1
|
Teichgräber U, Lehmann T, Ingwersen M, Aschenbach R, Zeller T, Brechtel K, Blessing E, Lichtenberg M, von Flotow P, Heilmeier B, Sixt S, Brucks S, Erbel C, Beschorner U, Werk M, Riambau V, Wienke A, Klumb C, Thieme M, Scheinert D. Long-Term Effectiveness and Safety of Femoropopliteal Drug-Coated Balloon Angioplasty : 5-Year Results of the Randomized Controlled EffPac Trial. Cardiovasc Intervent Radiol 2022; 45:1774-1783. [DOI: 10.1007/s00270-022-03265-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/21/2022] [Indexed: 11/02/2022]
Abstract
Abstract
Purpose
This study aimed to assess 5-year effectiveness and safety of femoropopliteal angioplasty with the Luminor® 35 drug-coated balloon (DCB).
Materials and Methods
The EffPac trial was a prospective, multicenter, randomized controlled trial that enrolled 171 patients of Rutherford category 2 to 4 with medium length femoropopliteal lesions. Patients were allocated 1:1 to either Luminor® 35 DCB angioplasty or plain old balloon angioplasty (POBA). Assessment at 5 years included primary patency, freedom from clinically driven target lesion revascularization (CD-TLR), clinical improvement, and target limb amputation. Long-term vital status was ascertained in 97.1% of the participants.
Results
Kaplan–Meier curves at 5 years demonstrate a primary patency of 61.4% after DCB angioplasty and 53.5% after POBA (log-rank p = 0.040) with a decreasing difference throughout the observation period. Freedom from TLR was 82.1% and 73.7%, respectively (log-rank p = 0.050). Incidence of primary clinical improvement was similar between groups (61% DCB vs. 64% POBA, p = 0.94). Major target limb amputation was necessary in one POBA-group participant. Freedom from all-cause death at 5 years was 88.5% after DCB and 86.0% after POBA (log-rank p = 0.34).
Conclusions
Primary patency after femoropopliteal DCB angioplasty remained superior to POBA throughout 5 years, however, with decreasing difference. Clinical improvement, freedom from TLR, and all-cause mortality were similar between groups over the long term. (Effectiveness of Paclitaxel-Coated Luminor® Balloon Catheter Versus Uncoated Balloon Catheter in the Superficial Femoral Artery [EffPac]; NCT02540018).
Collapse
|
2
|
Teichgräber U, Lehmann T, Aschenbach R, Thieme M, Zeller T, Beschorner U, Scheinert D. Femoropopliteal Drug-coated Balloon Angioplasty: Long-term Results of the Randomized EffPac Trial. Radiology 2022; 304:225-227. [PMID: 35315720 DOI: 10.1148/radiol.212622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Ulf Teichgräber
- From the Department of Radiology, Friedrich-Schiller University, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany (U.T., R.A.); Center for Clinical Studies, Jena University Hospital, Jena, Germany (T.L.); Department of Angiology, Cardiology, Diabetology, Regiomed-Vascular Center, Sonneberg, Germany (M.T); University Heart Center Freiburg Bad Krozingen, Bad Krozingen, Germany (T.Z., U.B.); and Department of Angiology, University Hospital Leipzig, Leipzig, Germany (D.S.)
| | - Thomas Lehmann
- From the Department of Radiology, Friedrich-Schiller University, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany (U.T., R.A.); Center for Clinical Studies, Jena University Hospital, Jena, Germany (T.L.); Department of Angiology, Cardiology, Diabetology, Regiomed-Vascular Center, Sonneberg, Germany (M.T); University Heart Center Freiburg Bad Krozingen, Bad Krozingen, Germany (T.Z., U.B.); and Department of Angiology, University Hospital Leipzig, Leipzig, Germany (D.S.)
| | - René Aschenbach
- From the Department of Radiology, Friedrich-Schiller University, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany (U.T., R.A.); Center for Clinical Studies, Jena University Hospital, Jena, Germany (T.L.); Department of Angiology, Cardiology, Diabetology, Regiomed-Vascular Center, Sonneberg, Germany (M.T); University Heart Center Freiburg Bad Krozingen, Bad Krozingen, Germany (T.Z., U.B.); and Department of Angiology, University Hospital Leipzig, Leipzig, Germany (D.S.)
| | - Markus Thieme
- From the Department of Radiology, Friedrich-Schiller University, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany (U.T., R.A.); Center for Clinical Studies, Jena University Hospital, Jena, Germany (T.L.); Department of Angiology, Cardiology, Diabetology, Regiomed-Vascular Center, Sonneberg, Germany (M.T); University Heart Center Freiburg Bad Krozingen, Bad Krozingen, Germany (T.Z., U.B.); and Department of Angiology, University Hospital Leipzig, Leipzig, Germany (D.S.)
| | - Thomas Zeller
- From the Department of Radiology, Friedrich-Schiller University, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany (U.T., R.A.); Center for Clinical Studies, Jena University Hospital, Jena, Germany (T.L.); Department of Angiology, Cardiology, Diabetology, Regiomed-Vascular Center, Sonneberg, Germany (M.T); University Heart Center Freiburg Bad Krozingen, Bad Krozingen, Germany (T.Z., U.B.); and Department of Angiology, University Hospital Leipzig, Leipzig, Germany (D.S.)
| | - Ulrich Beschorner
- From the Department of Radiology, Friedrich-Schiller University, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany (U.T., R.A.); Center for Clinical Studies, Jena University Hospital, Jena, Germany (T.L.); Department of Angiology, Cardiology, Diabetology, Regiomed-Vascular Center, Sonneberg, Germany (M.T); University Heart Center Freiburg Bad Krozingen, Bad Krozingen, Germany (T.Z., U.B.); and Department of Angiology, University Hospital Leipzig, Leipzig, Germany (D.S.)
| | - Dierk Scheinert
- From the Department of Radiology, Friedrich-Schiller University, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany (U.T., R.A.); Center for Clinical Studies, Jena University Hospital, Jena, Germany (T.L.); Department of Angiology, Cardiology, Diabetology, Regiomed-Vascular Center, Sonneberg, Germany (M.T); University Heart Center Freiburg Bad Krozingen, Bad Krozingen, Germany (T.Z., U.B.); and Department of Angiology, University Hospital Leipzig, Leipzig, Germany (D.S.)
| |
Collapse
|
3
|
Teichgräber U, Lehmann T, Aschenbach R, Scheinert D, Zeller T, Brechtel K, Blessing E, Lichtenberg M, von Flotow P, Heilmeier B, Sixt S, Brucks S, Erbel C, Beschorner U, Werk M, Riambau V, Wienke A, Klumb CT, Thieme M. Drug-coated Balloon Angioplasty of Femoropopliteal Lesions Maintained Superior Efficacy over Conventional Balloon: 2-year Results of the Randomized EffPac Trial. Radiology 2020; 295:478-487. [DOI: 10.1148/radiol.2020191619] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
4
|
Teichgräber U, Lehmann T, Aschenbach R, Scheinert D, Zeller T, Brechtel K, Blessing E, Lichtenberg M, Sixt S, Brucks S, Beschorner U, Klumb CT, Thieme M. Efficacy and safety of a novel paclitaxel-nano-coated balloon for femoropopliteal angioplasty: one-year results of the EffPac trial. EUROINTERVENTION 2020; 15:e1633-e1640. [PMID: 31687933 DOI: 10.4244/eij-d-19-00292] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AIMS Although paclitaxel drug-coated balloon (DCB) angioplasty is an established endovascular treatment for peripheral artery disease, restenosis remains a major concern. Thus, we compared a novel paclitaxel-coated DCB with nano-coating technology with uncoated plain old balloon angioplasty (POBA). METHODS AND RESULTS This multicentre trial randomly assigned 171 patients with stenotic and occlusive lesions of the femoropopliteal artery to angioplasty with a novel DCB or uncoated POBA. The primary endpoint, late lumen loss at six months, was 0.92 mm lower in the DCB group (95% CI: -1.36 to -0.49 mm, p<0.001). Patients showed improved walking after DCB treatment at six months (p=0.021). In the DCB group, 44.6% and 50% of the patients improved by three Rutherford-Becker classification stages after six to 12 months, respectively (POBA: 27.8% and 36.8%, respectively). Only one patient needed TLR (1.3%) in the DCB group, compared to 14 patients (18.7%) in the POBA group after 12 months (relative risk [RR]=0.08, 95% CI: 0.01-0.53, p<0.001). Primary patency was 90.3% (DCB group) versus 65.3% (POBA group) after 12 months (RR=1.38, 95% CI: 1.14-1.67, p<0.001). CONCLUSIONS The novel DCB was effective and safe for inhibiting restenosis. Moreover, it demonstrated a better improvement in walking than POBA and showed no mortality concerns due to paclitaxel application after 12 months. Clinical Trials Identifier: NCT02540018
Collapse
Affiliation(s)
- Ulf Teichgräber
- Department of Radiology, University Hospital Jena, Jena, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Multivariable Regression Analysis of Clinical Data from the Randomized-Controlled EffPac Trial: Efficacy of Femoropopliteal Drug-Coated Balloon Angioplasty. Cardiovasc Intervent Radiol 2020; 43:840-849. [PMID: 32236675 PMCID: PMC7225207 DOI: 10.1007/s00270-020-02452-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/12/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE The post-hoc multivariable analysis of EffPac study data aimed to identify explanatory variables for efficacy of femoropopliteal artery angioplasty. METHODS In the prospective, randomized, controlled EffPac study, patients were allocated to either DCB or plain old balloon angioplasty. Multivariable regression including interaction analysis was conducted to assess the impact of selected variables on the outcome measures of late lumen loss (LLL) at 6 months, and on binary restenosis, target lesion revascularization (TLR), clinical improvement, and hemodynamic improvement at 12 months. RESULTS A total of 171 patients (69 ± 8 years, 111 men) were treated at 11 German centers. Hypertension increased, and advanced age decreased LLL (B coefficient [B]: 0.7 [95% CI - 0.04 to 1.3], p = 0.06 and - 0.3 per 10 years [95% CI - 0.5 to 0.01], p = 0.06, respectively). DCB angioplasty decreased odds of 12-month TLR and binary restenosis (OR 0.4 [95% CI 0.2 to 0.8], p = 0.01 and OR 0.1 [95% CI 0.01 to 0.6], p = 0.02, respectively). Lesion length and severe calcification decreased clinical improvement (B: - 0.1 per 10 mm [95% CI - 0.1 to - 0.03], p = 0.001 and - 0.1 [95% CI - 1.7 to - 0.1], p = 0.03, respectively). DCB angioplasty in former smokers improved ABI (0.2 [95% CI 0.01 to 0.5], p = 0.04). CONCLUSION DCB angioplasty decreased the incidence of 12-month restenosis and TLR. Increasing lesion length and severe calcification reduced clinical improvement. Hypertension is suspected to facilitate, and advanced age to mitigate LLL. DCB improved ABI most in former smokers.
Collapse
|
6
|
Teichgräber U, Aschenbach R, Scheinert D, Zeller T, Brechtel K, Thieme M, Blessing E, Treitl M, Lichtenberg M, von Flotow P, Vogel B, Werk M, Riambau V, Wienke A, Lehmann T, Sixt S. Erratum to: The effectiveness of the paclitaxel-coated Luminor® balloon catheter versus an uncoated balloon catheter in superficial femoral and popliteal arteries in preventing vessel restenosis or reocclusion: study protocol for a randomized controlled trial. Trials 2017; 18:193. [PMID: 28446251 PMCID: PMC5405525 DOI: 10.1186/s13063-017-1884-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 03/09/2017] [Indexed: 11/18/2022] Open
|
7
|
Kayssi A, Al‐Atassi T, Oreopoulos G, Roche‐Nagle G, Tan KT, Rajan DK. Drug-eluting balloon angioplasty versus uncoated balloon angioplasty for peripheral arterial disease of the lower limbs. Cochrane Database Syst Rev 2016; 2016:CD011319. [PMID: 27490003 PMCID: PMC8504434 DOI: 10.1002/14651858.cd011319.pub2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Atherosclerotic peripheral arterial disease (PAD) can lead to disabling ischemia and limb loss. Treatment modalities have included risk factor optimization through life-style modifications and medications, or operative approaches using both open and minimally invasive techniques, such as balloon angioplasty. Drug-eluting balloon (DEB) angioplasty has emerged as a promising alternative to uncoated balloon angioplasty for the treatment of this difficult disease process. By ballooning and coating the inside of atherosclerotic vessels with cytotoxic agents, such as paclitaxel, cellular mechanisms responsible for atherosclerosis and neointimal hyperplasia are inhibited and its devastating complications are prevented or postponed. DEBs are considerably more expensive than uncoated balloons, and their efficacy in improving patient outcomes is unclear. OBJECTIVES To assess the efficacy of drug-eluting balloons (DEBs) compared with uncoated, nonstenting balloon angioplasty in people with symptomatic lower-limb peripheral arterial disease (PAD). SEARCH METHODS The Cochrane Vascular Trials Search Co-ordinator (TSC) searched the Specialised Register (last searched December 2015) and Cochrane Register of Studies (CRS) (2015, Issue 11). The TSC searched trial databases for details of ongoing and unpublished studies. SELECTION CRITERIA We included all randomized controlled trials that compared DEBs with uncoated, nonstenting balloon angioplasty for intermittent claudication (IC) or critical limb ischemia (CLI). DATA COLLECTION AND ANALYSIS Two review authors (AK, TA) independently selected the appropriate trials and performed data extraction, assessment of trial quality, and data analysis. The senior review author (DKR) adjudicated any disagreements. MAIN RESULTS Eleven trials that randomized 1838 participants met the study inclusion criteria. Seven of the trials included femoropopliteal arterial lesions, three included tibial arterial lesions, and one included both. The trials were carried out in Europe and in the USA and all used the taxane drug paclitaxel in the DEB arm. Nine of the 11 trials were industry-sponsored. Four companies manufactured the DEB devices (Bard, Bavaria Medizin, Biotronik, and Medtronic). The trials examined both anatomic and clinical endpoints. There was heterogeneity in the frequency of stent deployment and the type and duration of antiplatelet therapy between trials. Using GRADE assessment criteria, the quality of the evidence presented was moderate for the outcomes of target lesion revascularization and change in Rutherford category, and high for amputation, primary vessel patency, binary restenosis, death, and change in ankle-brachial index (ABI). Most participants were followed up for 12 months, but one trial reported outcomes at five years.There were better outcomes for DEBs for up to two years in primary vessel patency (odds ratio (OR) 1.47, 95% confidence interval (CI) 0.22 to 9.57 at six months; OR 1.92, 95% CI 1.45 to 2.56 at 12 months; OR 3.51, 95% CI 2.26 to 5.46 at two years) and at six months and two years for late lumen loss (mean difference (MD) -0.64 mm, 95% CI -1.00 to -0.28 at six months; MD -0.80 mm, 95% CI -1.44 to -0.16 at two years). DEB were also superior to uncoated balloon angioplasty for up to five years in target lesion revascularization (OR 0.28, 95% CI 0.17 to 0.47 at six months; OR 0.40, 95% CI 0.31 to 0.51 at 12 months; OR 0.28, 95% CI 0.18 to 0.44 at two years; OR 0.21, 95% CI 0.09 to 0.51 at five years) and binary restenosis rate (OR 0.44, 95% CI 0.29 to 0.67 at six months; OR 0.38, 95% CI 0.15 to 0.98 at 12 months; OR 0.26, 95% CI 0.10 to 0.66 at two years; OR 0.12, 95% CI 0.05 to 0.30 at five years). There was no significant difference between DEB and uncoated angioplasty in amputation, death, change in ABI, change in Rutherford category and quality of life (QoL) scores, or functional walking ability, although none of the trials were powered to detect a significant difference in these clinical endpoints. We carried out two subgroup analyses to examine outcomes in femoropopliteal and tibial interventions as well as in people with CLI (4 or greater Rutherford class), and showed no advantage for DEBs in tibial vessels at six and 12 months compared with uncoated balloon angioplasty. There was also no advantage for DEBs in CLI compared with uncoated balloon angioplasty at 12 months. AUTHORS' CONCLUSIONS Based on a meta-analysis of 11 trials with 1838 participants, there is evidence of an advantage for DEBs compared with uncoated balloon angioplasty in several anatomic endpoints such as primary vessel patency (high-quality evidence), binary restenosis rate (moderate-quality evidence), and target lesion revascularization (low-quality evidence) for up to 12 months. Conversely, there is no evidence of an advantage for DEBs in clinical endpoints such as amputation, death, or change in ABI, or change in Rutherford category during 12 months' follow-up. Well-designed randomized trials with long-term follow-up are needed to compare DEBs with uncoated balloon angioplasties adequately for both anatomic and clinical study endpoints before the widespread use of this expensive technology can be justified.
Collapse
Affiliation(s)
- Ahmed Kayssi
- University of TorontoDivision of Vascular SurgeryEaton North, 6th Floor, Room EN 6‐214200 Elizabeth StreetTorontoONCanadaM5G 2C4
| | - Talal Al‐Atassi
- University of Ottawa Heart InstituteDivision of Cardiac Surgery40 Ruskin StreetOttawaONCanadaK1Y 4W7
| | - George Oreopoulos
- University of TorontoDivision of Vascular SurgeryEaton North, 6th Floor, Room EN 6‐214200 Elizabeth StreetTorontoONCanadaM5G 2C4
| | - Graham Roche‐Nagle
- University of TorontoDivision of Vascular SurgeryEaton North, 6th Floor, Room EN 6‐214200 Elizabeth StreetTorontoONCanadaM5G 2C4
| | - Kong Teng Tan
- University of TorontoDivision of Vascular and Interventional RadiologyNCSB 1C‐572, 585 University AvenueTorontoONCanadaM5G 2N2
| | - Dheeraj K Rajan
- University of TorontoDivision of Vascular and Interventional RadiologyNCSB 1C‐572, 585 University AvenueTorontoONCanadaM5G 2N2
| | | |
Collapse
|