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Suriyanto MGRI, Pranata R, Kamarullah W, Putra ICS, Wahyudi DP, Karwiky G, Sihite TA, Akbar MR, Martha JW, Hidayat S. The efficacy and safety of atherectomy combined with drug-coated balloon angioplasty vs. drug-coated balloon angioplasty for the treatment of lower extremity artery disease: a systematic review and meta-analysis. Front Cardiovasc Med 2024; 11:1472064. [PMID: 39399517 PMCID: PMC11470443 DOI: 10.3389/fcvm.2024.1472064] [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: 07/28/2024] [Accepted: 09/16/2024] [Indexed: 10/15/2024] Open
Abstract
Background This study aimed to systematically evaluate the efficacy and safety of atherectomy followed by drug-coated balloon angioplasty (A-DCB) in comparison with drug-coated balloon (DCB) angioplasty alone for the treatment of lower extremity artery disease (LEAD). Methods Systematic literature search was performed using several online databases including MEDLINE (via PubMed), Europe PMC, and ScienceDirect databases from inception until February 21st, 2024. We included all studies comprised three main variables including A-DCB, DCB, and LEAD. The primary outcomes were primary patency and target lesion revascularization (TLR). Whereas secondary outcomes were all-cause mortality, post-procedural complications, and clinical characteristics. Results A total of 15 studies (10 cohort studies and 5 randomized controlled trials studies) consisting of 1,385 participants with mean age 68.7 ± 8.9 were included. In comparison with DCB alone, A-DCB was significantly associated with a higher risk of primary patency [RR = 1.16 (95% CI = 1.07-1.26); P < 0.001; I 2 = 20.9%, P-heterogeneity = 0.221] and lower risk of TLR [RR = 0.61 (95% CI = 0.46-0.81); P < 0.001; I 2 = 0%, P-heterogeneity = 0.475]. Subgroup analysis showed that only directional, rotational, and laser atherectomy increased the probability of primary patency, but only rotational atherectomy decreased the risk of TLR. Regarding secondary outcomes, A-DCB was substantially associated with a lower likelihood of bailout stenting, any amputation, and major amputation, as well as higher ankle brachial index (ABI) following follow-up duration. Meta-regression analysis suggested that pre-intervention s (p = 0.015) and pre-intervention Rutherford classification (p = 0.038) were significantly affected the association between A-DCB and primary patency. Begg's funnel plot and Egger's test analyses indicated no publication bias in this meta-analysis. Conclusions The addition of atherectomy improves primary patency and reduces the risk of TLR with similar safety outcomes. Systematic Review Registration www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022382831, PROSPERO (CRD42022382831).
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Yu C, Tang W, Ren T, Chen Q, Lu R, Gao Y. Network Meta-Analysis of All Available Regimens Based on Drug-Coated Balloon Angioplasty and Laser Atherectomy for Femoropopliteal In-Stent Restenosis. J Endovasc Ther 2024; 31:390-399. [PMID: 36189843 DOI: 10.1177/15266028221125581] [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] [Indexed: 12/24/2022]
Abstract
PURPOSE Drug-coated balloon (DCB) angioplasty and laser atherectomy (LA) have been frequently utilized to treat femoropopliteal in-stent restenosis (ISR); however, no studies have concurrently compared available regimens, including DCB, LA+DCB, and LA + plain balloon angioplasty (PB). Therefore, we conducted this network meta-analysis to determine whether there were significant differences in outcomes among these regimens. MATERIALS AND METHODS A comprehensive search was conducted in PubMed, EMBASE, and the Cochrane library to identify all randomized controlled trials comparing DCB or LA-based regimes with POBA or each other for treating femoropopliteal in-stent restenosis (ISR) from their inception until March 2021. The primary outcome measure was binary restenosis, and secondary outcome measures were target lesion revascularization (TLR) and mortality, evaluated at 6 and 12 months, respectively. Statistical analysis was performed using Aggregate Data Drug Information System (ADDIS) 1.4 software, and all data were graphically summarized using Microsoft Excel software. RESULTS The final analysis included 11 studies, of which 6 studies compared DCB with PB, 2 studies compared PB vs LA+PB, 2 studies compared DCB vs LA+DCB, and 1 study compared LA+DCB with LA+PB. DCB was better than PB in decreasing binary restenosis at 6 (odds ratio [OR]: 0.22, 95% credible interval [CrI]: 0.04-0.91) and 12 (OR: 0.26, 95% CrI: 0.12-0.50) months. DCB was associated with lower TLR than PB at 6 months (OR: 0.31, 95% CrI: 0.13-0.69). LA+DCB was also superior to PB in treating binary restenosis at 12 months (OR: 6.10, 95% CrI: 1.94-24.41) and TLR at 6 months (OR: 5.32, 95% CrI: 1.43-28.06). There was no statistical difference in mortality between PB, DCB, and LA+PB. DCB and LA+DCB were the first 2 options for reducing binary restenosis and TLR. CONCLUSION The current network meta-analysis demonstrates that both DCB and LA+DCB are superior to PB alone, and that DCB and LA+DCB may be the preferred treatment options for reducing binary restenosis and TLR. CLINICAL IMPACT The treatment for femoropopliteal in-stent restenosis (ISR) remains challenging clinical practice. One important reason is that no optimal treatment strategy was available. Drug-coated balloon angioplasty (DCB) and laser atherectomy (LA) have been extensively utilized to treat ISR; however, different combinations of these treatments further confused the clinicians' choices. This network meta-analysis systematically investigated the difference between the currently available treatments regarding therapeutic effects and safety, indicating that DCB and LA+DCB may be the optimal treatment for decreasing the risk of binary restenosis and target lesion revascularization. The results of the current network meta-analysis help to resolve the confusion of clinicians in making the decision.
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Affiliation(s)
- Chaowen Yu
- Department of Vascular Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu City, China
| | - Wenbo Tang
- Department of Vascular Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu City, China
| | - Tiancai Ren
- Department of Vascular Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu City, China
| | - Qiwei Chen
- Department of Vascular Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu City, China
| | - Ran Lu
- Department of Vascular Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu City, China
| | - Yong Gao
- Department of Vascular Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu City, China
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Soukas P, Becker M, Stark K, Tepe G. Erratum: Three-Year Results of the GORE VIABAHN Endoprosthesis in the Superficial Femoral Artery for In-Stent Restenosis. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:101183. [PMID: 39129897 PMCID: PMC11308595 DOI: 10.1016/j.jscai.2023.101183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/18/2023] [Accepted: 01/30/2023] [Indexed: 08/13/2024]
Abstract
[This corrects the article DOI: 10.1016/j.jscai.2023.100598.].
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Affiliation(s)
- Peter Soukas
- Lifespan Cardiovascular Institute, the Miriam Hospital, Alpert School of Medicine of Brown University, Providence, Rhode Island
| | - Matthew Becker
- Lake Erie College of Medicine Heart and Vascular Institute, Cardiovascular Medicine, Interventional Cardiology and Cardiac Catheterization Laboratory, Ambulatory Surgical Vascular Institute, Erie, Pennsylvania
| | - Karl Stark
- Midwest Aortic and Vascular Institute, University of Missouri at Kansas City School of Medicine, University of Health Sciences, Kansas City, Missouri
| | - Gunnar Tepe
- Department of Diagnostic and Interventional Radiology, RoMed Clinic Rosenheim, Germany
| | - RELINE MAX Investigators
- Lifespan Cardiovascular Institute, the Miriam Hospital, Alpert School of Medicine of Brown University, Providence, Rhode Island
- Lake Erie College of Medicine Heart and Vascular Institute, Cardiovascular Medicine, Interventional Cardiology and Cardiac Catheterization Laboratory, Ambulatory Surgical Vascular Institute, Erie, Pennsylvania
- Midwest Aortic and Vascular Institute, University of Missouri at Kansas City School of Medicine, University of Health Sciences, Kansas City, Missouri
- Department of Diagnostic and Interventional Radiology, RoMed Clinic Rosenheim, Germany
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Soukas P, Becker M, Stark K, Tepe G. Three-Year Results of the GORE VIABAHN Endoprosthesis in the Superficial Femoral Artery for In-Stent Restenosis. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:100598. [PMID: 39130699 PMCID: PMC11308227 DOI: 10.1016/j.jscai.2023.100598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/18/2023] [Accepted: 01/30/2023] [Indexed: 08/13/2024]
Abstract
Background The study objective was to assess the postmarket safety and effectiveness of the GORE VIABHAN endoprosthesis with heparin bioactive surface for the treatment of in-stent restenosis (ISR) of the superficial femoral artery (SFA). Methods A prospective, single-arm, international study enrolled patients at 23 sites from October 2015 to April 2018. Patients with ≥50% ISR or occlusions in the SFA, Rutherford categories 2-5, and at least 1 patent runoff vessel were eligible. The primary effectiveness endpoint was primary patency at 12 months. The primary safety endpoint was the rate of device- or procedure related serious adverse events at 30 days. Results One hundred and eight patients were enrolled, and 86 were included for analysis through 3 years (mean age, 70.0 ± 10.4 years; 48.8% female). The mean core lab reported lesion length was 12.4 ± 6.92 cm (29.1% occlusions); 10.5% presented with chronic limb-threatening ischemia, and 81.9% of lesions were Tosaka II and II. Acute procedural success was 98.8%. Freedom from device- or procedure-related SAE was 96.5% through 30 days. At 1-year, primary, primary-assisted, and secondary patency rates were 74.7%, 80.4%, and 98.4%, respectively. Freedom from target lesion revascularization was 84.8%, 74.6%, and 65.0% at 1, 2, and 3 years, respectively. Per core laboratory assessment, no major amputations or device failures occurred through 3 years. At 3 years, 80.4% of patients had ≥ 1 Rutherford category improvement. Conclusions The VIABAHN endoprosthesis is a safe and effective treatment for long and complex lesions in the SFA through 3 years.
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Affiliation(s)
- Peter Soukas
- Lifespan Cardiovascular Institute, the Miriam Hospital, Alpert School of Medicine of Brown University, Providence, Rhode Island
| | - Matthew Becker
- Lake Erie College of Medicine Heart and Vascular Institute, Cardiovascular Medicine, Interventional Cardiology and Cardiac Catheterization Laboratory, Ambulatory Surgical Vascular Institute, Erie, Pennsylvania
| | - Karl Stark
- Midwest Aortic and Vascular Institute, University of Missouri at Kansas City School of Medicine, University of Health Sciences, Kansas City, Missouri
| | - Gunnar Tepe
- Department of Diagnostic and Interventional Radiology, RoMed Clinic Rosenheim, Germany
| | - RELINE MAX Investigators
- Lifespan Cardiovascular Institute, the Miriam Hospital, Alpert School of Medicine of Brown University, Providence, Rhode Island
- Lake Erie College of Medicine Heart and Vascular Institute, Cardiovascular Medicine, Interventional Cardiology and Cardiac Catheterization Laboratory, Ambulatory Surgical Vascular Institute, Erie, Pennsylvania
- Midwest Aortic and Vascular Institute, University of Missouri at Kansas City School of Medicine, University of Health Sciences, Kansas City, Missouri
- Department of Diagnostic and Interventional Radiology, RoMed Clinic Rosenheim, Germany
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Rammos C, Manzke A, Lortz J, Messiha D, Petrikhovich O, Jánosi RA, Steinmetz M, Rassaf T. Mechanical atherothrombectomy improves endothelial function through plaque burden reduction in PAD. VASA 2022; 51:377-385. [DOI: 10.1024/0301-1526/a001034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Summary: Background: Endothelial dysfunction defines outcomes and serves as a surrogate parameter for the progression of cardiovascular disease. For symptomatic peripheral artery disease (PAD) endovascular treatment is the primary revascularization strategy, which affects endothelial function. Interventional mechanical atherothrombectomy (MATH) provides advantages when treating complex atherosclerotic and thrombotic lesions. We now aimed to determine the impact and mechanisms of MATH on endothelial function. Patients and methods: Endothelial function was determined using flow-mediated dilation (FMD) before and after lower limb intervention with a six-month follow-up in the target and control vessel in 15 PAD MATH+DCB treated patients and compared to 15 non-Math controls. In a further cohort of 20 patients the impact of MATH and DCB on vascular structure and virtual histology was assessed through intravascular ultrasound (IVUS) and compared to DCB treatment alone. Results: Improved endothelial function after 6 months was observed in both groups for the target and nontarget vessel. When comparing the changes from baseline endothelial function, treatment with MATH+DCB was superior to DCB treatment in the target vessel. IVUS revealed a greater improvement in luminal area and plaque burden reduction after MATH treatment. Virtual histology disclosed MATH-associated changes in plaque composition evidenced by alterations in fibrous volume and reductions in superficial calcium. Conclusions: We demonstrate an improved endothelial function after MATH treatment as compared to DCB treatment. The improved vessel function is evidenced by MATH-related plaque burden reduction, improved luminal gain and a decrease in superficial calcification. Clinicaltrials.gov: NCT04092972.
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Affiliation(s)
- Christos Rammos
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany
| | - Anna Manzke
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany
| | - Julia Lortz
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany
| | - Daniel Messiha
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany
| | - Olga Petrikhovich
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany
| | - Rolf Alexander Jánosi
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany
| | - Martin Steinmetz
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany
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Voll F, Wolf F, Ingwersen M, Kinstner CM, Kufner S, Ibrahim T, Ott I, Krankenberg H, Fusaro M, Cassese S. Diabetes mellitus and femoropopliteal in-stent restenosis. VASA 2022; 51:247-255. [DOI: 10.1024/0301-1526/a001006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Summary: Background: The influence of diabetes mellitus (DM) on recurrent in-stent restenosis (ISR) of femoropopliteal arteries remains understudied. We investigated whether DM has an impact on recurrent restenosis after femoropopliteal stenting in patients included in the dRug-coatEd balloon angioPlasty for femoropopliteAl In-stent Restenosis (REPAIR) cooperation. Patients and methods: The REPAIR cooperation pooled the patient-level data from 3 randomized trials in which patients with ISR of femoropopliteal arteries received either drug-coated balloon (DCB) or plain balloon angioplasty. For this analysis, patients were divided in two groups based on whether they had or had not a DM diagnosis at the time of enrollment. The primary outcome was target lesion revascularization (TLR). The main secondary outcome was recurrent ISR. Other outcomes of interest were death, Rutherford class improvement and ankle-brachial index at follow-up. Results: 256 patients (DM, n=99 vs. non-DM, n=157) with 12-month follow-up were included in the analysis. Compared to non-DM patients, DM patients displayed no difference in terms of TLR [adjusted hazard ratio (95% Confidence intervals): 0.96 (0.55, 1.69), p=0.89] and recurrent ISR [1.04 (0.61, 1.77), p=0.88], whilst mortality was higher [9.38 (1.06, 83.11), p=0.044]. There were no differences between groups with respect to other secondary outcomes. The percutaneous treatment with DCB as compared to plain balloon angioplasty significantly reduced the risk of TLR and recurrent ISR without an excess risk of death irrespective of DM (p for interaction ≥0.70). Conclusions: In patients with femoropopliteal ISR, diabetes has a neutral effect on the risk of recurrence, but increases mortality at 12-month follow-up. DCB as compared to plain balloon angioplasty is associated with superior efficacy without trade-off in safety, regardless of diabetes.
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Affiliation(s)
- Felix Voll
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Germany
| | - Florian Wolf
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Austria
| | - Maja Ingwersen
- Department of Radiology, Friedrich-Schiller-University, Jena University Hospital, Jena, Germany
| | - Christian M. Kinstner
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Austria
| | - Sebastian Kufner
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Germany
| | - Tareq Ibrahim
- I. Medical Department – Cardiology, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Ilka Ott
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Germany
- Cardiology Clinic, Helios Hospital Pforzheim, Germany
| | | | - Massimiliano Fusaro
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Germany
- Department of Interventional Cardiology, Klinik Vincentinum, Augsburg, Germany
- These authors contributed equally
| | - Salvatore Cassese
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Germany
- These authors contributed equally
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