1
|
Nicholas WJ, Maloney TG. Drug-Coated Balloon Angioplasty for Thoracic Great Vessel Stenosis Due to Takayasu Arteritis With 1-Year Follow-up. J Endovasc Ther 2023; 30:976-979. [PMID: 35735200 DOI: 10.1177/15266028221105180] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Takayasu arteritis is a large-vessel vasculitis in women of childbearing age that affects large vessels including the aorta and its main branches. Inflammation of arteries can produce lesions that lead to occlusion, stenosis, or aneurysms which can lead to complications. If signs of organ dysfunction are present, vascular intervention may be necessary. CASE REPORT In this article, we present a case of Takayasu arteritis with high-grade stenosis of all the great vessels of the thoracic aorta treated with drug-coated balloon (DCB) angioplasty and stenting requiring multiple follow-up interventions over a 1-year follow-up. CONCLUSION The DCB angioplasty is a potential endovascular treatment for thoracic great artery stenosis in Takayasu arteritis that could be further explored.
Collapse
Affiliation(s)
| | - Thomas G Maloney
- Internal Medicine Residency, Freeman Health System, Joplin, MO, USA
| |
Collapse
|
2
|
Shazly T, Uline M, Webb C, Pederson B, Eberth JF, Kolachalama VB. Novel Payloads to Mitigate Maladaptive Inward Arterial Remodeling in Drug-Coated Balloon Therapy. J Biomech Eng 2023; 145:121004. [PMID: 37542712 PMCID: PMC10578076 DOI: 10.1115/1.4063122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/03/2023] [Accepted: 08/03/2023] [Indexed: 08/07/2023]
Abstract
Drug-coated balloon therapy is a minimally invasive endovascular approach to treat obstructive arterial disease, with increasing utilization in the peripheral circulation due to improved outcomes as compared to alternative interventional modalities. Broader clinical use of drug-coated balloons is limited by an incomplete understanding of device- and patient-specific determinants of treatment efficacy, including late outcomes that are mediated by postinterventional maladaptive inward arterial remodeling. To address this knowledge gap, we propose a predictive mathematical model of pressure-mediated femoral artery remodeling following drug-coated balloon deployment, with account of drug-based modulation of resident vascular cell phenotype and common patient comorbidities, namely, hypertension and endothelial cell dysfunction. Our results elucidate how postinterventional arterial remodeling outcomes are altered by the delivery of a traditional anti-proliferative drug, as well as by codelivery with an anti-contractile drug. Our findings suggest that codelivery of anti-proliferative and anti-contractile drugs could improve patient outcomes following drug-coated balloon therapy, motivating further consideration of novel payloads in next-generation devices.
Collapse
Affiliation(s)
- Tarek Shazly
- College of Engineering and Computing, Biomedical Engineering Program, University of South Carolina, Columbia, SC 29208; College of Engineering and Computing, Department of Mechanical Engineering, University of South Carolina, Columbia, SC 29208; Cardiovascular Translational Research Center, University of South Carolina, Columbia, SC 29208
| | - Mark Uline
- College of Engineering and Computing, Biomedical Engineering Program, University of South Carolina, Columbia, SC 29208; Cardiovascular Translational Research Center, University of South Carolina, Columbia, SC 29208; College of Engineering and Computing, Department of Chemical Engineering, University of South Carolina, Columbia, SC 29208
| | - Clinton Webb
- College of Engineering and Computing, Biomedical Engineering Program, University of South Carolina, Columbia, SC 29208; Cardiovascular Translational Research Center, University of South Carolina, Columbia, SC 29208; School of Medicine, Department of Cell Biology and Anatomy, University of South Carolina, Columbia, SC 29208
| | - Breanna Pederson
- College of Engineering and Computing, Biomedical Engineering Program, University of South Carolina, Columbia, SC 29208
| | - John F. Eberth
- Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA 19104
| | - Vijaya B. Kolachalama
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118; Department of Computer Science and Faculty of Computing and Data Sciences, Boston University, Boston, MA 02115
| |
Collapse
|
3
|
Nikishyn O, Altman I, Al-Qashgish I, Gavretskiy A, Savoluk S, Muz M. Use of stents with medication coating for the treatment of occlusive-stenotic lesions of the superficial femoral artery. UKRAINIAN INTERVENTIONAL NEURORADIOLOGY AND SURGERY 2023. [DOI: 10.26683/2786-4855-2022-3(41)-38-45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Objective ‒ to analyze the results of endovascular revascularization of the femoropopliteal segment with drug-eluting stents. Materials and methods. Endovascular intervention was performed in 23 patients with stenotic lesions of the superficial femoral artery (SFA). Paclitaxel-eluting stents were used. There were 10 men (43.5 %), 13 women (56.5 %). The mean age of the patients was (66.0 ± 3.5) years. There were 16 (69.6 %) patients with diabetes mellitus type 2 and diabetic angiopathy, and 7 (23.4 %) patients had obliterating atherosclerosis of the arteries of the lower limbs. Critical ischemia of the lower extremities was diagnosed in 18 (56.5 %) cases, intermittent claudication ‒ in 5 (21.7 %). Isolated lesions of the femoral-popliteal segment were noted in 3 (13.4 %) patients, lesions of the iliac and femoral-popliteal segments ‒ in 4 (17.4 %), lesions of the femoral-popliteal and ankle segments ‒ in 16 (69.6 %). Results. Twenty (86.6 %) scheduled procedures for stenting of the SFA were technically successful. Among postoperative complications, 3 (13.04 %) patients had puncture site hematomas that did not require surgical evacuation. In 6 (26.1 %) patients, signs of reperfusion syndrome were observed, which were treated with conservative treatment. During follow-up period (3 months), there were no cases of reocclusion or clinically significant restenosis at the stented level. In 1 (5.0 %) case, a hemodynamically significant stenosis of the SFA was observed outside the implanted stent. The patient successfully underwent angioplasty of SFA stenosis. There were no «major» amputations during follow-up period. «Small» ankle amputations were performed in 7 (35.0 %) patients with diabetic gangrene, where endovascular revascularization of the femoro-popliteal and ankle segments was the stage of surgical treatment. Conclusions. Implantation of drug-eluting stents is an effective method of endovascular revascularization in patients with SFA lesions. To compare the results of implantation of drug-eluting stents with other methods of revascularization of the lesions of the femoro-popliteal segment, it is necessary to accumulate more data and increase the duration of the follow-up period.
Collapse
|
4
|
Nikishyn OL, Altman IV, Al-Qashkish II, Gavretskiy AI, Savolyuk SI, Muz MI. DRUG-ELUTING STENTS IN THE TREATMENT OF PATIENTS WITH OCCLUSIVE-STENOTIC LESIONS OF THE SUPERFICIAL FEMORAL ARTER. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:1216-1219. [PMID: 37364075 DOI: 10.36740/wlek202305212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVE The aim: To analyze the results of endovascular revascularization of the femoropopliteal segment using drug-eluting stents. PATIENTS AND METHODS Materials and methods: Endovascular intervention was performed in 23 patients with occlusive-stenotic lesions of the superficial femoral artery (SFA). Paclitaxel-eluting stents were used. There were 16 (69.6%) patients with diabetes mellitus type 2 and diabetic angiopathy, and 7 (30.4%) patients had obliterating atherosclerosis of the arteries of the lower limbs. Critical ischemia of the lower extremities was diagnosed in 18 (78.3%) cases, and intermittent claudication - in 5 (21.7%). RESULTS Results: Twenty (86.6 %) scheduled procedures for stenting of the SFA were technically successful. During follow-up period (3 months), there were no cases of reocclusion or clinically significant restenosis at the stented level. There were no "major" amputations during follow -up period. "Small" ankle amputations were performed in 7 (35%) patients with diabetic gangrene. CONCLUSION Conclusions: Implantation of drug-eluting stents is an effective method of endovascular revascularization in patients with SFA lesions. To compare the results of implantation of drug-eluting stents with other methods of revascularization of the lesions of the femoro-popliteal segment, it is necessary to accumulate more data and increase the duration of the follow-up period.
Collapse
Affiliation(s)
- Oleksandr L Nikishyn
- SI «SCIENTIFIC-PRACTICAL CENTER OF ENDOVASCULAR NEURORADIOLOGY NAMS OF UKRAINE», KYIV, UKRAINE
| | - Igor V Altman
- SI «SCIENTIFIC-PRACTICAL CENTER OF ENDOVASCULAR NEURORADIOLOGY NAMS OF UKRAINE», KYIV, UKRAINE
| | - Iyad I Al-Qashkish
- SI «SCIENTIFIC-PRACTICAL CENTER OF ENDOVASCULAR NEURORADIOLOGY NAMS OF UKRAINE», KYIV, UKRAINE
| | | | | | | |
Collapse
|
5
|
Lyden SP, Brodmann M, Parikh SA, Krishnan P, Schroeder H, Werner M, Holden A, Ouriel K, Tarra T, Gray WA. Four-Year Patient-Level Pooled Mortality Analysis of the ILLUMENATE US Pivotal and EU Randomized Controlled Trials. J Vasc Surg 2021; 75:600-607. [PMID: 34506898 DOI: 10.1016/j.jvs.2021.07.244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/16/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To perform a meta-analysis of two concordant randomized controlled trials (RCTs) examining the long-term, four-year safety profile of the Stellarex drug-coated balloon (DCB) versus percutaneous transluminal angioplasty (PTA) for the treatment of peripheral artery disease. METHODS An independent, third-party, meta-analysis of homogenous, patient-level data from the ILLUMENATE Pivotal and ILLUMENATE EU RCTs was performed to assess mortality (time to death) in patients treated for symptomatic femoropopliteal disease. Kaplan Meier (KM) methodology was used to estimate hazard rates of all-cause mortality and Cox proportional hazard modeling was used to assess predictors of mortality. All serious adverse events, including deaths, were adjudicated by an independent, blinded clinical events committee (CEC). RESULTS In total, 589 (419 DCB; 170 PTA) patients were included in the pooled analysis of the ILLUMENATE Pivotal and ILLUMENATE EU RCTs. The median follow-up was 1735 days (IQR 1434-1829), equivalent to 4.75 years. Vital status compliance was >95% in each RCT. The total number of deaths through four years was 81/589 (13.8%); 58/419 (13.8%) in the DCB arm and 23/170 (13.5%) in the PTA arm. The one-year KM estimate of all-cause mortality was 1.9% ± 0.7% (estimate ± SE) in those treated with DCB versus 1.2 ± 0.9% in those treated with PTA. At two, three, and four years, the respective KM estimates were 6.6 ± 1.2% versus 4.9 ± 1.7%, 9.3 ± 1.4% versus 9.9 ± 2.4%, and 14.0% ± 1.7% versus 14.4% ± 2.8% (P = 0.864). There were no significant differences in CEC-adjudicated deaths between the two cohorts. In multivariate analysis, predictors of four-year mortality were age (HR, 1.048; 95% CI, 1.026 - 1.071; P < 0.0001), renal insufficiency (HR, 2.440; 95% CI, 1.566 - 3.800; P < 0.0001), and lesion length (HR, 1.004; 95% CI, 1.000 - 1.008; P = 0.041). Neither paclitaxel exposure (DCB versus PTA; HR, 1.086; 95% CI, 0.709 - 1.664; P = 0.705) nor dose (mg; HR, 1.043; 95% CI, 0.971 - 1.119; P = 0.248) were predictors of all-cause mortality at four years. CONCLUSIONS This systematic meta-analysis of two concordant ILLUMENATE RCTs shows no difference in all-cause mortality through four-years between Stellarex DCB and PTA, confirming the acceptable, long-term safety profile of the Stellarex DCB.
Collapse
Affiliation(s)
- Sean P Lyden
- Department of Vascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Sahil A Parikh
- Center for Interventional Vascular Therapy, New York Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY
| | | | - Henrik Schroeder
- Center for Diagnostic Radiology and Minimally Invasive Therapy, The Jewish Hospital, Berlin, Germany
| | - Martin Werner
- Department of Angiology, Hanusch Hospital, Vienna, Austria
| | - Andrew Holden
- Department of Radiology, Auckland City Hospital, Auckland, New Zealand
| | | | | | - William A Gray
- Division of Cardiology, Lankenau Heart Institute/Main Line Health, Philadelphia, Pa.
| |
Collapse
|
6
|
Ren H, Zhuang J, Li X, Li T, Luan J, Wang C. Avoiding revascularization strategy versus revascularization with drug-coated balloon for the treatment of superficial femoral artery occlusive disease. J Interv Med 2021; 4:87-93. [PMID: 34805954 PMCID: PMC8562207 DOI: 10.1016/j.jimed.2021.02.002] [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: 11/03/2020] [Revised: 02/11/2021] [Accepted: 02/17/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare the efficacy, safety and treatment costs of superficial femoral artery revascularization (SFA) with drug-coated balloon(DCB) versus avoiding revascularization strategy for the treatment of symptomatic SFA disease. METHODS This retrospective single-center study reviewed 96 patients (113 limbs) with severe stenosis and occlusive SFA disease. All patients underwent either DCB(Group 1: n = 55 limbs) or nonrevascularization (Group 2: n = 58 limbs) between March 2015 and June 2019. The improvement of Rutherford class, walking impairment questionnaire score(WIQ), target limb reintervention, perioperative major adverse events, the catheterization laboratory cost and length of hospital stay were compared. The limb salvage and survival rates were calculated using the Kaplan-Meier method. Univariate and multivariate logistic regression analysis were performed to assess the association between factors and the improvement of Rutherford category at 12 months. RESULTS The median follow-up time of Groups 1 and 2 was 17 and 33 months, respectively. At 12 months, the Rutherford category significantly decreased in both groups (P < 0.001), with no significant difference (79.7% vs. 64.3%, P = 0.074). Furthermore, multivariate analysis showed that the selected therapeutic method was not an influential factor for the improvement of Rutherford class at 12 months. The WIQ overall score as well as three subscales scores (distance, speed and stair-climbing), the survival rate, limb salvage rate and the length of stay between the two groups were comparable. The perioperative adverse events rate and catheterization laboratory cost in Group 2 was significantly lower compared to Group 1 [(34253.69 ± 28172.87) yuan vs. (56936.76 ± 41278.36) yuan, P = 0.001]. CONCLUSIONS This study suggests that avoiding superficial femoral artery revascularization strategy has favorable efficacy and safety outcomes compared to combining revascularization with DCB in selected patients.
Collapse
Affiliation(s)
- Hongcheng Ren
- Department of Intervention Vascular Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Jinman Zhuang
- Department of Intervention Vascular Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Xuan Li
- Department of Intervention Vascular Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Tianrun Li
- Department of Intervention Vascular Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Jingyuan Luan
- Department of Intervention Vascular Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Changming Wang
- Department of Intervention Vascular Surgery, Peking University Third Hospital, Beijing 100191, China
| |
Collapse
|
7
|
Amlani V, Falkenberg M, Nordanstig J. The current status of drug-coated devices in lower extremity peripheral artery disease interventions. Prog Cardiovasc Dis 2021; 65:23-28. [PMID: 33587964 DOI: 10.1016/j.pcad.2021.02.002] [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: 02/08/2021] [Accepted: 02/08/2021] [Indexed: 11/18/2022]
Abstract
Lower limb peripheral artery disease is a leading cause of cardiovascular disease morbidity and mortality. Endovascular revascularization is often indicated to improve walking function and to prevent limb loss but restenosis in the treated vessel segment remains a concern that limits the overall effectiveness of the treatment. The most promising technique to prevent restenosis is the use of drug-coated devices, and the most common drug used to coat lower limb balloon angioplasty balloons and stents is paclitaxel. A systematic review and meta-analysis in 2018 reported a possible increase in late mortality attributable to paclitaxel-coated devices. Since then, their use has been brought into question. Here, we present an update of data focusing on the efficacy and safety of paclitaxel-coated devices in lower limb treatment applications. While paclitaxel-coated devices appear to reduce restenosis rates it is still unclear how these surrogate marker improvements translate to direct patient benefits and uncertainty remains as to whether paclitaxel-coated devices confer an increased risk of long-term mortality. Available randomized clinical data is hampered by trial heterogeneity, insufficient power, potential attrition bias and the lack of a plausible mechanistic explanation. An important step forward is that the ongoing trials that were temporarily halted due to the Katsanos et al. report have now both commenced recruitment and may ultimately resolve this clinical dilemma by virtue of their larger sample sizes. Other possible ways forward are the ongoing investigation of alternative anti-proliferative coating agents and use of new sophisticated vascular imaging techniques to more clearly identify patients at risk of restenosis already in the preoperative setting.
Collapse
Affiliation(s)
- Vishal Amlani
- Department of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Mårten Falkenberg
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska University Hospital and Academy, Gothenburg, Sweden
| | - Joakim Nordanstig
- Department of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
8
|
Parra DA, Brandao L. Use of drug-coated balloons in the management of a recalcitrant postsurgical hepatic vein stenosis in a pediatric patient. Radiol Case Rep 2020; 15:1864-1869. [PMID: 32817778 PMCID: PMC7426328 DOI: 10.1016/j.radcr.2020.07.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 07/17/2020] [Accepted: 07/17/2020] [Indexed: 11/25/2022] Open
|
9
|
Feng H, Chen X, Guo X, Zhang Z, Zhang Z, Liu B, Lian L. Comparison of efficacy and safety of drug-eluting versus uncoated balloon angioplasty for femoropopliteal arterial occlusive disease: a meta-analysis. BMC Cardiovasc Disord 2020; 20:395. [PMID: 32867681 PMCID: PMC7457510 DOI: 10.1186/s12872-020-01667-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 08/13/2020] [Indexed: 12/14/2022] Open
Abstract
Background This quantitative meta-analysis was conducted to evaluate the efficacy and safety of drug-eluting balloon (DEB) vs. uncoated balloon (UCB) in patients with femoropopliteal arterial occlusive disease. Methods Electronic databases were searched to identify randomized controlled trials (RCTs) that compared DEB and UCB till November 2018. The random-effects model was used for conducting pooled analyses. Results Seventeen RCTs with 2706 patients were included in the final meta-analysis. Patients who received DEB had higher levels of minimal luminal diameter (MLD) at 6 (WMD: 0.77; 95%CI: 0.53 to 1.02; P < 0.001) and 12 months (WMD: 1.33; 95%CI: 0.93 to 1.73; P < 0.001) than those who received UCB. DEB reduced the late lumen loss (LLL) levels after 6 (WMD: -0.57; 95%CI: − 1.07 to − 0.06; P = 0.029) and 12 months (WMD: -0.95; 95%CI: − 1.28 to − 0.62; P < 0.001). DEB was found not superior over UCB on primary patency after 6 months (RR: 1.44; 95%CI: 0.88–2.35; P = 0.149), whereas DEB increased the primary patency after 12 (RR: 1.51; 95%CI: 1.25–1.83; P < 0.001) and 24 months (RR: 1.51; 95%CI: 1.30–1.77; P < 0.001). Patients who received DEB had reduced the risk of restenosis after 6 (RR: 0.47; 95%CI: 0.33–0.67; P < 0.001) and 12 months (RR: 0.55; 95%CI: 0.35–0.85; P = 0.008). DEB reduced the risk of major adverse events after 6 (RR: 0.30; 95%CI: 0.14–0.61; P = 0.001), 12 (RR: 0.49; 95%CI: 0.32–0.76; P = 0.001) and 24 months (RR: 0.62; 95%CI: 0.41–0.92; P = 0.018). Conclusions DEB yielded additional benefits on MLD, LLL, primary patency, restenosis, TLR, and major adverse events than UCB in patients with femoropopliteal arterial occlusive disease.
Collapse
Affiliation(s)
- Hai Feng
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
| | - Xueming Chen
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Xiaobo Guo
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Zhe Zhang
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Zhiwen Zhang
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Bin Liu
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Lishan Lian
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| |
Collapse
|
10
|
Nooromid M, Chen EB, Xiong L, Shapiro K, Jiang Q, Demsas F, Eskandari M, Priyadarshini M, Chang EB, Layden BT, Ho KJ. Microbe-Derived Butyrate and Its Receptor, Free Fatty Acid Receptor 3, But Not Free Fatty Acid Receptor 2, Mitigate Neointimal Hyperplasia Susceptibility After Arterial Injury. J Am Heart Assoc 2020; 9:e016235. [PMID: 32580613 PMCID: PMC7670501 DOI: 10.1161/jaha.120.016235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Arterial restenosis after vascular surgery is a common cause of midterm restenosis and treatment failure. Herein, we aim to investigate the role of microbe‐derived butyrate, FFAR2 (free fatty acid receptor 2), and FFAR3 (free fatty acid receptor 3) in mitigating neointimal hyperplasia development in remodeling murine arteries after injury. Methods and Results C57BL/6 mice treated with oral vancomycin before unilateral femoral wire injury to deplete gut microbiota had significantly diminished serum and stool butyrate and more neointimal hyperplasia development after arterial injury, which was reversed by concomitant butyrate supplementation. Deficiency of FFAR3 but not FFAR2, both receptors for butyrate, exacerbated neointimal hyperplasia development after injury. FFAR3 deficiency was also associated with delayed recovery of the endothelial layer in vivo. FFAR3 gene expression was observed in multiple peripheral arteries, and expression was increased after arterial injury. Treatment of endothelial but not vascular smooth muscle cells with the pharmacologic FFAR3 agonist 1‐methylcyclopropane carboxylate stimulated cellular migration and proliferation in scratch assays. Conclusions Our results support a protective role for butyrate and FFAR3 in the development of neointimal hyperplasia after arterial injury and delineate activation of the butyrate‐FFAR3 pathway as a valuable strategy for the prevention and treatment of neointimal hyperplasia.
Collapse
Affiliation(s)
- Michael Nooromid
- Department of Surgery Feinberg School of Medicine Northwestern University Chicago IL
| | - Edmund B Chen
- Department of Surgery Feinberg School of Medicine Northwestern University Chicago IL
| | - Liqun Xiong
- Department of Surgery Feinberg School of Medicine Northwestern University Chicago IL
| | - Katherine Shapiro
- Department of Surgery Feinberg School of Medicine Northwestern University Chicago IL
| | - Qun Jiang
- Department of Surgery Feinberg School of Medicine Northwestern University Chicago IL
| | - Falen Demsas
- Geisel School of Medicine at Dartmouth Hanover NH
| | - Maeve Eskandari
- Department of Surgery Feinberg School of Medicine Northwestern University Chicago IL
| | - Medha Priyadarshini
- Department of Medicine University of Illinois at Chicago and Jesse Brown VA Medical Center Chicago IL
| | - Eugene B Chang
- Section of Gastroenterology Department of Medicine University of Chicago, Chicago, IL
| | - Brian T Layden
- Department of Medicine University of Illinois at Chicago and Jesse Brown VA Medical Center Chicago IL
| | - Karen J Ho
- Department of Surgery Feinberg School of Medicine Northwestern University Chicago IL
| |
Collapse
|
11
|
Efficacy of Paclitaxel Balloon for Hemodialysis Stenosis Fistulae After One Year Compared to High-Pressure Balloons: A Controlled, Multicenter, Randomized Trial. Cardiovasc Intervent Radiol 2019; 43:382-390. [DOI: 10.1007/s00270-019-02372-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 10/31/2019] [Indexed: 12/31/2022]
|
12
|
Klumb C, Lehmann T, Aschenbach R, Eckardt N, Teichgräber U. Benefit and risk from paclitaxel-coated balloon angioplasty for the treatment of femoropopliteal artery disease: A systematic review and meta-analysis of randomised controlled trials. EClinicalMedicine 2019; 16:42-50. [PMID: 31832619 PMCID: PMC6890981 DOI: 10.1016/j.eclinm.2019.09.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/16/2019] [Accepted: 09/10/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Paclitaxel-coated balloons (DCB) are suitable to reduce the risk of restenosis after angioplasty of atherosclerotic femoropopliteal lesions. However, numerous types of DCBs are distinguished by drug density and coating. Conflicting evidence exists about the risk of mortality. This study sought to evaluate benefit and risk of DCB angioplasty compared to plain old balloon angioplasty (POBA). METHODS Randomised trials published between January 1, 2005 and February 3, 2019 were identified by searching MEDLINE, CENTRAL, and Clinical.trials.gov. Studies on DCB versus POBA for the treatment of femoropopliteal artery disease were included, and those focused on in-stent restenosis or critical limb ischemia were excluded. Random-effects meta-analysis was conducted to assess the main outcomes of freedom from target lesion revascularisation (FfTLR) and all-cause mortality. FINDINGS Of 552 identified records, 14 studies including 2504 patients were eligible. DCB significantly increased the risk of FfTLR with substantial heterogeneity (12-month: risk ratio [RR] 1·24 [95% CI 1·14-2·27], I 2 = 66%; 24-month RR 1·39 [95% CI 1·39-1·52], I 2 = 21%). The risk of 24-month all-cause mortality was increased after DCB (random-effects model: RR 1·53 [95% CI 0·94-2·50], p = 0·09; fixed-effect model: RR 1·74 [95% CI 1·08-2·81], p = 0·02). INTERPRETATION Efficacy of DCB differs substantially across studies. Effect size depends on the type of DCB, treatment strategy, and lesion complexity. The risk of 2-year all-cause mortality at 2 years was increased, but without evidence of causation.
Collapse
Affiliation(s)
- Christof Klumb
- Department of Radiology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Thomas Lehmann
- Center for Clinical Studies, Jena University Hospital, Salvador-Allende-Platz 27, 07747 Jena, Germany
| | - René Aschenbach
- Department of Radiology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Niklas Eckardt
- Department of Radiology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Ulf Teichgräber
- Department of Radiology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
- Corresponding author at: Universitätsklinikum Jena, Institut für Diagnostische und Interventionelle Radiologie, Am Klinikum 1, 07747 Jena, Germany.
| |
Collapse
|
13
|
Midterm Outcomes of Drug-Coated Balloon Angioplasty in Femoropopliteal Lesions in a Daily Practice Cohort. Ann Vasc Surg 2019; 64:188-197. [PMID: 31634609 DOI: 10.1016/j.avsg.2019.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 09/17/2019] [Accepted: 09/18/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Most previous drug-coated balloon (DCB) angioplasty studies used strict inclusion and exclusion criteria and therefore might not be representative for daily practice. This study was performed to evaluate the midterm outcomes of DCB angioplasty in femoropopliteal artery disease and to identify risk factors for restenosis. MATERIALS AND METHODS All patients treated with DCB angioplasty between January 2015 and September 2016 were included. Provisional stents were placed if indicated. Data were retrospectively collected from digital patient records. No exclusion criteria were applied. The primary end point was primary patency. Secondary end points were primary assisted patency, secondary patency, clinically driven target lesion revascularization (CD-TLR) and major adverse events. All end points were calculated with the Kaplan-Meier analysis. The univariable and multivariable Cox regression analyses were performed to identify risk factors for restenosis. RESULTS A total of 109 patients (113 legs) were included (45% male; mean age, 72 ± 10). The rate of critical limb ischemia was 52% and total occlusions were treated in 38%. The mean follow-up was 24 ± 13 months. Primary patency rates were 87%, 79%, and 61% at 1, 2, and 3 years, respectively. Primary assisted patency rates were 95%; 89%, and 79%; secondary patency rates were 99%, 97%, and 91%; and CD-TLR rates were 6.9%, 14.3%, and 20.6% at 1, 2, and 3 years, respectively. Overall mortality and major target limb amputation rates were 18% and 5% at 3 years. Multivariable analysis demonstrated that only Trans-Atlantic Inter-Society Consensus (TASC) D lesions were associated with restenosis (P = 0.008). CONCLUSIONS DCB angioplasty is an effective and safe treatment option for femoropopliteal lesions in daily practice with excellent 1- and 2-year results. The 3-year results were slightly less favorable, which may be caused by the ongoing vascular disease or a late "catch-up" phenomenon. Only TASC D lesions were associated with loss of primary patency after adjustment for confounders.
Collapse
|
14
|
Gray WA, Jaff MR, Parikh SA, Ansel GM, Brodmann M, Krishnan P, Razavi MK, Vermassen F, Zeller T, White R, Ouriel K, Adelman MA, Lyden SP. Mortality Assessment of Paclitaxel-Coated Balloons: Patient-Level Meta-Analysis of the ILLUMENATE Clinical Program at 3 Years. Circulation 2019; 140:1145-1155. [PMID: 31567024 PMCID: PMC6784772 DOI: 10.1161/circulationaha.119.040518] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND A recent summary-level meta-analysis comprising randomized, controlled trials (RCTs) of femoropopliteal paclitaxel-coated balloon and stent intervention identified excess late mortality in the paclitaxel-treated patients. METHODS We evaluated the safety of the Stellarex drug-coated balloon (DCB) for femoropopliteal artery disease with an independently performed meta-analysis of patient-level data from all patients in the Stellarex femoropopliteal clinical program. To compare mortality after DCB or uncoated percutaneous transluminal angioplasty (PTA), we aggregated data from 2 RCTs comprising 419 patients treated with DCB and 170 patients treated with PTA. In an additional analysis, data were aggregated from 6 poolable Stellarex DCB studies (2 RCTs, 3 single-arm studies, and 1 registry). All serious adverse events including deaths were adjudicated by a blinded, third-party, independent Clinical Events Committee. Kaplan-Meier estimates in the RCTs were compared with restricted mean survival time. Predictors of death were assessed with hazard ratios (HRs) and Cox proportional hazards modeling. RESULTS Baseline characteristics were similar in the patients treated with DCB and PTA in the pooled RCT analysis, with the exception that the DCB cohort was younger (67.4±9.7 versus 69.4±9.4 years, P=0.02), smoked more frequently (86.6% versus 78.8%, P=0.02), and were less often treated for recurrent lesions (8.8% versus 14.7%, P=0.04). In the RCTs, patients treated with DCB had all-cause mortality rates that were not different from those of patients treated with PTA (Kaplan-Meier estimates 1.8±0.7% versus 1.3±0.9%, 6.5±1.2% versus 5.9±1.9%, and 9.3±1.5% versus 9.9±2.4% at 1, 2, and 3 years, respectively, P=0.86). All-cause mortality rates were similar in a 1906-patient pooled nonrandomized DCB data set (Kaplan-Meier estimates of 2.1%, 4.9%, and 7.0% at 1, 2, and 3 years, respectively). Clinical Events Committee-adjudicated causes of death were balanced between the DCB and PTA cohorts. Multivariable Cox modeling identified age (HR, 1.06; 95% CI, 1.04-1.08; P<0.001), diabetes mellitus (HR, 1.42; 95% CI, 1.01-2.00; P=0.04), congestive heart failure (HR, 1.88; 95% CI, 1.12-3.16; P=0.02), and renal insufficiency (HR, 2.00; 95% CI, 1.33-3.01; P<0.001) as predictors of mortality. Paclitaxel exposure was unrelated to mortality (HR, 1.04; 95% CI, 0.98-1.10; P=0.23). CONCLUSIONS The mortality rates for patients treated with the DCB and uncoated PTA were indistinguishable over 3-year follow-up. Additional patient-level, adequately powered meta-analyses with larger RCT data sets will be needed to confirm the generalizability of these findings. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifiers: NCT02110524, NCT01858363, NCT01858428, NCT03421561, NCT01912937, NCT01927068, and NCT02769273.
Collapse
Affiliation(s)
- William A Gray
- Lankenau Heart Institute/Main Line Health, Philadelphia, PA (W.A.G.)
| | | | - Sahil A Parikh
- New York Presbyterian Hospital, Columbia University Irving Medical Center (S.A.P.)
| | - Gary M Ansel
- OhioHealth Heart and Vascular Physicians, Columbus (G.M.A.)
| | | | | | | | | | - Thomas Zeller
- Universitäts - Herzzentrum, Freiburg, Germany (T.Z.)
| | | | | | | | | |
Collapse
|
15
|
Mechanical rotational thrombectomy with Rotarex system augmented with drug-eluting balloon angioplasty versus stenting for the treatment of acute thrombotic and critical limb ischaemia in the femoropopliteal segment. Wideochir Inne Tech Maloinwazyjne 2019; 14:311-319. [PMID: 31118999 PMCID: PMC6528111 DOI: 10.5114/wiitm.2018.80006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/23/2018] [Indexed: 12/05/2022] Open
Abstract
Introduction Mechanical thrombectomy is an alternative to local thrombolysis for the treatment of severe ischaemia in the femoropopliteal segment, but stent implantation is usually required after this procedure. The use of drug-eluting balloons (DEBs) may overcome long-term problems associated with stents, but it remains unclear how often such a treatment is technically feasible and efficient. Aim This post hoc single-centre study was aimed at assessment of the feasibility, safety and efficacy of mechanical thrombectomy followed by application of DEBs. Material and methods Fifty-one patients, aged 69.1 ±11.6 years, were managed for acute thrombotic or chronic critical ischaemia in the femoropopliteal segment using the Rotarex device. Following mechanical thrombectomy, on condition that there was no significant residual stenosis or dissection, lesions were managed with paclitaxel-coated DEBs, which was a desired strategy (24 patients). The remaining 25 patients underwent stent implantations, which was regarded as bailout treatment. Final follow-up was scheduled 12 months after the procedure. Results The primary-assisted patency rate after mechanical rotational thrombectomy with additional balloon angioplasty and/or stenting was 97.1% (49 patients). The early mortality rate was 2.0% (1 patient) and the amputation rate was 4.1% (2 patients). There were no late mortalities or limb amputations at 12-month follow-up, but significant restenoses occurred in 13 (27.1%) patients. These restenoses were more frequent in patients who underwent stent implantation (45.5%) than those managed with DEBs (12.5%), and in patients managed for secondary lesions. Conclusions In selected patients mechanical rotational thrombectomy in the femoropopliteal segment followed by application of DEB is a safe, effective and long-lasting method of revascularisation.
Collapse
|
16
|
Outcome of drug-eluting balloon angioplasty versus endarterectomy in common femoral artery occlusive disease. J Vasc Surg 2019; 69:141-147. [DOI: 10.1016/j.jvs.2018.05.225] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 05/24/2018] [Indexed: 11/24/2022]
|
17
|
Kokkinidis DG, Jeon-Slaughter H, Khalili H, Brilakis ES, Shammas NW, Banerjee S, Armstrong EJ. Adjunctive stent use during endovascular intervention to the femoropopliteal artery with drug coated balloons: Insights from the XLPAD registry. Vasc Med 2018; 23:358-364. [DOI: 10.1177/1358863x18775593] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
With growing use of drug-coated balloons (DCB) for femoropopliteal (FP) artery interventions, there is limited information on rates of real-world adjunctive stent use and its association with short and long-term outcomes. We report on 225 DCB treated FP lesions in 224 patients from the Excellence in Peripheral Artery Disease (XLPAD) registry (NCT01904851) between 2014 and 2016. Cochran–Mantel–Haenszel and Wilcoxon rank sum statistics were used to compare stented (planned or ‘bail-out’) versus non-stented DCB treated lesions. Stents were implanted in 31% of FP DCB interventions. Among the 70 stents implanted, 46% were for ‘bail-out’ indications and 54% were planned. Lesions treated with stents were longer (mean 150 mm vs 100 mm; p < 0.001) and less likely to be in-stent restenosis lesions (10% vs 28%; p=0.003). Stenting was significantly more frequent in complex FP lesions, including chronic total occlusions (66% vs 34%; p < 0.001). For bail-out stenting, interwoven nitinol stents were the most common type (50%) followed by drug-eluting stents (34%) and bare-metal stents (22%). There were no differences in peri-procedural complication rates or 12-month target limb revascularization rates (18.6% vs 11.6%; p=0.162) or 12-month amputation rates (11.4% vs 11%; p=0.92) between lesions where adjunctive stenting was used versus lesions without adjunctive stenting, respectively. In conclusion, in a contemporary ‘real-world’ adjudicated multicenter US registry, adjunctive stenting was necessary in nearly a third of the lesions, primarily for the treatment of more complex FP lesions, with similar short and intermediate-term clinical outcomes compared with non-stented lesions. ClinicalTrials.gov Identifier: NCT01904851
Collapse
Affiliation(s)
- Damianos G Kokkinidis
- Division of Cardiology, VA Eastern Colorado Health Care System and University of Colorado, Denver, CO, USA
| | - Haekyung Jeon-Slaughter
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center and VA North Texas Health Care System, Dallas, TX, USA
| | - Houman Khalili
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center and VA North Texas Health Care System, Dallas, TX, USA
| | | | | | - Subhash Banerjee
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center and VA North Texas Health Care System, Dallas, TX, USA
| | - Ehrin J Armstrong
- Division of Cardiology, VA Eastern Colorado Health Care System and University of Colorado, Denver, CO, USA
| |
Collapse
|
18
|
Kim K, Ko YG, Ahn CM, Min PK, Lee JH, Yoon CH, Yu CW, Lee SW, Lee SR, Choi SH, Koh YS, Chae IH, Choi D. Clinical Outcomes of Subintimal vs. Intraluminal Revascularization Approaches for Long Femoropopliteal Occlusions in a Korean Multicenter Retrospective Registry Cohort. Circ J 2018; 82:1900-1907. [PMID: 29681585 DOI: 10.1253/circj.cj-17-1464] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND There are limited data comparing the outcomes of subintimal vs. intraluminal approach in the treatment of long femoropopliteal artery occlusions. The objective of this study was to investigate the efficacy and safety of the subintimal approach for long femoropopliteal artery occlusions.Methods and Results:From a multicenter retrospective registry cohort, we included a total of 461 patients with 487 femoropopliteal artery occlusions classified as Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC) II C/D for this analysis. We compared the immediate and mid-term outcomes of subintimal vs. intraluminal approaches. There were 228 patients with 243 limbs in the subintimal group, and 233 patients with 244 limbs in the intraluminal group. Baseline clinical and lesion characteristics were comparable between the 2 groups. The technical success rate was significantly higher in the subintimal group than in the intraluminal group (95.1% vs. 89.8%, P=0.041). The clinical primary patency (67.5% vs. 73.4% at 12 months, 54.0% vs. 61.3% at 24 months; P=0.086) and target lesion revascularization (TLR)-free survival (89.5% vs. 86.3% at 12 months, 77.6% vs. 76.0% at 24 months; P=0.710) did not differ significantly between the subintimal and the intraluminal groups. CONCLUSIONS In long femoropopliteal occlusions, the subintimal approach achieved a higher technical success rate and similar mid-term primary patency and TLR-free survival compared with intraluminal approach.
Collapse
Affiliation(s)
- Kyu Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Pil-Ki Min
- Division of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine
| | - Jae-Hwan Lee
- Division of Cardiology, Chungnam National University Hospital
| | - Chang-Hwan Yoon
- Division of Cardiology, Seoul National University Bundang Hospital
| | | | - Seung Whan Lee
- Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan
| | - Sang-Rok Lee
- Division of Cardiology, Chonbuk National University Hospital
| | - Seung Hyuk Choi
- Division of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Yoon Seok Koh
- Division of Cardiology, Seoul St. Mary's Hospital, the Catholic University of Korea
| | - In-Ho Chae
- Division of Cardiology, Seoul National University Bundang Hospital
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| |
Collapse
|
19
|
Deloge C, Boesmans E, Van Damme H, Defraigne JO. Revascularization of the superficial femoral artery with paclitaxel-coated balloon for claudication. Acta Chir Belg 2018; 118:42-47. [PMID: 28891401 DOI: 10.1080/00015458.2017.1374593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Percutaneous angioplasty of the superficial femoral artery (SFA) with paclitaxel-coated balloon, intended to reduce restenosis, has been proven safe and effective in recent randomized controlled trials. OBJECTIVE To assess outcome results of angioplasty of the SFA with paclitaxel-coated balloon in claudicants in real-world practice of a single center. MATERIAL & METHODS A continuous prospective cohort study of 53 claudicants (62 lower limbs) from January 2015 to December 2016. Study end points include primary patency, freedom from clinically driven target-lesion revascularization and symptom relief. RESULTS It concerns 17 women (32%) and 36 men (68%) with a mean age of 67.8 years, suffering life-style-limiting claudication. Only short to intermediate-length stenoses or occlusions (30.6%), with a mean length of 59.6 mm were selected for percutaneous angioplasty with a paclitaxel-coated balloon. Technical success was 100%. At 16 months, primary patency attained 92.0% (3 early occlusions, 2 restenoses). There were two re-interventions at 6 and 9 months, resulting in a clinically driven target lesion revascularization rate of 3.2%. At the end of the follow-up of 16 months, all but two patients (96.2%) remained symptom-free. Two patients died during follow-up (no procedure-related deaths). CONCLUSION Paclitaxel-coated balloon angioplasty of the SFA gives in routine clinical practice excellent midterm results, with a restenosis rate of 6.5% at 1 year. This procedure has authors' preference as first-choice technique for correction of short- and intermediate-length symptomatic stenoses of the SFA.
Collapse
Affiliation(s)
- Celine Deloge
- Dpt Cardiovascular Surgery, University Hospital Sart Tilman, Liège, Belgium
| | - Evelyne Boesmans
- Dpt Cardiovascular Surgery, University Hospital Sart Tilman, Liège, Belgium
| | - Hendrik Van Damme
- Dpt Cardiovascular Surgery, University Hospital Sart Tilman, Liège, Belgium
| | | |
Collapse
|
20
|
Jongsma H, van Mierlo-van den Broek P, Imani F, van den Heuvel D, de Vries JPP, Fioole B. Randomized comparison of femoropopliteal artery drug-eluting balloons and drug-eluting stents (FOREST trial): Study protocol for a randomized controlled trial. J Vasc Surg 2017; 66:1293-1298. [DOI: 10.1016/j.jvs.2017.05.098] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 05/06/2017] [Indexed: 11/28/2022]
|
21
|
Jongsma H, Akkersdijk GP, de Smet AA, Vroegindeweij D, de Vries JPP, Fioole B. Drug-eluting balloons and uncoated balloons perform equally to rescue infrainguinal autologous bypasses at risk. J Vasc Surg 2017; 66:454-460. [DOI: 10.1016/j.jvs.2017.02.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 02/06/2017] [Indexed: 10/19/2022]
|