1
|
D'Oria M, Mastrorilli D, Secemsky E, Behrendt CA, Veraldi G, DeMartino R, Mani K, Budtz-Lilly J, Scali S, Saab F, Calvagna C, Mezzetto L, Ruaro B, Lepidi S. Robustness of Longitudinal Safety and Efficacy After Paclitaxel-Based Endovascular Therapy for Treatment of Femoro-Popliteal Artery Occlusive Disease: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials. Ann Vasc Surg 2024; 101:164-178. [PMID: 38154491 DOI: 10.1016/j.avsg.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND The aims of this study were: i) to assess fragility indices (FIs) of individual randomized controlled trials (RCTs) that compared paclitaxel-based drug-coated balloons (DCBs) or drug-eluting stents (DESs) versus standard endovascular devices, and ii) to meta-analyze mid-term and long-term safety and efficacy outcomes from available RCT data while also estimating the FI of pooled results. METHODS This systematic review has been registered in the PROSPERO public database (CRD42022304326 http://www.crd.york.ac.uk/PROSPERO). A query of PubMed (Medline), EMBASE (Excerpta Medical Database), Scopus, and CENTRAL (Cochrane Central Register of Controlled Trials) databases was performed to identify eligible RCTs. Rates of primary patency (PP) and target lesion revascularization (TLR) were assessed as efficacy outcomes, while lower limb amputation (LLA) consisting of major amputation that is. below or above the knee and all-cause mortality were estimated as safety outcomes. All outcomes were pooled with a random effects model to account for any clinical and study design heterogeneity. The analyses were performed by dividing the RCTs according to their maximal follow-up length (mid-term was defined as results up to 2-3 years, while long-term was defined as results up to 4-5 years). For each individual outcome, the FI and reverse fragility index (RFI) were calculated according to whether the outcome results were statistically significant or not, respectively. The fragility quotient (FQ) and reverse fragility quotient (RFQ), which are the FI or RFI divided by the sample size, were also calculated. RESULTS A total of 2,337 patients were included in the systematic review and meta-analysis. There were 2 RCTs examining DES devices and 14 RCTs evaluating different DCBs. For efficacy outcomes, there was evidence that paclitaxel-based endovascular therapy increased the PP rate and reduced the TLR rate at mid-term, with a calculated pooled risk ratio (RR) of 1.66 for patency (95% CI, 1.55-1.86; P < 0.001), with a corresponding number needed-to-treat (NNT) of 3 patients (95% CI, 2.9-3.8) and RR of 0.44 for TLR (95% CI, 0.35-0.54; P = 0.027), respectively. Similarly, there was evidence that paclitaxel-based endovascular therapy both increased PP and decreased TLR rates at long-term, with calculated pooled RR values of 1.73 (95% CI, 1.12-2.61; P = 0.004) and 0.53 (95% CI, 0.45-0.62; P = 0.82), respectively. For safety outcomes, there was evidence that paclitaxel-based endovascular therapy increased all-cause mortality at mid-term, with a calculated pooled RR of 2.05 (95% CI, 1.21-3.24). However, there was no difference between treatment arms in LLA at mid-term (95% CI, 0.1-2.7; P = 0.68). Similarly, neither all-cause mortality nor LLA at long-term differed between treatment arms, with a calculated pooled RR of 0.66, 1.02 (95% CI, 0.31-3.42) and 1.02 (95% CI, 0.30-5.21; P = 0.22), respectively. The pooled estimates of PP at mid-term were robust (FI = 28 and FQ = 1.9%) as were pooled rates of TLR (FI = 18 and FQ = 0.9%). However, when safety outcomes were analyzed, the robustness of the meta-analysis decreased significantly. In fact, the relationship between the use of paclitaxel-coated devices and all-cause mortality at mid-term showed very low robustness (FI = 4 and FQ = 0.2%). At 5 years, only the benefit of paclitaxel-based devices to reduce TLR remained robust, with an FI of 32 and an FQ of 3.1%. CONCLUSIONS The data supporting clinical efficacy endpoints of RCTs that examined paclitaxel-based devices in the treatment of femoral-popliteal arterial occlusive disease were robust; however, the pooled safety endpoints were highly fragile and prone to bias due to loss of patient follow-up in the original studies. These findings should be considered in the ongoing debate concerning the safety of paclitaxel-based devices.
Collapse
Affiliation(s)
- Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Davide Mastrorilli
- Department of Vascular Surgery, University Hospital and Trust of Verona, Verona, Italy.
| | - Eric Secemsky
- Department of Medicine, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Christian-Alexander Behrendt
- Department of Vascular Medicine, Research Group GermanVasc, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Gianfranco Veraldi
- Department of Vascular Surgery, University Hospital and Trust of Verona, Verona, Italy
| | - Randall DeMartino
- Division of Vascular and Endovascular Surgery, Gonda Vascular Center, Mayo Clinic Rochester Campus, Rochester, MN
| | - Kevin Mani
- Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Jacob Budtz-Lilly
- Department of Cardiovascular Surgery, Aarhus University, Aarhus, Denmark
| | - Salvatore Scali
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL
| | - Fadi Saab
- Advanced Cardiac and Vascular Centers for Amputation Prevention, Grand Rapids, MI
| | - Cristiano Calvagna
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Luca Mezzetto
- Department of Vascular Surgery, University Hospital and Trust of Verona, Verona, Italy
| | - Barbara Ruaro
- Division of Pulmonary Medicine, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| |
Collapse
|
2
|
Briody H, Kearns CA, Lee MJ. Mortality, Safety, and Effectiveness of Paclitaxel-Containing Balloons and Stents in the Femoropopliteal Artery: Systematic Review and Meta-Analysis of Randomized Controlled Trials since 2018. J Vasc Interv Radiol 2024:S1051-0443(24)00198-2. [PMID: 38428483 DOI: 10.1016/j.jvir.2023.12.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/18/2023] [Accepted: 12/09/2023] [Indexed: 03/03/2024] Open
Abstract
PURPOSE To provide an updated systematic review and meta-analysis of safety and effectiveness outcomes with paclitaxel-containing devices. MATERIALS AND METHODS A systematic review and meta-analysis of randomized controlled trials (RCTs) investigating paclitaxel-containing balloons or stents in the treatment of femoropopliteal disease was performed. Pooled risk ratio (RR) was calculated using the inverse-variance, random-effects model in the assessment of primary patency, all-cause mortality, target limb major amputation, target lesion revascularization (TLR), and thrombosis. RESULTS In total, 19 RCTs were included comprising 4,284 participants. All-cause mortality rates did not differ significantly between the 2 arms at 12 months (RR, 1.06; 95% confidence interval [CI], 0.66-1.72; P = .80), 24 months (RR, 0.92; 95% CI, 0.56-1.50; P = .73), 36 months (RR, 1.21; 95% CI, 0.65-2.25; P = .55), or 48-60 months (RR, 0.95; 95% CI, 0.66-1.39; P = .81) after intervention. Primary patency was significantly higher at 12 months in the paclitaxel-containing arm: 80.92% (1,438/1,777) versus 57.48% (607/1,056) in the control arm (RR, 1.44; 95% CI, 1.30-1.59; P < .00001). CONCLUSIONS The present study demonstrates no statistically significant difference in all-cause mortality, target limb major amputation, or thrombosis with paclitaxel drug-eluting therapy to the femoropopliteal region. Additionally, improved and durable patency rates with a statistically significantly lower risk of clinically driven TLR with paclitaxel drug-eluting therapy have been demonstrated.
Collapse
Affiliation(s)
- Hayley Briody
- Department of Radiology, Beaumont Hospital, Dublin, Ireland.
| | | | - Michael J Lee
- Department of Radiology, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
3
|
Gressler LE, Avila-Tang E, Mao J, Avalos-Pacheco A, Shaya FT, Torosyan Y, Liebeskind A, Kinard M, Mack CD, Normand SL, Ritchey ME, Marinac-Dabic D. Data sources and applied methods for paclitaxel safety signal discernment. Front Cardiovasc Med 2024; 10:1331142. [PMID: 38463423 PMCID: PMC10920218 DOI: 10.3389/fcvm.2023.1331142] [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: 10/31/2023] [Accepted: 12/11/2023] [Indexed: 03/12/2024] Open
Abstract
Background Following the identification of a late mortality signal, the Food and Drug Administration (FDA) convened an advisory panel that concluded that additional clinical study data are needed to comprehensively evaluate the late mortality signal observed with the use of drug-coated balloons (DCB) and drug-eluting stent (DES). The objective of this review is to (1) identify and summarize the existing clinical and cohort studies assessing paclitaxel-coated DCBs and DESs, (2) describe and determine the quality of the available data sources for the evaluation of these devices, and (3) present methodologies that can be leveraged for proper signal discernment within available data sources. Methods Studies and data sources were identified through comprehensive searches. original research studies, clinical trials, comparative studies, multicenter studies, and observational cohort studies written in the English language and published from January 2007 to November 2021, with a follow-up longer than 36 months, were included in the review. Data quality of available data sources identified was assessed in three groupings. Moreover, accepted data-driven methodologies that may help circumvent the limitations of the extracted studies and data sources were extracted and described. Results There were 39 studies and data sources identified. This included 19 randomized clinical trials, nine single-arm studies, eight registries, three administrative claims, and electronic health records. Methodologies focusing on the use of existing premarket clinical data, the incorporation of all contributed patient time, the use of aggregated data, approaches for individual-level data, machine learning and artificial intelligence approaches, Bayesian approaches, and the combination of various datasets were summarized. Conclusion Despite the multitude of available studies over the course of eleven years following the first clinical trial, the FDA-convened advisory panel found them insufficient for comprehensively assessing the late-mortality signal. High-quality data sources with the capabilities of employing advanced statistical methodologies are needed to detect potential safety signals in a timely manner and allow regulatory bodies to act quickly when a safety signal is detected.
Collapse
Affiliation(s)
- Laura Elisabeth Gressler
- Office for Clinical Evidence and Analysis, United States Food and Drug Administration, Silver Spring, MD, United States
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Erika Avila-Tang
- Office for Clinical Evidence and Analysis, United States Food and Drug Administration, Silver Spring, MD, United States
| | - Jialin Mao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Alejandra Avalos-Pacheco
- Applied Statistics Research Unit, Faculty of Mathematics and Geoinformation, TU Wien, Vienna, Austria
- Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, United States
| | - Fadia T. Shaya
- School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, United States
| | - Yelizaveta Torosyan
- Office for Clinical Evidence and Analysis, United States Food and Drug Administration, Silver Spring, MD, United States
- Division of Clinical Evidence and Analysis 3, United States Food and Drug Administration, Silver Spring, MD, United States
- Office of Product Evaluation and Quality, United States Food and Drug Administration, Silver Spring, MD, United States
| | - Alexander Liebeskind
- Office for Clinical Evidence and Analysis, United States Food and Drug Administration, Silver Spring, MD, United States
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | | | - Christina D. Mack
- IQVIA Real World Solutions, Research Triangle Park, Raleigh, NC, United States
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Sharon-Lise Normand
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, United States
| | - Mary E. Ritchey
- Med Tech Epi, Philadelphia, PA, United States
- Center for Pharmacoepidemiology and Treatment Science, Rutgers University, New Brunswick, NJ, United States
| | - Danica Marinac-Dabic
- Office for Clinical Evidence and Analysis, United States Food and Drug Administration, Silver Spring, MD, United States
| |
Collapse
|
4
|
Salih M, Alom M, Kazem A, DeVille B, Potluri S. Drug-Coated Balloon Venoplasty to Treat Iatrogenic Pulmonary Vein Stenosis. JACC Case Rep 2023; 24:102019. [PMID: 37869215 PMCID: PMC10589447 DOI: 10.1016/j.jaccas.2023.102019] [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: 02/06/2023] [Revised: 04/19/2023] [Accepted: 05/18/2023] [Indexed: 10/24/2023]
Abstract
Pulmonary vein stenosis (PVS) is a condition that has seen a decrease in incidence in recent years. Whereas balloon angioplasty and stenting are both acceptable treatment options for PVS, they are limited by the high rate of restenosis. This research paper presents 4 cases of severe symptomatic PVS that were successfully treated with the use of drug-coated balloons, resulting in positive outcomes. (Level of Difficulty: Advanced.).
Collapse
Affiliation(s)
- Mohammed Salih
- Baylor, Scott, and White, Baylor University Medical Center/The Heart Hospital Plano, Plano, Texas, USA
| | - Modar Alom
- Baylor, Scott, and White, Baylor University Medical Center/The Heart Hospital Plano, Plano, Texas, USA
| | - Ahmed Kazem
- Baylor, Scott, and White, Baylor University Medical Center/The Heart Hospital Plano, Plano, Texas, USA
| | - Brian DeVille
- Baylor, Scott, and White, Baylor University Medical Center/The Heart Hospital Plano, Plano, Texas, USA
| | - Srinivasa Potluri
- Baylor, Scott, and White, Baylor University Medical Center/The Heart Hospital Plano, Plano, Texas, USA
| |
Collapse
|
5
|
Wang W, Luan Z, Shu Z, Xu K, Wang T, Liu S, Wu X, Liu H, Ye S, Dan R, Zhao X, Yang S, Xing M, Fan C. Biosynthetic Plastics as Tunable Elastic and Visible Stent with Shape-Memory to Treat Biliary Stricture. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2303779. [PMID: 37552006 PMCID: PMC10582434 DOI: 10.1002/advs.202303779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Indexed: 08/09/2023]
Abstract
Common biliary tract is ≈4 mm in diameter to deliver bile from liver to small intestine to help digestion. The abnormal narrowing leads to severe symptoms such as pain and nausea. Stents are an effective treatment. Compared with non-degradable stents which require repeated removal, biodegradable stents have the advantage of reducing secondary injury related to endoscopic operation and patient burden. However, current biodegradable materials may cause tissue hyperplasia and the treatment method does not target etiology of stricture. So recurrence rates after biodegradable stent implantation are still high. Here, a biodegradable helical stent fabricated from biosynthetic P(3HB-co-4HB) is reported. Tunable properties can be acquired through altering culture substrates. Stent shows shape memory in various solvents. The stent has an optimized design with helical structure and outer track. The self-expanding of helical structure and double drainage realized by outer track greatly improve drainage of bile. Importantly, stent-loading triamcinolone acetonide can inhibit proliferation of fibroblasts and reduce incidence of restricture. Therapeutic effect is also demonstrated in minipigs with biliary stricture. The results of minipig experiments show that biliary duct in treatment group is unobstructed and tissue hyperplasia is effectively inhibited.
Collapse
Affiliation(s)
- Wei Wang
- Department of GastroenterologyXinqiao HospitalArmy Medical UniversityNO.183, Xinqiao StreetChongqing400037China
| | - Zhaohui Luan
- Department of GastroenterologyXinqiao HospitalArmy Medical UniversityNO.183, Xinqiao StreetChongqing400037China
| | - Zhenzhen Shu
- Department of GastroenterologyXinqiao HospitalArmy Medical UniversityNO.183, Xinqiao StreetChongqing400037China
| | - Kaige Xu
- Department of Mechanical EngineeringUniversity of ManitobaWinnipegManitobaMB R3T 2N2Canada
| | - Tongchuan Wang
- Department of GastroenterologyXinqiao HospitalArmy Medical UniversityNO.183, Xinqiao StreetChongqing400037China
| | - Shuang Liu
- Department of GastroenterologyXinqiao HospitalArmy Medical UniversityNO.183, Xinqiao StreetChongqing400037China
| | - Xiaozhuo Wu
- Department of Mechanical EngineeringUniversity of ManitobaWinnipegManitobaMB R3T 2N2Canada
| | - Hangzong Liu
- Department of GastroenterologyXinqiao HospitalArmy Medical UniversityNO.183, Xinqiao StreetChongqing400037China
| | - Shaosong Ye
- Department of GastroenterologyXinqiao HospitalArmy Medical UniversityNO.183, Xinqiao StreetChongqing400037China
| | - Ruijue Dan
- Department of GastroenterologyXinqiao HospitalArmy Medical UniversityNO.183, Xinqiao StreetChongqing400037China
| | - Xiaoyan Zhao
- Department of GastroenterologyXinqiao HospitalArmy Medical UniversityNO.183, Xinqiao StreetChongqing400037China
| | - Shiming Yang
- Department of GastroenterologyXinqiao HospitalArmy Medical UniversityNO.183, Xinqiao StreetChongqing400037China
- Chongqing Municipality Clinical Research Center for Gastroenterology, Office of Science and Technology of ChongqingNo. 2 Xingai roadChongqing, Yubei401147China
- Chongqing Institute for Brain and Intelligence, Guangyang Bay LaboratoryChongqing400064China
| | - Malcolm Xing
- Department of Mechanical EngineeringUniversity of ManitobaWinnipegManitobaMB R3T 2N2Canada
| | - Chaoqiang Fan
- Department of GastroenterologyXinqiao HospitalArmy Medical UniversityNO.183, Xinqiao StreetChongqing400037China
- Chongqing Municipality Clinical Research Center for Gastroenterology, Office of Science and Technology of ChongqingNo. 2 Xingai roadChongqing, Yubei401147China
| |
Collapse
|
6
|
Shi T, Liu K, Peng Y, Dai W, Du D, Li X, Liu T, Song N, Meng Y. Research progress on the therapeutic effects of nanoparticles loaded with drugs against atherosclerosis. Cardiovasc Drugs Ther 2023:10.1007/s10557-023-07461-0. [PMID: 37178241 DOI: 10.1007/s10557-023-07461-0] [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] [Accepted: 04/24/2023] [Indexed: 05/15/2023]
Abstract
Presently, there are many drugs for the treatment of atherosclerosis (AS), among which lipid-lowering, anti-inflammatory, and antiproliferative drugs have been the most studied. These drugs have been shown to have inhibitory effects on the development of AS. Nanoparticles are suitable for AS treatment research due to their fine-tunable and modifiable properties. Compared with drug monotherapy, experimental results have proven that the effects of nanoparticle-encapsulated drugs are significantly enhanced. In addition to nanoparticles containing a single drug, there have been many studies on collaborative drug treatment, collaborative physical treatment (ultrasound, near-infrared lasers, and external magnetic field), and the integration of diagnosis and treatment. This review provides an introduction to the therapeutic effects of nanoparticles loaded with drugs to treat AS and summarizes their advantages, including increased targeting ability, sustained drug release, improved bioavailability, reduced toxicity, and inhibition of plaque and vascular stenosis.
Collapse
Affiliation(s)
- Tianfeng Shi
- Department of Radiology, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, 030009, Shanxi, China
- Department of Physiology, College of Basic Medicine, Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Kunkun Liu
- Department of Radiology, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, 030009, Shanxi, China
- Department of Physiology, College of Basic Medicine, Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Yueyou Peng
- Department of Radiology, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, 030009, Shanxi, China
| | - Weibin Dai
- Department of Radiology, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, 030009, Shanxi, China
| | - Donglian Du
- Department of Radiology, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, 030009, Shanxi, China
| | - Xiaoqiong Li
- Department of Radiology, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, 030009, Shanxi, China
| | - Tingting Liu
- Department of Radiology, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, 030009, Shanxi, China
- Medical Imaging Department of Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Ningning Song
- Department of Radiology, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, 030009, Shanxi, China
- Medical Imaging Department of Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Yanfeng Meng
- Department of Radiology, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, 030009, Shanxi, China.
- Department of Physiology, College of Basic Medicine, Shanxi Medical University, Taiyuan, 030001, Shanxi, China.
- Medical Imaging Department of Shanxi Medical University, Taiyuan, 030001, Shanxi, China.
| |
Collapse
|
7
|
Barbarawi M, Qazi AH, Lee J, Barbarawi O, Al-Abdouh A, Mhanna M, Vashist A. Meta-Analysis Comparing Drug-Coated Balloons and Percutaneous Transluminal Angioplasty for Infrapopliteal Artery Disease. Am J Cardiol 2022; 183:115-121. [PMID: 36116953 DOI: 10.1016/j.amjcard.2022.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/25/2022] [Accepted: 08/06/2022] [Indexed: 11/01/2022]
Abstract
Limited data is available regarding the safety and effectiveness of drug-coated balloon (DCB) versus conventional percutaneous transluminal balloon angioplasty (PTA) in the treatment of critical limb ischemia because of infrapopliteal peripheral arterial disease. We conducted an updated meta-analysis to assess the safety and efficacy of DCB in the treatment of infrapopliteal disease. A database search of PubMed/MEDLINE, EMBASE, and the Cochrane Library was performed by 2 reviewers from inception through November 15, 2021. Randomized trials that compared DCB with conventional PTA in treating infrapopliteal arterial disease were included. The risk ratios (RRs) and 95% confidence intervals (CIs) were reported. A total of 9 trials were included (1,501 participants) in the study. The mean age was 71.1 ± 10.2 years. Regarding the primary end points, treating infrapopliteal arterial disease with DCB had a lower incidence of re-stenosis (RR 0.48, 95% CI 0.33 to 0.70, p = 0.0001) with no significant difference in all-cause mortality (RR 1.11, 95% CI 0.73 to 1.69, p = 0.61), compared with conventional PTA. With regards to the secondary end points, DCB usage was associated with a significant reduction in clinically driven target lesion revascularization (RR 0.54, 95% CI 0.35 to 0.84, p = 0.006) with no significant difference with regards to major target limb amputation and major adverse cardiovascular events (p ≥0.05). In conclusion, among patients with critical limb ischemia secondary to infrapopliteal artery disease, DCB usage was associated with a significantly lower number of restenosis and clinically driven target lesion revascularization compared with conventional PTA. There was no increase in all-cause mortality or major target limb amputation with the use of DCB.
Collapse
Affiliation(s)
- Mahmoud Barbarawi
- Division of Cardiology, University of Connecticut, Farmington, Connecticut
| | - Abdul Haseeb Qazi
- Division of Cardiology, University of Connecticut, Farmington, Connecticut; Division of Cardiology, Saint Francis Hospital and Medical Center, Hartford, Connecticut
| | - Juyong Lee
- Division of Cardiology, University of Connecticut, Farmington, Connecticut
| | - Owais Barbarawi
- Department of Internal Medicine, Islamic Hospital, Amman, Jordan
| | - Ahmad Al-Abdouh
- Department of Internal Medicine, University of Kentucky, Lexington, Kentucky
| | - Mohammed Mhanna
- Department of Internal Medicine, University of Toledo, Toledo, Ohio
| | - Aseem Vashist
- Division of Cardiology, University of Connecticut, Farmington, Connecticut; Division of Cardiology, Saint Francis Hospital and Medical Center, Hartford, Connecticut; Division of Cardiology, VACT Healthcare System, West Haven, Connecticut; Frank H. Netter School of Medicine at Quinnipiac School of Medicine, North Haven, Connecticut.
| |
Collapse
|
8
|
Valle JA, Morrison JT. Paclitaxel Therapy in Peripheral Arterial Disease. JACC Cardiovasc Interv 2022; 15:2103-2104. [DOI: 10.1016/j.jcin.2022.08.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022]
|
9
|
Woolford S, Tran M, Yoda C, Oktem B, NguyenPho A, McDermott M, Wickramasekara S. Studying the effect of drug-to-excipient ratio on drug release profile for drug coated balloons. Int J Pharm 2022; 620:121749. [DOI: 10.1016/j.ijpharm.2022.121749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/07/2022] [Accepted: 04/09/2022] [Indexed: 11/29/2022]
|
10
|
Gholizadeh E, Naim M, Belibel R, Hlawaty H, Barbaud C. Novelty in the development of biodegradable polymer coatings for biomedical devices: paclitaxel grafting on PDMMLA derivatives. Des Monomers Polym 2022; 25:64-74. [PMID: 35341119 PMCID: PMC8942506 DOI: 10.1080/15685551.2022.2054116] [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] [Indexed: 11/03/2022] Open
Abstract
Biocompatible and biodegradable polymers are widely used in the medical field. In some cases, the biopolymer is accompanied by an active drug, which is delivered locally in a controlled manner in order to improve the healing conditions. Poly([R,S]-3,3-dimethylmalic acid) (PDMMLA) is a synthetic amphiphilic biodegradable polymer, which unlike PLA, can be chemically modified to adapt hydrophilic/hydrophobic balance, degradation kinetics, and physicochemical and biological properties. It may contain a lateral alkyl group or a functional group for coupling bioactive molecules to release during its degradation. In this work, we realized the chemical grafting of paclitaxel (PTX), a microtubule stabilizing anti-cancer agent on PDMMLA derivatives bio-polyesters following a Steglich esterification protocol. 1D and 2D NMR analyses validated the reaction with 10% (using 0.1 equivalent) of PTX on the copolymer PDMMLAH40-co-Hex60 (PDMMLA 40/60) and a maximal PTX grafting rate of 55% on the homopolymer PDMMLAH (PDMMLA 100/0). In vitro adhesion and cytotoxicity assays were carried out on HUVEC cells with PDMMLA 40/60, PDMMLA-PTX 30/10/60 and PLA.
Collapse
Affiliation(s)
- Elnaz Gholizadeh
- Institut Galilée, Laboratory for Vascular Transitional Science (LVTS), Université Sorbonne Paris Nord, Villetaneuse, France
| | - Meriem Naim
- Smbh, Laboratory for Vascular Transitional Science (LVTS), Université Sorbonne Paris Nord, Bobigny, France
| | - Rima Belibel
- Université Sorbonne Paris Nord, KymiaNova, Châtenay Malabry, France
| | - Hanna Hlawaty
- Smbh, Laboratory for Vascular Transitional Science (LVTS), Université Sorbonne Paris Nord, Bobigny, France
| | - Christel Barbaud
- Institut Galilée, Laboratory for Vascular Transitional Science (LVTS), Université Sorbonne Paris Nord, Villetaneuse, France
| |
Collapse
|
11
|
Rationale and design of a randomized study comparing the agent drug coated balloon to plain old balloon angioplasty in patients with In-stent restenosis. Am Heart J 2021; 241:101-107. [PMID: 34314727 DOI: 10.1016/j.ahj.2021.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/17/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Drug-coated balloon (DCB) technology was developed as an alternative treatment for obstructive coronary artery disease (CAD) and in-stent restenosis (ISR). Management of coronary ISR is clinically challenging and frequently encountered in practice. The Agent DCB uses an inactive excipient to effectively deliver a targeted, therapeutic dose of paclitaxel to the vessel wall. STUDY DESIGN AGENT IDE is a prospective, multicenter, randomized controlled trial to evaluate superiority of the Agent DCB to balloon angioplasty in treating patients with ISR. A total of 480 patients with ISR of a previously treated lesion length <26 mm and reference vessel diameter >2.0 mm to ≤4.0 mm will be initially randomized. Subjects presenting with recent myocardial infarction (MI), complex lesions, or thrombus in the target vessel will be excluded. An adaptive group sequential design with one formal interim analysis for sample size re-estimation will be conducted, and the sample size may be increased to a maximum of 600 subjects. The primary endpoint is the rate of 12-month target lesion failure (TLF; composite of any ischemia-driven revascularization of the target lesion (TLR), target vessel related MI, or cardiac death) and will be tested for superiority in the test arm against the control. Functional status and general health-related quality of life will be measured by changes in the EQ-5D scores. Subjects will be followed for 5 years following the index procedure. CONCLUSION This study will prospectively evaluate the safety and efficacy of Agent DCB in patients treated for coronary ISR.
Collapse
|
12
|
Tay S, Abdulnabi S, Saffaf O, Harroun N, Yang C, Semenkovich CF, Zayed MA. Comprehensive Assessment of Current Management Strategies for Patients With Diabetes and Chronic Limb-Threatening Ischemia. Clin Diabetes 2021; 39:358-388. [PMID: 34866779 PMCID: PMC8603325 DOI: 10.2337/cd21-0019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Chronic limb-threatening ischemia (CLTI) is the most severe form of peripheral artery disease. It is estimated that 60% of all nontraumatic lower-extremity amputations performed annually in the United States are in patients with diabetes and CLTI. The consequences of this condition are extraordinary, with substantial patient morbidity and mortality and high socioeconomic costs. Strategies that optimize the success of arterial revascularization in this unique patient population can have a substantial public health impact and improve patient outcomes. This article provides an up-to-date comprehensive assessment of management strategies for patients afflicted by both diabetes and CLTI.
Collapse
Affiliation(s)
- Shirli Tay
- Department of Surgery, Section of Vascular Surgery, Washington University School of Medicine, St. Louis, MO
| | - Sami Abdulnabi
- Department of Surgery, Section of Vascular Surgery, Washington University School of Medicine, St. Louis, MO
| | - Omar Saffaf
- Department of Surgery, Section of Vascular Surgery, Washington University School of Medicine, St. Louis, MO
| | - Nikolai Harroun
- Department of Surgery, Section of Vascular Surgery, Washington University School of Medicine, St. Louis, MO
| | - Chao Yang
- Department of Surgery, Section of Vascular Surgery, Washington University School of Medicine, St. Louis, MO
| | - Clay F. Semenkovich
- Department of Internal Medicine, Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine, St. Louis, MO
| | - Mohamed A. Zayed
- Department of Surgery, Section of Vascular Surgery, Washington University School of Medicine, St. Louis, MO
- Division of Molecular Cell Biology, Washington University School of Medicine, St. Louis, MO
- Department of Biomedical Engineering, Washington University McKelvey School of Engineering, St. Louis, MO
- Veterans Affairs St. Louis Health Care System, St. Louis, MO
| |
Collapse
|
13
|
Characteristics of atherosclerosis in femoropopliteal artery and its clinical relevance. Atherosclerosis 2021; 335:31-40. [PMID: 34547588 DOI: 10.1016/j.atherosclerosis.2021.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/28/2021] [Accepted: 09/09/2021] [Indexed: 12/12/2022]
Abstract
Atherosclerosis is a systemic disease with different faces. Despite identical or similar pathogenetic mechanisms, atherosclerotic lesions and their clinical manifestations vary in different parts of the vascular system. Peripheral arterial disease (PAD) represents one of the most frequent clinical manifestations of atherosclerosis with predominant location in the superficial femoral artery (SFA). Morphological characteristics of atherosclerotic plaques in peripheral arteries differ from lesions in the coronary and carotid arteries. Plaques in SFA have more fibrotic components, less lipids and inflammatory cells, which makes them more stable and less prone to rupture. Factors that determine the different structure of plaques in SFA compared to coronary arteries include hemodynamic forces, vasa vasorum and calcification. Low shear stress in SFA in the adductor canal is one of the factors which determines frequent atherosclerotic lesions in this region. Lower lipid content and fewer inflammatory cells explain higher stability of SFA plaques. The specific structure of SFA plaques may require preventive and therapeutic measures, which to some extent differ from prevention of coronary atherosclerosis and may include inhibition of fibrotic proliferation in SFA plaques and calcification. Revascularization of PAD differs from procedures used in coronary arteries and requires specific technical expertise and devices.
Collapse
|
14
|
Mortality is not associated with paclitaxel-coated devices usage in peripheral arterial disease of lower extremities. Sci Rep 2021; 11:18214. [PMID: 34521940 PMCID: PMC8440584 DOI: 10.1038/s41598-021-97675-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 08/26/2021] [Indexed: 12/24/2022] Open
Abstract
A recent meta-analysis addressed increased risk of death following revascularization with paclitaxel-coated devices in femopopliteal artery. We evaluated differences in all-cause mortality and amputation free survival between peripheral arterial disease (PAD) patients who were treated with paclitaxel-coated devices and non-paclitaxel-coated devices. This was retrospective population-based cohort study from the National Health Insurance Service claims in South Korea from 2015 to 2019. Multivariate Cox regression analyses after propensity score matching were applied to identify all-cause mortality and amputation-free survival. After propensity score matching, there were 6090 patients per group. The median follow-up days was 580 days (interquartile range [IQR] 240–991 days) and 433 days (IQR 175–757 days) for the non-paclitaxel-coated device group and paclitaxel-coated device group, respectively. Multivariate analysis adjusted for age, sex, diabetes, hypertension, warfarin, and new oral anticoagulants showed that the mortality rate associated with paclitaxel-coated devices was not significantly higher than non-paclitaxel-coated devices (hazard ratio [HR] 0.992; 95% CI 0.91–1.08). The rate of amputation events was higher in patients with paclitaxel-coated devices than those with non-paclitaxel-coated devices (HR 1.614; 95% CI 1.46–1.78). In this analysis, the mortality rate in patients with PAD was not associated with the use of paclitaxel-coated devices, despite a higher amputation rate.
Collapse
|
15
|
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
|
16
|
Edwards CT, Schneider PA, Huynh C. Paclitaxel Exposure and Dosage of Drug-coated Devices for the Treatment of Femoropopliteal Peripheral Artery Disease. VASCULAR AND ENDOVASCULAR REVIEW 2021. [DOI: 10.15420/ver.2020.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The role of paclitaxel in the treatment of femoropopliteal peripheral arterial disease is currently ambiguous. A summary-level meta-analysis of randomised trials published in 2018 demonstrated that paclitaxel-coated devices were associated with an increased all-cause mortality in those who underwent treatment at 2 years and 5 years. Further evaluation has been undertaken to establish whether there is a specific dose response, mechanism or reproducible signal. At this time, there has been no confirmation of dose response, as was initially asserted by the summary-level meta-analysis. No mechanism of harm has been identified. Although an association with increased mortality has been confirmed by patient-level meta-analysis, the strength of the signal has been inconsistent. The information suggests there is only an association between paclitaxel-coated devices and increased all-cause mortality, not causation. The authors encourage additional studies designed to follow long-term results after treatment with paclitaxel-coated devices, using real patient data, before a conclusion can be made.
Collapse
Affiliation(s)
- Ceazón T Edwards
- Division of Vascular and Endovascular Surgery, University of California at San Francisco, San Francisco, CA, US
| | - Peter A Schneider
- Division of Vascular and Endovascular Surgery, University of California at San Francisco, San Francisco, CA, US
| | - Cindy Huynh
- Division of Vascular and Endovascular Surgery, University of California at San Francisco, San Francisco, CA, US
| |
Collapse
|
17
|
Krawisz AK, Secemsky EA. The Safety of Paclitaxel-Coated Devices for Patients with Peripheral Artery Disease. Curr Cardiol Rep 2021; 23:48. [PMID: 33738616 PMCID: PMC8075633 DOI: 10.1007/s11886-021-01477-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW Peripheral artery disease (PAD) is a common, debilitating disease that impacts 8.5 million Americans and carries a poor prognosis. The most common manifestation of lower extremity PAD is claudication-a condition which significantly reduces quality of life and functional status. Paclitaxel-coated balloons and stents (PCBs and PESs) represented a breakthrough in the ability to treat medication-refractory patients relative to bare metal stents (BMSs) and percutaneous transluminal angioplasty (PTA) because they improve primary patency rates, reduce target lesion revascularization (TLR), and minimize late-lumen loss for femoropopliteal lesions. As a result, paclitaxel-coated devices (PCDs) were swiftly established as the standard of care for revascularization of femoropopliteal artery disease. A recent meta-analysis of summary-level data demonstrated a late mortality signal for patients treated with paclitaxel-coated devices relative to uncoated devices. This has had a major impact on the vascular community and for the treatment of patients with PAD. Herein, we provide a detailed review of the available data on the late mortality signal associated with paclitaxel. RECENT FINDINGS In December of 2018, Katsanos et al. J Am Heart Assoc 7: e011245, 2018) published data from randomized-controlled trials (RCTs) that demonstrated an increase in mortality at 2 and 5 years in patients treated with PCDs involving the femoropopliteal arterial segment relative to patients treated with uncoated devices. As a result of this analysis, randomized trials were stopped and the FDA sent a letter to healthcare providers recommending restriction of use of these devices to patients at the highest risk of restenosis. As additional data emerged supporting the safety of these devices, the FDA organized an advisory committee meeting to review the available data and to determine a pathway forward. The FDA concluded that there were insufficient data to make a final decision regarding the safety of PCDs. They allowed these devices to remain on the market, but with revised safety labeling and updated their letter to healthcare providers to continue to restrict use to patients at highest risk of reintervention. The FDA also called for additional long-term data, including from RCTs and real-world data. To date, an updated patient-level meta-analysis of clinical trial data, RCTs with longer-term follow-up, and large observational studies have been conducted. While meta-analyses conducted using overlapping clinical trial data have found a persistent increase in mortality for those treated with PCDs, individual industry-sponsored RCTs and large observational studies have consistently failed to detect a corresponding mortality increase. To date, no mechanism linking paclitaxel to mortality has been observed. We are currently at an impasse for drawing definitive conclusions regarding the long-term safety of paclitaxel-coated devices. As we await enrollment in ongoing clinical trials, we must proceed with making reasonable decisions for our patients' care from the available data, as these devices have important clinical implications for our patients. A critical lesson that can be learned from this controversy is that, for future device trials, committing to long-term follow-up is crucial.
Collapse
Affiliation(s)
- Anna K Krawisz
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, 375 Longwood Avenue, 4th Floor, Boston, MA, 02215, USA
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Eric A Secemsky
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Harvard Medical School, 375 Longwood Avenue, 4th Floor, Boston, MA, 02215, USA.
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| |
Collapse
|
18
|
Krawisz AK, Raja A, Secemsky EA. Femoral-popliteal peripheral artery disease: From symptom presentation to management and treatment controversies. Prog Cardiovasc Dis 2021; 65:15-22. [PMID: 33592208 PMCID: PMC8169531 DOI: 10.1016/j.pcad.2021.02.004] [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: 02/08/2021] [Accepted: 02/08/2021] [Indexed: 12/24/2022]
Abstract
Peripheral artery disease (PAD) is a common condition with increasing prevalence domestically and worldwide. Patients with PAD have a poor prognosis, as PAD is associated with high rates of myocardial infarction, ischemic stroke, and cardiovascular disease death. The primary symptom of PAD, claudication, significantly reduces quality of life and functional status and is associated with depression. In addition to several advances in medications for PAD over the last decade, endovascular device therapy has seen a significant breakthrough in the form of paclitaxel-coated devices (PCDs), which significantly reduce rates of restenosis relative to non-PCDs, a finding which has been demonstrated in numerous randomized clinical trials. After their introduction to the market in 2012 (paclitaxel-eluting stents) and 2014 (paclitaxel-coated balloons) their use surged as they replaced non-PCDs and were designated the first-line endovascular therapy by society guidelines. This trend was abruptly reversed, however, after a meta-analysis of summary-level data was published in December of 2018 that reported an elevated mortality associated with PCDs compared with non-PCDs 2-5 years after treatment. This meta-analysis has been criticized for considerable methodological flaws. The Food and Drug Administration conducted a review and concluded that insufficient data existed to make a definitive statement regarding the safety of PCDs. They called for restriction of the use of PCDs to the highest-risk patient populations. At the same time, the FDA deemed pursuing new RCTs to better evaluate PCDs unfeasible due to the high numbers of patients and long follow-up time that would be required. In this setting, real-world data emerged as a powerful source of information for the evaluation of PCDs. Real-world data offers advantages over randomized-controlled trials including expeditious access to and analysis of data and the availability of large numbers of patients. Several retrospective observational studies demonstrate no difference in long-term all-cause mortality in patients treated with PCDs relative to those treated with non-PCDs. This paclitaxel controversy has illustrated the critical role that real-world data is assuming in long-term safety monitoring of medical devices.
Collapse
Affiliation(s)
- Anna K Krawisz
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Aishwarya Raja
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Eric A Secemsky
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| |
Collapse
|
19
|
Affiliation(s)
- Mary M McDermott
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Melina R Kibbe
- Department of Surgery and Department of Biomedical Engineering, University of North Carolina, Chapel Hill, NC, USA
| |
Collapse
|
20
|
Ito K, Kato K, Tanaka H. Experience using drug-coated balloon venoplasty for acquired pulmonary vein stenosis after radiofrequency ablation. J Cardiol Cases 2021; 23:3-5. [PMID: 33437330 DOI: 10.1016/j.jccase.2020.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/03/2020] [Accepted: 08/10/2020] [Indexed: 11/17/2022] Open
Abstract
Pulmonary vein stenosis is a rare but severe complication of catheter ablation for arterial fibrillation (AF). Symptoms include dyspnea, hemoptysis, recurrent pneumonia, and pulmonary hypertension. We herein discuss a 27-year-old male patient who presented with hemoptysis and dyspnea three months after catheter ablation for AF. Computed tomography demonstrated an occluded left inferior pulmonary vein (LIPV) and left lower lung edema secondary to severe stenosis of the LIPV. The patient underwent treatment, including drug-coated balloon (DCB) venoplasty. Treatment of pulmonary vein stenosis involving percutaneous interventions with balloon angioplasty and stenting carry a high risk of restenosis. DCB therapy may be used to prevent stenosis. <Learning objective: The use of a drug-coated balloon is feasible and may provide good long-term outcomes in acquired pulmonary vein stenosis after radiofrequency ablation.>.
Collapse
Affiliation(s)
- Kansuke Ito
- Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Ken Kato
- Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Hiroyuki Tanaka
- Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| |
Collapse
|
21
|
Schneider PA, Varcoe RL, Secemsky E, Schermerhorn M, Holden A. Update on paclitaxel for femoral-popliteal occlusive disease in the 15 months following a summary level meta-analysis demonstrated increased risk of late mortality and dose response to paclitaxel. J Vasc Surg 2021; 73:311-322. [PMID: 32890719 PMCID: PMC8076887 DOI: 10.1016/j.jvs.2020.07.093] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 07/20/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Peripheral vascular devices (stents and balloons) coated with paclitaxel were developed to address suboptimal outcomes associated with percutaneous revascularization procedures of the femoral-popliteal arteries. In randomized controlled trials (RCT), paclitaxel-coated devices (PCD) provided increased long-term patency and a decreased need for repeat revascularization procedures compared with uncoated devices. This finding resulted in the adoption of their use for endovascular lower extremity revascularization procedures. However, in late 2018 a study-level meta-analysis showed increased all-cause mortality at 2 years or more after the procedure in patients treated with PCDs. This review examines the subsequent data evaluation following the publication of the meta-analysis. METHODS We review the published responses of physicians, regulatory agencies, and patient advocates during 15-month period after the meta-analysis. We present the additional data gathered from RCTs that comprised the meta-analysis and safety outcomes from large insurance databases in both the United States and Europe. RESULTS Immediately after the publication of the meta-analysis, concern for patient safety resulted in less PCD use, the suspension of large RCTs evaluating their use, and the publication of a letter from the U.S. Food and Drug Administration informing physicians that there was uncertainty in the benefit-risk profile of these devices for indicated patients and that the potential risk should be assessed before the use of PCDs. Review of the meta-analysis found that a mortality signal was present, but criticisms included that the evaluation was performed on study-level, not patient-level data, and the studies in the analysis were heterogenous in device type, paclitaxel doses, and patient characteristics. Further, the studies were not designed to be pooled nor were they powered for evaluating long-term safety. Clinical characteristics associated with a drug effect or causal relationship were also absent. Specifically, there was no dose response, no clustering of causes of death, and a lack of signal consistency across geographic regions. As more long-term data became available in the RCTs the strength of the mortality signal diminished and analysis of real-world use in large insurance databases, showed that there was no significant increase in all-cause mortality associated with PCD use. CONCLUSIONS The available data do not provide definitive proof for increased mortality with PCD use. A key observation is that trial design improvements will be necessary to better evaluate the risk-benefit profile of PCDs.
Collapse
Affiliation(s)
- Peter A Schneider
- Division of Vascular and Endovascular Surgery, University of California San Francisco, San Francisco, Calif.
| | - Ramon L Varcoe
- The Vascular Institute, Prince of Wales Hospital and University of New South Wales, Sydney, Australia
| | - Eric Secemsky
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Marc Schermerhorn
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Andrew Holden
- Department of Interventional Radiology, Auckland Hospital and University of Auckland School of Medicine, Auckland, New Zealand
| |
Collapse
|
22
|
Heinrich A, Engler MS, Güttler FV, Matthäus C, Popp J, Teichgräber UKM. Systematic evaluation of particle loss during handling in the percutaneous transluminal angioplasty for eight different drug-coated balloons. Sci Rep 2020; 10:17220. [PMID: 33057070 PMCID: PMC7560869 DOI: 10.1038/s41598-020-74227-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/29/2020] [Indexed: 11/11/2022] Open
Abstract
Paclitaxel drug coated balloons (DCBs) should provide optimal drug transfer exclusively to the target tissue. The aim of this study was to evaluate the particle loss by handling during angioplasty. A robotic arm was developed for systematic and reproducible drug abrasion experiments. The contact force on eight different commercially available DCB types was gradually increased, and high-resolution microscopic images of the deflated and inflated balloons were recorded. Three types of DCBs were classified: no abrasion of the drug in both statuses (deflated and inflated), significant abrasion only in the inflated status, and significant abrasion in both statuses. Quantitative measurements via image processing confirmed the qualitative classification and showed changes of the drug area between 2.25 and 45.73% (13.28 ± 14.29%) in the deflated status, and between 1.66 and 40.41% (21.43 ± 16.48%) in the inflated status. The structures and compositions of the DCBs are different, some are significantly more susceptible to drug loss. Particle loss by handling during angioplasty leads to different paclitaxel doses in the target regions for same DCB types. Susceptibility to involuntary drug loss may cause side effects, such as varying effective paclitaxel doses, which may explain variations in studies regarding the therapeutic outcome.
Collapse
Affiliation(s)
- Andreas Heinrich
- Department of Radiology, Jena University Hospital-Friedrich Schiller University, Am Klinikum 1, 07747, Jena, Germany.
| | - Martin S Engler
- Department of Radiology, Jena University Hospital-Friedrich Schiller University, Am Klinikum 1, 07747, Jena, Germany
| | - Felix V Güttler
- Department of Radiology, Jena University Hospital-Friedrich Schiller University, Am Klinikum 1, 07747, Jena, Germany
| | | | - Jürgen Popp
- Leibniz Institute of Photonic Technology, 07745, Jena, Germany.,Institute of Physical Chemistry & Abbe Center of Photonics, Friedrich Schiller University Jena, 07743, Jena, Germany
| | - Ulf K-M Teichgräber
- Department of Radiology, Jena University Hospital-Friedrich Schiller University, Am Klinikum 1, 07747, Jena, Germany
| |
Collapse
|
23
|
Wang Q, Zhu RM, Ren HL, Leng R, Zhang WD, Li CM. Combination of Percutaneous Rotational Thrombectomy and Drug-Coated Balloon for Treatment of Femoropopliteal Artery Nonembolic Occlusion: 12-Month Follow-up. J Vasc Interv Radiol 2020; 31:1661-1667. [PMID: 32921564 DOI: 10.1016/j.jvir.2020.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 03/10/2020] [Accepted: 03/15/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To evaluate safety and efficacy of percutaneous mechanical thrombectomy using the Rotarex catheter combined with drug-coated balloon (DCB) in treatment of femoropopliteal artery occlusive disease. MATERIALS AND METHODS Between January 2016 and February 2018, 81 patients with acute or subacute femoropopliteal artery occlusions were treated with the Rotarex catheter combined with DCB. Lesions were classified according to the onset of symptoms as acutely (< 14 d) or subacutely (14 d to 3 mo) occluded. The mean lesion length was 12.1 cm ± 6.7. The primary endpoint was target lesion patency at 1 year as evaluated by duplex ultrasound (peak systolic velocity ratio < 2.4) and freedom from clinically indicated target lesion revascularization. Amputation rate, major adverse events, and ankle-brachial index at 12 months were evaluated. RESULTS Technical success rate was 100% (n = 81). Bailout stents were necessary in 14 patients owing to residual stenosis or flow-limiting dissection. Additional thrombolysis was applied in 10 interventions. No major adverse events occurred during hospital stay. There were 9 restenosis cases during the 12-month follow-up period. Primary patency rate was 87.3% (62/71), and freedom from target lesion revascularization rate was 90.1% (64/71). Ankle-brachial index significantly increased from 0.46 ± 0.15 to 0.77 ± 0.14 during follow-up. The amputation rate was 1.4% at 12 months. CONCLUSIONS These initial data from 2 centers suggest that the combination of the Rotarex catheter and DCB may be safe and effective for treatment of acute or subacute thrombotic femoropopliteal occlusion with superior immediate and midterm results achieved.
Collapse
Affiliation(s)
- Qi Wang
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Gongren Tiyuchang Nanlu, Beijing 100020, China
| | - Ren-Ming Zhu
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hua-Liang Ren
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Gongren Tiyuchang Nanlu, Beijing 100020, China
| | - Rui Leng
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Gongren Tiyuchang Nanlu, Beijing 100020, China
| | - Wang-De Zhang
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Gongren Tiyuchang Nanlu, Beijing 100020, China
| | - Chun-Min Li
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Gongren Tiyuchang Nanlu, Beijing 100020, China.
| |
Collapse
|
24
|
Ansari E, Anderson B, Kauser K. Retained Functionality of Atherosclerotic Human Arteries Following Photoactivated Linking of the Extracellular Matrix by Natural Vascular Scaffolding Treatment. J Cardiovasc Transl Res 2020; 14:441-448. [PMID: 32748207 PMCID: PMC8219574 DOI: 10.1007/s12265-020-10063-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/24/2020] [Indexed: 01/08/2023]
Abstract
In this study, we investigated natural vascular scaffolding (NVS) treatment on vascular functionality using freshly isolated human popliteal arteries in vitro. Arteries were exposed to intraluminal NVS treatment consisting of a compound (4 amino-1,8-naphthalimide) photoactivated by a 450-nm light-emitting light fiber placed inside the artery. This procedure results in covalent linking between the extracellular matrix proteins to achieve a larger vessel diameter post-angioplasty and minimizing elastic recoil. Immediately following NVS treatment, rings were cut from the treated arteries and mounted in organ baths for contractility testing in response to U46619 and sodium nitroprusside. We also investigated the effect of NVS treatment on IL-6 cytokine release from vascular rings following a 4-h organoculture post-NVS treatment. Based on our results, we conclude that exposure of the vessels to NVS treatment does not adversely affect the contractile responsiveness of the vascular smooth muscle and exerts no pro-inflammatory effect. Graphical abstract.
Collapse
Affiliation(s)
| | - Blake Anderson
- Alucent Biomedical Inc., 675 Arapeen Dr Ste 102, Salt Lake City, UT, 84108, USA
| | - Katalin Kauser
- Alucent Biomedical Inc., 675 Arapeen Dr Ste 102, Salt Lake City, UT, 84108, USA.
| |
Collapse
|
25
|
Nerla R, Castriota F, Cremonesi A, Micari A. Stellarex drug-coated balloon: a technology evaluation. Expert Opin Drug Deliv 2020; 17:1181-1188. [PMID: 32615811 DOI: 10.1080/17425247.2020.1787982] [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: 10/23/2022]
Abstract
The Stellarex® drug-coated balloon (DCB) is an over-the-wire dual lumen catheter with a distally premounted semi-compliant balloon, which has a low dose (2 μg/mm2 of the expanded balloon surface) paclitaxel coating. Its hybrid formulation, made of amorphous and crystalline paclitaxel combined with a polyethylene glycol excipient, provides maintenance of coating integrity and adequate drug release. This balanced combination of amorphous and crystalline paclitaxel is able to maintain drug on the surface during handling and balloon tracking, with an effective drug transfer to vessel wall in the lesion site. Clinical data associated with Stellarex balloon are growing and confirm clinical effectiveness over a long-term follow-up without any possible signal of a reduced safety for treated patients.
Collapse
Affiliation(s)
- Roberto Nerla
- Interventional Cardiology Unit, Cardiovascular Department, Humanitas Gavazzeni , Bergamo, Italy
| | - Fausto Castriota
- Interventional Cardiology Unit, Cardiovascular Department, Humanitas Gavazzeni , Bergamo, Italy
| | - Alberto Cremonesi
- Interventional Cardiology Unit, Cardiovascular Department, Humanitas Gavazzeni , Bergamo, Italy
| | - Antonio Micari
- Interventional Cardiology Unit, Cardiovascular Department, Humanitas Gavazzeni , Bergamo, Italy
| |
Collapse
|
26
|
Affiliation(s)
- Rajesh V Swaminathan
- 1 Division of Cardiology Department of Medicine Duke University School of Medicine and the Duke Clinical Research Institute Durham NC
| | - W Schuyler Jones
- 1 Division of Cardiology Department of Medicine Duke University School of Medicine and the Duke Clinical Research Institute Durham NC
| | - Manesh R Patel
- 1 Division of Cardiology Department of Medicine Duke University School of Medicine and the Duke Clinical Research Institute Durham NC
| |
Collapse
|
27
|
Ducasse E, Caradu C. Rigorous focus on paclitaxel-related mortality in femoropopliteal artery disease. J Vasc Surg 2020; 71:216-219. [DOI: 10.1016/j.jvs.2019.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 10/13/2019] [Indexed: 11/28/2022]
|
28
|
Matsuura S, Yamamoto K, Akai T, Isaji T, Takayama T, Hoshina K. Effect of drug-coated balloons in treatment of stenosis of the femoral artery and vein bypass graft not responding to plain old balloon angioplasty: a case report. Surg Case Rep 2019; 5:204. [PMID: 31873813 PMCID: PMC6928170 DOI: 10.1186/s40792-019-0764-9] [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: 11/05/2019] [Accepted: 12/17/2019] [Indexed: 12/05/2022] Open
Abstract
Background The use of drug-coated balloons (DCBs) with anti-proliferative agents in treating femoropopliteal lesions was approved in Japan in 2017. A better limb salvage rate or amputation-free rate of DCBs relative to plain old balloon angioplasty (POBA) has been reported; however, there is little evidence of the direct effect on intimal hyperplasia (IH). Case presentation A 70-year-old man with chronic limb-threatening ischemia and foot gangrene had undergone bypass surgery from the left common femoral artery to the dorsalis pedis artery 2 years earlier. We evaluated the bypass graft using ultrasonography and found stenosis around the proximal anastomotic site, presumably due to IH. POBA was performed every 3 months due to the repeated re-stenosis of the lesion. Since using the DCB, no restenosis has been detected to date (10 months). Conclusion DCB might be an effective tool for treating re-stenosis due to IH or vein grafts that do not respond to POBA.
Collapse
Affiliation(s)
- Sohei Matsuura
- Division of Vascular Surgery, Department of Surgery, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kota Yamamoto
- Division of Vascular Surgery, Department of Surgery, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takafumi Akai
- Division of Vascular Surgery, Department of Surgery, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Toshihiko Isaji
- Division of Vascular Surgery, Department of Surgery, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Toshio Takayama
- Division of Vascular Surgery, Department of Surgery, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Katsuyuki Hoshina
- Division of Vascular Surgery, Department of Surgery, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| |
Collapse
|
29
|
Mottola G, Werlin EC, Wu B, Chen M, Chatterjee A, Schaller MS, Conte MS. Oral Resolvin D1 attenuates early inflammation but not intimal hyperplasia in a rat carotid angioplasty model. Prostaglandins Other Lipid Mediat 2019; 146:106401. [PMID: 31841663 DOI: 10.1016/j.prostaglandins.2019.106401] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 08/19/2019] [Accepted: 11/26/2019] [Indexed: 12/16/2022]
Abstract
Inflammation ensuing from vascular injury promotes intimal hyperplasia (IH) and restenosis. Resolvin D1 (RvD1) is a lipid mediator that attenuates IH in vivo when delivered locally to the vessel wall in animal models. We tested the hypothesis that peri-procedural oral administration of RvD1 could blunt the local inflammatory response to angioplasty, and attenuate downstream IH. Carotid angioplasty was performed on rats fed with either RvD1 or vehicle through oral gavage, starting one day prior to injury until post-operative day (POD) 3 or 14 when arteries were harvested. To study pharmacokinetics and bioactivity of oral RvD1, we measured plasma RvD1 by ELISA, whole blood phagocytosis activity using flow cytometry, and cAMP levels in the thoracic aorta by ELISA. Carotid arteries were harvested on POD3 for staining (anti-CD45, anti-Myeloperoxidase (MPO), anti-Ki67 or dihydroethidium (DHE) for reactive oxygen species), mRNA expression of target genes (quantitative RT-PCR), or on POD14 for morphometry (elastin stain). RvD1 plasma concentration peaked 3 h after gavage in rats, at which point we concurrently observed an increase in circulating monocyte phagocytosis activity and aortic cAMP levels in RvD1-treated rats vs. vehicle. Oral RvD1 attenuated local arterial inflammation after angioplasty by reducing CD45+, MPO+, Ki67+ cells, and DHE staining intensity. Oral RvD1 also reduced the expression of several pro-inflammatory genes within the injured vessels. However, oral RvD1 did not significantly reduce IH. Oral RvD1 attenuated acute inflammation within the arterial wall after angioplasty in rats, but did not significantly affect IH.
Collapse
Affiliation(s)
- Giorgio Mottola
- Department of Surgery, Division of Vascular and Endovascular Surgery, University of California San Francisco, Cardiovascular Research Institute, 555 Mission Bay Blvd South, San Francisco, 94143, CA, USA
| | - Evan C Werlin
- Department of Surgery, Division of Vascular and Endovascular Surgery, University of California San Francisco, Cardiovascular Research Institute, 555 Mission Bay Blvd South, San Francisco, 94143, CA, USA
| | - Bian Wu
- Department of Surgery, Division of Vascular and Endovascular Surgery, University of California San Francisco, Cardiovascular Research Institute, 555 Mission Bay Blvd South, San Francisco, 94143, CA, USA
| | - Mian Chen
- Department of Surgery, Division of Vascular and Endovascular Surgery, University of California San Francisco, Cardiovascular Research Institute, 555 Mission Bay Blvd South, San Francisco, 94143, CA, USA
| | - Anuran Chatterjee
- Department of Surgery, Division of Vascular and Endovascular Surgery, University of California San Francisco, Cardiovascular Research Institute, 555 Mission Bay Blvd South, San Francisco, 94143, CA, USA
| | - Melinda S Schaller
- Department of Surgery, Division of Vascular and Endovascular Surgery, University of California San Francisco, Cardiovascular Research Institute, 555 Mission Bay Blvd South, San Francisco, 94143, CA, USA
| | - Michael S Conte
- Department of Surgery, Division of Vascular and Endovascular Surgery, University of California San Francisco, Cardiovascular Research Institute, 555 Mission Bay Blvd South, San Francisco, 94143, CA, USA.
| |
Collapse
|
30
|
Paclitaxel-Based Devices for the Treatment of PAD: Balancing Clinical Efficacy with Possible Risk. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:57. [PMID: 31494757 DOI: 10.1007/s11936-019-0765-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE OF REVIEW Paclitaxel-based endovascular devices have become the standard of care in symptomatic, medication-refractory peripheral artery disease (PAD) and in critical limb ischemia (CLI). This review examines the data on the efficacy and safety of these devices relative to standard balloon angioplasty (PTA) and bare metal stents (BMS). RECENT FINDINGS Randomized controlled trials (RCTs) have found that peripheral devices coated with paclitaxel result in superior patency rates and decreased target lesion revascularization (TLR) compared with non-drug-coated devices. Recently, a meta-analysis of randomized controlled trials unexpectedly reported an increase in mortality in patients treated with paclitaxel-coated devices (PCDs), resulting in the pausing of ongoing trials and a warning of safety from the FDA. Observational data that has been published since this time has not supported this safety concern. PAD is a common disease that severely impacts quality and length of life. PCDs are a promising therapy for patients with PAD, offering a more effective and durable intervention when compared with traditional PTA/BMS. A meta-analysis of RCTs identified a signal of harm with these devices which has now been replicated by the FDA. However, there is significant missing data from the trials analyzed by the meta-analysis and FDA, no plausible mechanism linking paclitaxel to death, and no correlation between paclitaxel dose and mortality. Analyses in observational data have found no safety signal. An FDA panel evaluating the validity of this late-mortality signal recently adjourned, emphasizing that the available data is incomplete. PCDs will remain on the market, and an active discussion is underway for developing an approach for improved post-market surveillance, device-labeling, and cause of death adjudication.
Collapse
|
31
|
Wang Z, Zheng Q, Guan S, Sun Z, Liu S, Zhang B, Duan T, Xu K. In vitro and in vivo assessment of the biocompatibility of an paclitaxel-eluting poly-l-lactide-coated Mg-Zn-Y-Nd alloy stent in the intestine. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 105:110087. [PMID: 31546433 DOI: 10.1016/j.msec.2019.110087] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 07/21/2019] [Accepted: 08/14/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Zhanhui Wang
- Luoyang Central Hospital affiliated to Zhengzhou University, Luoyang 471000, China.
| | - Qiuxia Zheng
- The Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450003, China
| | - Shaokang Guan
- School of Materials Science and Engineering, Zhengzhou University, Zhengzhou 45002, China.
| | - Zongbin Sun
- Luoyang Central Hospital affiliated to Zhengzhou University, Luoyang 471000, China
| | - Shaopeng Liu
- Luoyang Central Hospital affiliated to Zhengzhou University, Luoyang 471000, China
| | - Bingbing Zhang
- Luoyang Central Hospital affiliated to Zhengzhou University, Luoyang 471000, China
| | - Tinghe Duan
- Luoyang Central Hospital affiliated to Zhengzhou University, Luoyang 471000, China
| | - Kai Xu
- Luoyang Central Hospital affiliated to Zhengzhou University, Luoyang 471000, China
| |
Collapse
|
32
|
Katsanos K, Spiliopoulos S, Kitrou P, Krokidis M, Karnabatidis D. Risk of Death Following Application of Paclitaxel-Coated Balloons and Stents in the Femoropopliteal Artery of the Leg: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Am Heart Assoc 2018; 7:e011245. [PMID: 30561254 PMCID: PMC6405619 DOI: 10.1161/jaha.118.011245] [Citation(s) in RCA: 585] [Impact Index Per Article: 97.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 11/07/2018] [Indexed: 02/05/2023]
Abstract
Background Several randomized controlled trials ( RCT s) have already shown that paclitaxel-coated balloons and stents significantly reduce the rates of vessel restenosis and target lesion revascularization after lower extremity interventions. Methods and Results A systematic review and meta-analysis of RCT s investigating paclitaxel-coated devices in the femoral and/or popliteal arteries was performed. The primary safety measure was all-cause patient death. Risk ratios and risk differences were pooled with a random effects model. In all, 28 RCT s with 4663 patients (89% intermittent claudication) were analyzed. All-cause patient death at 1 year (28 RCT s with 4432 cases) was similar between paclitaxel-coated devices and control arms (2.3% versus 2.3% crude risk of death; risk ratio, 1.08; 95% CI, 0.72-1.61). All-cause death at 2 years (12 RCT s with 2316 cases) was significantly increased in the case of paclitaxel versus control (7.2% versus 3.8% crude risk of death; risk ratio, 1.68; 95% CI, 1.15-2.47; -number-needed-to-harm, 29 patients [95% CI , 19-59]). All-cause death up to 5 years (3 RCT s with 863 cases) increased further in the case of paclitaxel (14.7% versus 8.1% crude risk of death; risk ratio, 1.93; 95% CI , 1.27-2.93; -number-needed-to-harm, 14 patients [95% CI , 9-32]). Meta-regression showed a significant relationship between exposure to paclitaxel (dose-time product) and absolute risk of death (0.4±0.1% excess risk of death per paclitaxel mg-year; P<0.001). Trial sequential analysis excluded false-positive findings with 99% certainty (2-sided α, 1.0%). Conclusions There is increased risk of death following application of paclitaxel-coated balloons and stents in the femoropopliteal artery of the lower limbs. Further investigations are urgently warranted. Clinical Trial Registration URL : www.crd.york.ac.uk/PROSPERO . Unique identifier: CRD 42018099447.
Collapse
|
33
|
Merinopoulos I, Gunawardena T, Wickramarachchi U, Ryding A, Eccleshall S, Vassiliou VS. Percutaneous Coronary Intervention in the Elderly: Are Drug-coated Balloons the Future? Curr Cardiol Rev 2018; 14:45-52. [PMID: 29278215 PMCID: PMC5872262 DOI: 10.2174/1573403x14666171226144120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 12/08/2017] [Accepted: 12/11/2017] [Indexed: 11/22/2022] Open
Abstract
Background: Balloon angioplasty revolutionised percutaneous treatment for coronary ar-tery disease four decades ago, but vessel-threatening dissections, elastic recoil and restenosis were major drawbacks to an otherwise successful long-lasting intervention. Subsequent advances with bare metal stents and then drug eluting stents followed, aiming to mitigate the risks of acute vessel closure and restenosis. However, stent implantation often necessitates dual antiplatelet therapy for a pro-longed period of time, which in itself can lead to adverse outcomes, especially in the frail elderly pop-ulation at higher risk of bleeding. More recently, bioabsorbable stents have been implemented in clini-cal practice enabling earlier intimal coverage of the stent and apposition. However, another addition to the armamentarium of percutaneous coronary intervention is the use of drug-coated balloons without the need for deploying any coronary stents or scaffolds. Drug-coated balloons are semi-compliant balloons coated with an antiproliferative agent that is rapidly released on contact with the vessel intima exerting an anti-restenotic effect. The absence of a metallic scaffold means that the need for antiplatelet therapy can potentially be negated in the longer term if required. In this article, we will review the history of percutaneous coronary intervention and the available evi-dence for the appropriate use of drug-coated balloons especially in the elderly population. Conclusion: We will conclude this review by demonstrating the potential use of drug-coated balloon rather percutaneous stenting through case examples.
Collapse
Affiliation(s)
- Ioannis Merinopoulos
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | | | - Upul Wickramarachchi
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Alisdair Ryding
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Simon Eccleshall
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Vassilios S Vassiliou
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom.,Norwich Medical School, University of East Anglia and Royal Brompton Hospital and Imperial College London, London, United Kingdom
| |
Collapse
|
34
|
Atigh MK, Turner E, Christians U, Yazdani SK. The use of an occlusion perfusion catheter to deliver paclitaxel to the arterial wall. Cardiovasc Ther 2018; 35. [PMID: 28445625 DOI: 10.1111/1755-5922.12269] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/24/2017] [Accepted: 04/22/2017] [Indexed: 12/17/2022] Open
Abstract
AIM Nonstent drug delivery platforms have recently emerged as an alternative treatment of peripheral arterial disease. Perfusion catheters have the potential to directly deliver antiproliferative agents to the medial arterial layer to prevent restenosis. The purpose of this study was to therefore determine the effectiveness of a perfusion catheter to deliver paclitaxel, a proven antiproliferative agent, to combat restenosis. METHODS A benchtop model was utilized to determine the varying parameters of a novel occlusion perfusion catheter to maximize paclitaxel delivery using pharmacokinetic evaluation and fluorescent microscopy. Parameters tested included concentration of paclitaxel, delivery pressure, duration of delivery, and the use of an excipient. In addition, bilateral rabbit iliac arteries were treated with the perfusion catheter and pharmacokinetic evaluation performed at 1 hour, 1 day and 3 days. RESULTS Benchtop testing demonstrated uniform and circumferential penetration of paclitaxel within the treated arteries. The results of the ex vivo test identified two groups with and without an excipient with similar loading conditions (with excipient: 15.4±8.6 ng/mg vs without excipient: 8.9±6.9 ng/mg, P=.77). The in vivo pharmacokinetic analysis of these two groups demonstrated the use of contrast agent increased arterial paclitaxel levels and maintained initial paclitaxel dosing up to 3 days (With excipient: 1 hour: 107±62 ng vs 3 days: 40±23 ng, P=.824; No excipient: 1 hour: 247±120 ng vs 3 days: 2.92±2.9 ng, P=.009). CONCLUSIONS These results demonstrate the feasibility to deliver paclitaxel directly to the medial layer of an artery via a perfusion catheter.
Collapse
Affiliation(s)
- Marzieh K Atigh
- Mechanical Engineering Department, University of South Alabama, Mobile, AL, USA
| | - Emily Turner
- Mechanical Engineering Department, University of South Alabama, Mobile, AL, USA
| | - Uwe Christians
- iC42 Clinical Research and Development, University of Colorado, Aurora, CO, USA
| | - Saami K Yazdani
- Mechanical Engineering Department, University of South Alabama, Mobile, AL, USA
| |
Collapse
|
35
|
Mitomo S, Jabbour RJ, Mangieri A, Ancona M, Regazzoli D, Tanaka A, Giannini F, Carlino M, Montorfano M, Chieffo A, Latib A, Colombo A. Mid-term clinical outcomes after bailout drug-eluting stenting for suboptimal drug-coated balloon results: Insights from a Milan registry. Int J Cardiol 2018; 263:17-23. [PMID: 29685691 DOI: 10.1016/j.ijcard.2018.04.050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 03/27/2018] [Accepted: 04/10/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Drug-coated balloon (DCB) is an alternative to drug-eluting stent (DES) for the treatment of small vessel or in-stent restenosis (ISR) lesions, with bailout stenting reserved for poor results after DCB inflation (residual stenosis or dissection). Data regarding bailout stenting with DES are limited. The aim of this study was to evaluate clinical outcomes after bailout stenting with DES for suboptimal DCB results. METHODS From June 2009 to December 2015, patients who underwent bailout DES implantation for suboptimal results after DCB (residual stenosis > 30% or type C-F dissection) in 2 high-volume centers in Italy were analyzed. The primary endpoint was target lesion failure (TLF) defined as composite of cardiac mortality, target vessel myocardial infarction (MI) and target lesion revascularization (TLR). RESULTS A total of 103 patients (125 lesions) were analyzed. Mean age was 68.8 ± 9.5 years, 21.4% were diabetic, and 92.2% underwent PCI for stable angina. The left anterior descending artery was most commonly treated (35.2%), followed by right coronary artery (17.6%) and left circumflex artery (17.6%). Lesion complexity was high (type B2/C: 88.8%) and 24.8% were ISR lesions. During the follow-up period (median: 858 days [interquartile range: 467-1665]), the TLF rate was 4.3% at 1 year and 15.4% at 2 years, and mainly driven by TLR (3.3% at 1 year, 14.5% at 2 years, respectively). There were no target vessel MI or definite/probable stent thrombosis events. CONCLUSIONS Bailout stenting with DES for suboptimal DCB results is a feasible and safe strategy at mid-term follow-up.
Collapse
Affiliation(s)
- Satoru Mitomo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | | | - Antonio Mangieri
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Ancona
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Damiano Regazzoli
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Akihito Tanaka
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Giannini
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Mauro Carlino
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Matteo Montorfano
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Alaide Chieffo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Azeem Latib
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Colombo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| |
Collapse
|
36
|
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]
|
37
|
Wang H, Wang K, Mu Q, Stephen ZR, Yu Y, Zhou S, Zhang M. Mesoporous carbon nanoshells for high hydrophobic drug loading, multimodal optical imaging, controlled drug release, and synergistic therapy. NANOSCALE 2017; 9:1434-1442. [PMID: 28094402 PMCID: PMC5334464 DOI: 10.1039/c6nr07894j] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Loading and controlled release of sufficient hydrophobic drugs to tumor cells has been the bottleneck in chemotherapy for decades. Herein we report the development of a fluorescent and mesoporous carbon nanoshell (FMP-CNS) that exhibits a loading capacity for the hydrophobic drug paclitaxel (PTX) as high as ∼80 wt% and releases the drug in a controllable fashion under NIR irradiation (825 nm) at an intensity of 1.5 W cm-2. The high drug loading is primarily attributed to its mesoporous structure and to the supramolecular π-stacking between FMP-CNSs and PTX molecules. The FMP-CNS also exhibits wavelength-tunable and upconverted fluorescence properties and thus can serve as an optical marker for confocal, two-photon, and near infrared (NIR) fluorescence imaging. Furthermore, our in vitro results indicate that FMP-CNSs demonstrate high therapeutic efficacy through the synergistic effect of combined chemo-photothermal treatment. In vivo studies demonstrate marked suppression of tumor growth in mice bearing rat C6 glioblastoma after administration with a single intratumoral injection of PTX-loaded FMP-CNS.
Collapse
Affiliation(s)
- Hui Wang
- Department of Materials Science and Engineering, University of Washington, Seattle, Washington 98195, United States
| | - Kui Wang
- Department of Materials Science and Engineering, University of Washington, Seattle, Washington 98195, United States
| | - Qingxin Mu
- Department of Materials Science and Engineering, University of Washington, Seattle, Washington 98195, United States
| | - Zachary R Stephen
- Department of Materials Science and Engineering, University of Washington, Seattle, Washington 98195, United States
| | - Yanyan Yu
- Department of Chemistry of The College of Staten Island and The Graduate Center, The City University of New York, Staten Island, New York 10314, United States
| | - Shuiqin Zhou
- Department of Chemistry of The College of Staten Island and The Graduate Center, The City University of New York, Staten Island, New York 10314, United States
| | - Miqin Zhang
- Department of Materials Science and Engineering, University of Washington, Seattle, Washington 98195, United States
| |
Collapse
|
38
|
A review of the coronary applications of the drug coated balloon. Int J Cardiol 2017; 226:77-86. [DOI: 10.1016/j.ijcard.2016.09.045] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 09/07/2016] [Accepted: 09/15/2016] [Indexed: 11/22/2022]
|
39
|
Jongsma H, Bekken JA, de Vries JPP, Verhagen HJ, Fioole B. Drug-eluting balloon angioplasty versus uncoated balloon angioplasty in patients with femoropopliteal arterial occlusive disease. J Vasc Surg 2016; 64:1503-1514. [DOI: 10.1016/j.jvs.2016.05.084] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 05/31/2016] [Indexed: 11/30/2022]
|
40
|
Hawkins BM. Ultrasound Plus Paclitaxel Trumps Drug-Coated Balloon. JACC Cardiovasc Interv 2016; 9:2154-2156. [DOI: 10.1016/j.jcin.2016.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 08/17/2016] [Indexed: 10/20/2022]
|
41
|
Paclitaxel-Coated Balloons in the Femoropopliteal Artery. JACC Cardiovasc Interv 2016; 9:1743-5. [DOI: 10.1016/j.jcin.2016.06.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 06/28/2016] [Indexed: 11/18/2022]
|
42
|
Delivering therapeutics in peripheral artery disease: challenges and future perspectives. Ther Deliv 2016; 7:483-93. [PMID: 27403631 DOI: 10.4155/tde-2016-0024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Targeted and sustained delivery of biologicals to improve neovascularization has been focused on stimulation angiogenesis. The formation of collaterals however is hemodynamically much more efficient, but as a target of therapy has been under-utilized. Although there is good understanding of the molecular processes involving collateral formation and there are interesting drugable candidates, the need for targeting and sustained delivery is still an obstacle towards safe and effective treatment. Molecular targeting with nanoparticles of liposomes is promising and so are peri-vascularly delivered polymer-based protein reservoirs. These developments will lead to future arteriogenesis strategies that are adjunct to current revascularization.
Collapse
|
43
|
Colleran R, Harada Y, Cassese S, Byrne RA. Drug coated balloon angioplasty in the treatment of peripheral artery disease. Expert Rev Med Devices 2016; 13:569-82. [DOI: 10.1080/17434440.2016.1184969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
44
|
Katsanos K, Spiliopoulos S, Paraskevopoulos I, Diamantopoulos A, Karnabatidis D. Systematic Review and Meta-analysis of Randomized Controlled Trials of Paclitaxel-Coated Balloon Angioplasty in the Femoropopliteal Arteries: Role of Paclitaxel Dose and Bioavailability. J Endovasc Ther 2016; 23:356-70. [PMID: 26823485 DOI: 10.1177/1526602815626557] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To provide a qualitative analysis and quantitative synthesis of randomized controlled trials (RCTs) investigating paclitaxel-coated balloons (PCBs) in the femoropopliteal artery. METHODS PubMed, EMBASE, AMED, Scopus, CENTRAL, online content, and abstracts from international meetings were last screened in April 2015 for eligible RCTs using the PRISMA selection process. Risk of bias was assessed using the Cochrane Collaboration's tool, and quality of evidence was evaluated with the GRADE system. Outcome measures included late lumen loss (LLL) at 6 months and event rates of major limb amputations, binary lesion restenosis, and target lesion revascularization (TLR). Pooled treatment effects were analyzed in a random effects model to account for clinical heterogeneity; the outcomes are presented as the rate ratios (RRs) and their 95% confidence intervals (CIs). Extensive meta-regression was performed to analyze potential confounders. The review was registered in the PROSPERO database (CRD42015023938; www.crd.york.ac.uk/PROSPERO). RESULTS Eleven RCTs with 1609 subjects (1403 claudicants and 206 patients with critical limb ischemia) with medium-length femoropopliteal lesions (mean range 5.1-11.9 cm) were included. There was consistently high-quality evidence supporting the clear superiority of PCBs in terms of reduced LLL (mean difference -0.89 mm, 95% CI -1.14 to -0.64, p<0.001), less binary restenosis (RR 0.47, 95% CI 0.37 to 0.61, p<0.001), and fewer TLR events (RR 0.33, 95% CI 0.22 to 0.49, p<0.001). Major amputations were rare in both active and control arms (pooled event rate: 0.7%, 95% CI 0.3% to 1.2%). Results were stable across all potential risk modifiers and in the presence of stents as well. There was high-quality evidence that the dose of paclitaxel was related to the magnitude of the treatment effect; standard dose (3.0-μg and 3.5-μg) PCBs were significantly more effective compared with low-dose 2-μg PCB in reducing both restenosis (RR 2.1, 95% CI 1.2 to 3.4, p<0.001) and TLR (RR 2.5, 95% CI 1.9 to 3.8, p<0.001). CONCLUSION PCBs reduce by more than half the rates of restenosis and TLR in the femoropopliteal artery regardless of stent placement. Biologic effect size may vary according to paclitaxel bioavailability.
Collapse
Affiliation(s)
- Konstantinos Katsanos
- Department of Interventional Radiology, Guy's and St. Thomas' Hospitals, NHS Foundation Trust, King's Health Partners, London, UK Department of Interventional Radiology, Patras University Hospital, School of Medicine, Patras, Rion, Greece
| | - Stavros Spiliopoulos
- Department of Interventional Radiology, Patras University Hospital, School of Medicine, Patras, Rion, Greece
| | - Ioannis Paraskevopoulos
- Department of Interventional Radiology, Guy's and St. Thomas' Hospitals, NHS Foundation Trust, King's Health Partners, London, UK
| | - Athanasios Diamantopoulos
- Department of Interventional Radiology, Guy's and St. Thomas' Hospitals, NHS Foundation Trust, King's Health Partners, London, UK
| | - Dimitris Karnabatidis
- Department of Interventional Radiology, Patras University Hospital, School of Medicine, Patras, Rion, Greece
| |
Collapse
|
45
|
Cheng Y, Leon MB, Granada JF. An update on the clinical use of drug-coated balloons in percutaneous coronary interventions. Expert Opin Drug Deliv 2016; 13:859-72. [PMID: 26924794 DOI: 10.1517/17425247.2016.1154530] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Drug-coated balloons (DCB) promise to deliver anti-proliferative drugs and prevent restenosis leaving nothing behind. Although, randomized clinical trials have demonstrated their efficacy for the treatment of in-stent restenosis, clinical evidence supporting their use in other coronary applications is still lacking. AREAS COVERED This review summarizes the development status of clinically available DCB technologies and provides an update on the current data for their coronary use. EXPERT OPINION Current generation DCB prevent restenosis by delivering paclitaxel particles on the surface of the vessel wall. Although clinically available technologies share a common mechanism of action, important differences in pharmacokinetic behavior and safety profiles do exist. Future technological improvements include the development of coatings displaying: high transfer efficiency; low particle embolization potential; and alternative drug formulations. Optimized balloon-based delivery systems and drug encapsulation technologies also promise to improve the technical limitations of current generation DCB. Although proving clinical superiority against DES may prove to be difficult in mainstream applications (i.e., de novo), new generation DCB technologies have the potential to achieve a strong position in the interventional field in clinical settings in which the efficacy of DES use is not proven or justified (i.e., bifurcations).
Collapse
Affiliation(s)
- Yanping Cheng
- a CRF-Skirball Center for Innovation , Orangeburg , NY , USA
| | - Martin B Leon
- b Center for Interventional Vascular Therapy , Columbia University Medical Center , New York , NY , USA
| | - Juan F Granada
- a CRF-Skirball Center for Innovation , Orangeburg , NY , USA
| |
Collapse
|
46
|
Effect of the association of 1-methyl-DL-tryptophan with paclitaxel on the expression of indoleamine 2,3-dioxygenase in cultured cancer cells from patients with breast cancer. Med Oncol 2015; 32:248. [PMID: 26442514 DOI: 10.1007/s12032-015-0694-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 09/26/2015] [Indexed: 12/13/2022]
Abstract
Breast cancer is the most common type of cancer among women and the survival of patients affected by it is increasing, mainly due to several new approaches in early diagnosis and more effective treatments. The enzyme indoleamine 2,3-dioxygenase (IDO) is expressed in many cells, including tumor cells. IDO acts by inhibiting the proliferation of T lymphocytes, thus compromising their cytotoxic activity. 1-Methyl-DL-tryptophan (1MT) is a competitive inhibitor of IDO, which blocks its immunosuppressive effect. Paclitaxel is an antineoplastic drug largely used in breast cancer therapy. Thus, this study aimed to determine the in vitro effect of the association of 1MT and paclitaxel chemotherapy, as an approach to reduce tumor growth. It is believed that this would allow the restoration of T lymphocyte proliferation capability and its cytotoxic response. The supplemented cultures showed that the most significant differences in the expression of IDO were observed in the group treated with paclitaxel associated with 1-MT continuous supplementation, reducing enzyme expression from 12.06 to 3.56 %. This association was more effective in reducing IDO expression and could collaborate in developing a new therapeutic strategy for breast cancer treatment.
Collapse
|