiographic net lumen gain. RESULTS Angiographic follow-up was completed in 109 (90.1%) patients in the per-protocol analysis. The mean ± SD angiographic net gains were 0.25 ± 0.40 mm with SCBs vs 0.48 ± 0.37 mm with PCBs, resulting in SCBs failing to meet the 0.30 mm criterion for noninferiority (Pnoninferiority = 0.173), with an absolute difference of -0.23 mm (95% CI: -0.37 to -0.09) secondary to a smaller late loss (0.00 ± 0.32 mm vs 0.32 ± 0.47 mm; P < 0.001) and more frequent late lumen enlargement (53.7% vs 30.0%; OR: 2.60; 95% CI: 1.22-5.67; P = 0.014) with PCBs. Binary restenosis rates were 32.8% and 12.5% following treatment with SCBs and PCBs, respectively (OR: 3.41; 95% CI: 1.36-9.44; P = 0.012). The mean angiography-derived fractional flow ratio at follow-up was 0.86 ± 0.15 following treatment with SCBs and 0.91 ± 0.09 following PCBs (P = 0.026); a fractional flow ratio ≤0.80 occurred in 13 and 5 vessels after treatment with SCBs and PCBs, respectively. CONCLUSIONS The SCB MagicTouch failed to demonstrate noninferiority for angiographic net lumen gain at 6 months compared to the PCB SeQuent Please Neo.
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Affiliation(s)
- Kai Ninomiya
- Department of Cardiology, University of Galway, Galway, Ireland
| | | | - Antonio Colombo
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Bernhard Reimers
- Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | | | - Faisal Sharif
- Department of Cardiology, University of Galway, Galway, Ireland
| | - Luca Testa
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology, Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Roberto Nerla
- Department of Cardio-Thoracic GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Daixin Ding
- The Lambe Institute for Translational Medicine, Smart Sensors Laboratory and Curam, University of Galway, Galway, Ireland
| | - Jiayue Huang
- The Lambe Institute for Translational Medicine, Smart Sensors Laboratory and Curam, University of Galway, Galway, Ireland
| | - Nozomi Kotoku
- Department of Cardiology, University of Galway, Galway, Ireland
| | | | - Momoko Kageyama
- Department of Cardiology, University of Galway, Galway, Ireland
| | | | - Simone Fezzi
- Department of Cardiology, University of Galway, Galway, Ireland
| | - Jouke Dijkstra
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Neil O'Leary
- Department of Cardiology, University of Galway, Galway, Ireland
| | | | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom
| | - Bernardo Cortese
- Cardiovascular Research Center, Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy
| | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, Galway, Ireland
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18
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Cortese B, Kalkat H, Bathia G, Basavarajaiah S. The evolution and revolution of drug coated balloons in coronary angioplasty: An up-to-date review of literature data. Catheter Cardiovasc Interv 2023; 102:1069-1077. [PMID: 37870079 DOI: 10.1002/ccd.30891] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/30/2023] [Indexed: 10/24/2023]
Abstract
European Society of Cardiology (ESC) guidelines gave class I A indication for use of DCB in in-stent restenosis. However, no indication exists for the usage of DCB in de novo lesions. Although the current generation DES offer excellent results, as we embark more complex lesions such as calcified lesion and chronic total occlusion, restenosis and stent thrombosis are higher and tend to increase within the years. There is increasing desire to leave nothing behind to abolish the risk of restenosis and stent thrombosis and hence the absorbable scaffolds were introduced, but with disappointing results. In addition, they take several years to be absorbed. Drug coated balloons offer an alternative to stents with no permanent implant of metal or polymer. They are already in use in in Europe and Asia and they have been approved for the first time in the United States for clinical trials specifically for restenotic lesions. There is emerging data in de novo lesions which have shown that DCB are noninferior and in some studies maybe even superior to current generation DES especially in small vessels. In this article, we provide a comprehensive review of the literature on this expanding technology focussing on the evidence in both re-stenotic and de novo lesions.
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Affiliation(s)
- Bernardo Cortese
- Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy
- DCB Academy, Milano, Italy
- Cardioparc, Lyon, France
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19
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Katsouras CS, Tousis A, Vasilagkos G, Semertzioglou A, Vratimos A, Samara I, Karanasiou G, Loukas VS, Tsigkas G, Fotiadis D, Michalis LK, Davlouros P, Moulas AN. Safety and Efficacy of an Innovative Everolimus-Coated Balloon in a Swine Coronary Artery Model. Life (Basel) 2023; 13:2053. [PMID: 37895434 PMCID: PMC10607937 DOI: 10.3390/life13102053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Drug-coated balloons have been used as a non-stenting treatment in coronary and peripheral artery disease. Until recently, only sirolimus- and paclitaxel-coated balloons have been investigated in clinical trials. We evaluated the safety and efficacy of an innovative everolimus-coated balloon (ECB) in a swine coronary artery model. METHODS thirty-two swine coronary arteries were prepared through dilatation with a non-coated angioplasty balloon in a closed-chest model. During a period of 90 days, the following four groups (four animals per group, two coronary arteries per animal) were compared for safety and efficacy: A, Rontis ECB with 2.5 μg/mm2 of drug per balloon surface; B, Rontis ECB with 7.5 μg/mm2; C, Rontis Europa Ultra bare balloon; and D, Magic Touch, Concept Medical, sirolimus-coated balloon with a drug load of 1.3 μg/mm2. RESULTS Differences in local biological effects (arterial reaction scores) and surface of intimal area (mm2) were not statistically significant between the treatment groups. Numerically, group A showed the lowest intimal area and intimal mean thickness, while group B showed the lowest stenosis among all groups. CONCLUSIONS ECB was safe and effective in a porcine coronary artery model. The dose of everolimus may play a role in the biocompatibility of the balloon.
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Affiliation(s)
- Christos S. Katsouras
- 2nd Department of Cardiology, University Hospital of Ioannina, University of Ioannina, 45110 Ioannina, Greece; (C.S.K.); (I.S.); (L.K.M.)
| | - Alexandros Tousis
- Department of Cardiology, University Hospital of Patras, 26504 Patras, Greece; (A.T.); (G.V.); (G.T.); (P.D.)
| | - Georgios Vasilagkos
- Department of Cardiology, University Hospital of Patras, 26504 Patras, Greece; (A.T.); (G.V.); (G.T.); (P.D.)
| | | | | | - Ioanna Samara
- 2nd Department of Cardiology, University Hospital of Ioannina, University of Ioannina, 45110 Ioannina, Greece; (C.S.K.); (I.S.); (L.K.M.)
| | - Georgia Karanasiou
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology, Department of Materials Science and Engineering, Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, 45110 Ioannina, Greece; (G.K.); (V.S.L.); (D.F.)
| | - Vasileios S. Loukas
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology, Department of Materials Science and Engineering, Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, 45110 Ioannina, Greece; (G.K.); (V.S.L.); (D.F.)
| | - Grigorios Tsigkas
- Department of Cardiology, University Hospital of Patras, 26504 Patras, Greece; (A.T.); (G.V.); (G.T.); (P.D.)
| | - Dimitrios Fotiadis
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology, Department of Materials Science and Engineering, Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, 45110 Ioannina, Greece; (G.K.); (V.S.L.); (D.F.)
| | - Lampros K. Michalis
- 2nd Department of Cardiology, University Hospital of Ioannina, University of Ioannina, 45110 Ioannina, Greece; (C.S.K.); (I.S.); (L.K.M.)
| | - Periklis Davlouros
- Department of Cardiology, University Hospital of Patras, 26504 Patras, Greece; (A.T.); (G.V.); (G.T.); (P.D.)
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20
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Meunier L, Godin M, Souteyrand G, Mottin B, Valy Y, Lordet V, Benoit C, Bakdi R, Laurençon V, Genereux P, Waliszewski M, Allix-Béguec C. Prospective, single-centre evaluation of the safety and efficacy of percutaneous coronary interventions following a decision tree proposing a no-stent strategy in stable patients with coronary artery disease (SCRAP study). Clin Res Cardiol 2023; 112:1164-1174. [PMID: 35776144 PMCID: PMC10449686 DOI: 10.1007/s00392-022-02054-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/13/2022] [Indexed: 11/25/2022]
Abstract
AIM We evaluated a decision algorithm for percutaneous coronary interventions (PCI) based on a no-stent strategy, corresponding to a combination of scoring balloon angioplasty (SCBA) and drug-coated balloon (DCB), as a first line approach. Stents were used only in unstable patients, or in case of mandatory bailout stenting (BO-stent). METHODS From April 2019 to March 2020, 984 consecutive patients, including 1922 lesions, underwent PCI. The 12-month primary end-point was a composite of major adverse cardiac events (MACE) defined as all-cause death, nonfatal myocardial infarction, nonfatal stroke, and target lesion revascularization. Patients were classified into conventional or no-stent strategy groups according to the PCI strategy. In the no-stent strategy group, they were further classified into BO-stent or DCB-only groups. Their metal index was calculated by stent length divided by the total lesion length. RESULTS The no-stent strategy was applied in 85% of the patients, and it was successful for 65% of them. MACE occurred in 7.1% of the study population, including 4.2% of all-cause death. Target lesion revascularization was required in 1.4%, 3.6%, and 1.5% of patients in the conventional DES, BO-stent, and DCB-only groups, respectively. MACE occurred more often in the elderly and in those treated with at least one stent (metal index greater than 0). CONCLUSIONS The no-stent strategy, i.e., revascularization of coronary lesions by SCBA followed by DCB and with DES bailout stenting, was effective and safe at 1 year. This PCI approach was applicable on a daily practice in our cath lab. TRIAL REGISTRATION This study was registered with clinicaltrials.gov (NCT03893396, first posted on March 28, 2019). Feasibility, safety and efficacy of percutaneous coronary interventions following a decision tree proposing a no-stent strategy in stable patients with coronary artery disease. DES: drug eluting stent; SCBA: scoring balloon angioplasty; BO-stent: at least one stent; DCB: drug coated balloon; BMS: bare metal stent; Bailout (dash lines); MACE: major adverse cardiac event.
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Affiliation(s)
- Ludovic Meunier
- Cardiology Department, Centre Hospitalier La Rochelle, La Rochelle, France
| | - Matthieu Godin
- Cardiology Department, Clinique St-Hilaire, Rouen, France
| | - Géraud Souteyrand
- Département de Cardiologie, CHU Clermont-Ferrand, ISIT, CaVITI, CNRS (UMR-6284), Université d'Auvergne, Clermont-Ferrand, France
| | - Benoît Mottin
- Cardiology Department, Centre Hospitalier La Rochelle, La Rochelle, France
| | - Yann Valy
- Cardiology Department, Centre Hospitalier La Rochelle, La Rochelle, France
| | - Vincent Lordet
- Cardiology Department, Centre Hospitalier La Rochelle, La Rochelle, France
| | - Christian Benoit
- Cardiology Department, Centre Hospitalier La Rochelle, La Rochelle, France
| | - Ronan Bakdi
- Cardiology Department, Centre Hospitalier La Rochelle, La Rochelle, France
| | - Virginie Laurençon
- Clinical Trials Unit, Centre Hospitalier La Rochelle, La Rochelle, France
| | - Philippe Genereux
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
- Morristown Medical Center, Gagnon Cardiovascular Institute, Morristown, NJ, USA
| | - Matthias Waliszewski
- Medical Scientific Affairs, B.Braun Melsungen AG, Berlin, Germany
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany
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21
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Sabaté M. Drug-Coated Balloon for De Novo Lesions: Back to the Past or Back to the Future? JACC Cardiovasc Interv 2023; 16:1804-1806. [PMID: 37495353 DOI: 10.1016/j.jcin.2023.05.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 05/30/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Manel Sabaté
- Interventional Cardiology Department, Cardiovascular Institute, Hospital Clinic, Barcelona, Spain.
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22
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Zhao H, Miao R, Lin F, Zhao G. Drug-Coated Balloon in Primary Percutaneous Coronary Intervention. J Interv Cardiol 2023; 2023:5210808. [PMID: 37404481 PMCID: PMC10317576 DOI: 10.1155/2023/5210808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/27/2023] [Accepted: 06/19/2023] [Indexed: 07/06/2023] Open
Abstract
According to the latest coronary interventional guidelines, a drug-eluting stent is the recommended reperfusion therapy in primary percutaneous coronary intervention (pPCI). However, deficiencies and defects, such as in-stent restenosis (ISR), incomplete stent apposition, stent thrombosis, reinfarction after stent implantation, long-term dual antiplatelet drug use, and adverse reactions of metal implants, plague clinicians and patients. Drug-coated balloon (DCB), which delivers antiproliferative agents into the vessel wall without stent implantation and leaves no implants behind after the procedure, is a novel option for percutaneous coronary intervention and has proven to be a promising strategy in cases of ISR, small vessel coronary artery disease, and bifurcation lesions. However, most of the available experience has been gained in elective percutaneous coronary intervention, and experience in pPCI is lacking. The current evidence for the use of DCB-only in pPCI was discussed and analyzed in this review.
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Affiliation(s)
- Hui Zhao
- First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan 453100, China
| | - Runran Miao
- First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan 453100, China
| | - Fei Lin
- First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan 453100, China
| | - Guoan Zhao
- First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan 453100, China
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23
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Giacoppo D, Saucedo J, Scheller B. Coronary Drug-Coated Balloons for De Novo and In-Stent Restenosis Indications. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:100625. [PMID: 39130710 PMCID: PMC11308150 DOI: 10.1016/j.jscai.2023.100625] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 02/20/2023] [Accepted: 02/24/2023] [Indexed: 08/13/2024]
Abstract
Drug-coated balloons are approved outside the United States, not only for the treatment of peripheral arteries but also for coronary arteries. This review describes the technological basics, the scenarios of clinical application, and the current available data from clinical trials for the different coronary indications.
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Affiliation(s)
- Daniele Giacoppo
- Cardiology Department, Alto Vicentino Hospital, Santorso, Italy
- Cardiovascular Research Institute, Mater Private Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
- ISAResearch Center, Deutsches Herzzentrum München, Technisches Universität München, Munich, Germany
| | - Jorge Saucedo
- Cardiology Department, Froedtert Hospital, Medical College of Wisconsin, Milwaukee, Illinois
| | - Bruno Scheller
- Clinical and Experimental Interventional Cardiology, University of Saarland, Homburg/Saar, Germany
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24
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Vos N, Vink M. Drug-Coated Balloon Angioplasty in Acute Myocardial Infarction: Tailored Therapy Beyond the Lifelong Implant? JACC Cardiovasc Interv 2023; 16:780-782. [PMID: 37045499 DOI: 10.1016/j.jcin.2023.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 04/14/2023]
Affiliation(s)
- Nicola Vos
- Department of Interventional Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
| | - Maarten Vink
- Department of Interventional Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
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25
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Lin L, Lu W, Wang X, Pan L, Wang X, Zheng X, Li R, Shan Y, Peng M, Qiu C. Short-term outcomes of drug-coated balloon versus drug-eluting stent for de novo saphenous vein graft lesions in coronary heart disease. Front Cardiovasc Med 2023; 10:982880. [PMID: 36950290 PMCID: PMC10025469 DOI: 10.3389/fcvm.2023.982880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 02/17/2023] [Indexed: 03/08/2023] Open
Abstract
Background As a device for percutaneous coronary intervention, drug-coated balloon (DCB) is widely used to treat in-stent restenosis. However, data regarding the use of DCB in treating de novo saphenous vein graft (SVG) lesions are limited. This study aimed to explore the outcomes of using the DCB in the treatment of de novo SVG lesions of coronary heart disease (CHD). Methods This retrospective and observational study analyzed CHD patients with de novo SVG lesions treated with DCB or the new-generation drug-eluting stent (DES) between January 2018 and December 2020. Restenosis was the primary endpoint, whereas target lesion revascularization (TLR), major adverse cardiac events, restenosis, cardiac death, target vessel revascularization, and myocardial infarction were the secondary outcomes. Results We enrolled 31 and 23 patients treated with DCB and DES, respectively. The baseline clinical data, lesion characteristics, and procedural characteristics were similar between the two groups. Twenty-eight (90.3%) patients in the DCB group and 21 (91.3%) in the DES group completed follow-up angiography after 1 year. The quantitative coronary angiography measurements at angiographic follow-up showing late lumen loss were -0.07 ± 0.95 mm for the DCB group and 0.86 ± 0.71 mm for the DES group (P = 0.039), and the rates of restenosis were 13.3% and 21.7% for the DCB and DES groups, respectively (P = 0.470). No significant differences were observed in the rates of MACE (16.7% vs. 26.1%, P = 0.402) and TLR (13.3% vs. 4.3%, P = 0.374) during clinical follow-up. Conclusion Our findings suggest that when pre-dilatation was successful, DCB might be safe and effective in treating de novo SVG lesions.
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26
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Cao Z, Li J, Fang Z, Feierkaiti Y, Zheng X, Jiang X. The factors influencing the efficiency of drug-coated balloons. Front Cardiovasc Med 2022; 9:947776. [PMCID: PMC9602405 DOI: 10.3389/fcvm.2022.947776] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/26/2022] [Indexed: 11/13/2022] Open
Abstract
The drug-coated balloon (DCB) is an emerging percutaneous coronary intervention (PCI) device that delivers drugs to diseased vessels to decrease the rate of vascular stenosis. Recent clinical studies have demonstrated that DCBs tend to have both good safety and efficacy profiles, leading to extended application indications in the clinic, including in-stent restenosis (ISR) for metal stents such as drug-eluting stents (DESs), small vascular disease, bifurcation disease, large vascular disease, acute coronary syndrome (ACS), and high bleeding risk. However, some previous clinical data have suggested that DCBs performed less effectively than DESs. No studies or reviews have systematically discussed the improvement strategies for better DCB performance until now. Drug loss during the process of delivery to the target lesion and inefficient delivery of the coating drug to the diseased vascular wall are two key mechanisms that weaken the efficiency of DCBs. This review is the first to summarize the key influencing factors of DCB efficiency in terms of balloon structure and principles, and then it analyzes how these factors cause outcomes in practice based on current clinical trial studies of DCBs in the treatment of different types of lesions. We also provide some recommendations for improving DCBs to contribute to better DCB performance by improving the design of DCBs and combining other factors in clinical practice.
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Affiliation(s)
- Zheng Cao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Jun Li
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Zhao Fang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Yushanjiang Feierkaiti
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Xiaoxin Zheng
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China,*Correspondence: Xiaoxin Zheng,
| | - Xuejun Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China,Xuejun Jiang,
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27
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Scheller B, Mangner N, Abdul Kader MASK, Wan Ahmad WA, Jeger R, Wöhrle J, Ong TK, Liew HB, Gori T, Mahfoud F, Nuruddin AA, Woitek F, Abidin IZ, Schwenke C, Schnorr B, Mohd Ali R. Combined Analysis of Two Parallel Randomized Trials of Sirolimus-Coated and Paclitaxel-Coated Balloons in Coronary In-Stent Restenosis Lesions. Circ Cardiovasc Interv 2022; 15:e012305. [PMID: 36126132 DOI: 10.1161/circinterventions.122.012305] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Paclitaxel-coated balloons (PCBs) are a preferred treatment option for coronary in-stent restenosis. To date, data from randomized trials of alternative drug coatings are lacking. The aim of the randomized Malaysian and German-Swiss randomized trials was to investigate a novel sirolimus-coated balloon (SCB) compared with a PCB in in-stent restenosis. METHODS One hundred one patients with drug-eluting stent in-stent restenosis were enrolled in 2 identical randomized trials comparing the novel SCB (SeQuent SCB, 4 μg/mm²) with the clinically proven PCB (SeQuent Please, 3 μg/mm²). Primary end point was angiographic late lumen loss at 6 months. Secondary end points included procedural success, major adverse cardiac events, and individual clinical end points such as stent thrombosis, cardiac death, target lesion myocardial infarction, clinically driven target lesion revascularization, and binary restenosis. RESULTS Quantitative coronary angiography revealed no differences in baseline parameters. After 6 months, in-segment late lumen loss was 0.25±0.57 mm in the PCB group versus 0.26±0.60 mm in the SCB group. Mean difference between SCB and PCB was 0.01 (95% CI, -0.23 to 0.24). Noninferiority at a predefined margin of 0.35 was shown. Clinical events up to 12 months did not differ between the groups. CONCLUSIONS This first-in man comparison of a novel SCB with a crystalline coating showed similar angiographic and clinical outcomes in the treatment of coronary drug-eluting stent in-stent restenosis compared with PCB. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02996318, NCT03242096.
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Affiliation(s)
- Bruno Scheller
- Clinical and Experimental Interventional Cardiology, University of Saarland, Germany (B.S.).,Department of Internal Medicine III, Cardiology, Angiology, Intensive Care Medicine, University Hospital of Saarland, Homburg/Saar, Germany (B.S.' F.M.)
| | - Norman Mangner
- Klinik für Innere Medizin und Kardiologie Herzzentrum Dresden GmbH Universitätsklinik an der Technischen Universität Dresden, Germany (N.M., F.W.)
| | | | - Wan Azman Wan Ahmad
- Department of Medicine, University Malaya Medical Center, Malaysia (W.A.W.A.)
| | - Raban Jeger
- Cardiology, University Hospital Basel, University of Basel, Switzerland (R.J.)
| | - Jochen Wöhrle
- Department of Cardiology and Intensive Care, Medical Campus Lake Constance, Friedrichshafen, Germany (J.W.)
| | - Tiong Kiam Ong
- Cardiology Department, Sarawak Heart Centre, Malaysia (T.K.O.)
| | - Houng Bang Liew
- Cardiology Department and Clinical Research Center, Queen Elizabeth Hospital II, Malaysia (H.B.L.)
| | - Tommaso Gori
- Zentrum für Kardiologie, Universitätsmedizin der Johannes-Gutenberg Universität Mainz, Germany (T.G.)
| | - Felix Mahfoud
- Department of Internal Medicine III, Cardiology, Angiology, Intensive Care Medicine, University Hospital of Saarland, Homburg/Saar, Germany (B.S.' F.M.)
| | - Amin Ariff Nuruddin
- Cardiology Department, National Heart Institute Malaysia, Kuala Lumpur (A.A.N., R.M.A.)
| | - Felix Woitek
- Klinik für Innere Medizin und Kardiologie Herzzentrum Dresden GmbH Universitätsklinik an der Technischen Universität Dresden, Germany (N.M., F.W.)
| | | | | | - Beatrix Schnorr
- Experimental Radiology, Charité Universitätsmedizin, Berlin, Germany (B.S.)
| | - Rosli Mohd Ali
- Cardiology Department, National Heart Institute Malaysia, Kuala Lumpur (A.A.N., R.M.A.).,Cardiac Vascular Sentral Kuala Lumpur, Malaysia (R.M.A.)
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28
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Limus-Coated Balloons in "de Novo" Coronary Lesions: Quo Vadis? JACC Cardiovasc Interv 2022; 15:1227-1230. [PMID: 35637127 DOI: 10.1016/j.jcin.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 11/20/2022]
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29
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Effect of PEGylation on the Drug Release Performance and Hemocompatibility of Photoresponsive Drug-Loading Platform. Int J Mol Sci 2022; 23:ijms23126686. [PMID: 35743128 PMCID: PMC9224259 DOI: 10.3390/ijms23126686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 12/10/2022] Open
Abstract
Coronary stenosis has been one of the most common heart diseases that drastically increases the risk of fatal disorders such as heart attack. Angioplasty using drug coated balloons (DCB) has been one of the most safe and promising treatments. To minimize the risk of thrombosis of such DCBs during intervention, a different approach that can secure high hemocompatibility under blood flow is necessary. Here we report a method of improving the photoresponsive platform's hemocompatibility by conjugating polyethylene glycol (PEG), onto the functional groups located at the balloon surface. In this study, latex microbeads were used as models for balloons to enable precise observation of its surface under microscopy. These beads were decorated with PEG polymers of a variety of lengths and grafting densities, along with the Cy5-Photoclevable (PC) linker conjugate to mimic drugs to be loaded onto the platform. Results showed that PEG length and grafting density are both critical factors that alter not only its hemocompatibility, but also the drug load and release efficiency of such platform. Thus, although further investigation is necessary to optimize the tradeoff between hemocompatibility, drug load, and release efficiency, it is safe to conclude that PEGylation of DCB surface is an effective method of enhancing and maintaining high hemocompatibility to minimize the risk of thrombosis during angioplasty.
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30
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Sabaté M. Sirolimus Versus Paclitaxel: Second Round. JACC Cardiovasc Interv 2022; 15:780-782. [PMID: 35305907 DOI: 10.1016/j.jcin.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/01/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Manel Sabaté
- Interventional Cardiology Department, Cardiovascular Institute, Hospital Clinic, Barcelona, Spain.
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