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Zhao Y, Wang P, Zheng Z, Ma Q, Shi Y, Liu J. Efficacy and safety of drug-coated balloons in chronic total coronary occlusion recanalization: a systematic review and meta-analysis. BMC Cardiovasc Disord 2024; 24:324. [PMID: 38918738 PMCID: PMC11200994 DOI: 10.1186/s12872-024-03993-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 06/20/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND With advancements in chronic total coronary occlusion (CTO) recanalization techniques and concepts, the success rate of recanalization has been steadily increasing. However, the current data are too limited to draw any reliable conclusions about the efficacy and safety of drug-coated balloons (DCBs) in CTO percutaneous coronary intervention (PCI). Herein, we conducted a meta-analysis to confirm the efficacy of DCB in CTO PCI. METHODS We systematically searched PubMed, Web of Science and Embase from inception to July 25, 2023. The primary outcome was major advent cardiovascular events (MACE), including cardiac death, nonfatal myocardial infarction (MI), target lesion revascularization (TLR), and target vessel revascularization (TVR). The follow-up angiographic endpoints were late lumen enlargement (LLE), reocclusion and restenosis. RESULTS Five studies with a total of 511 patients were included in the meta-analysis. Across studies, patients were predominantly male (72.9-85.7%) and over fifty years old. The summary estimate rate of MACE was 13.0% (95% CI 10.1%-15.9%, I2 = 0%, p = 0.428). The summary estimate rates of cardiac death and MI were 2.2% (95% CI 0.7%-3.7%, I2 = 0%, p = 0.873) and 1.2% (95% CI -0.2-2.6%, I2 = 13.7%, p = 0.314), respectively. Finally, the pooled incidences of TLR and TVR were 10.1% (95% CI 5.7%-14.5%, I2 = 51.7%, p = 0.082) and 7.1% (95% CI 3.0%-11.2%, I2 = 57.6%, p = 0.070), respectively. Finally, the summary estimate rates of LLE, reocclusion and restenosis were 59.4% (95% CI 53.5-65.3%, I2 = 0%, p = 0.742), 3.3% (95% CI 1.1-5.4%, I2 = 0%, p = 0.865) and 17.5% (95% CI 12.9-22.0%, I2 = 0%, p = 0.623), respectively. CONCLUSION Accordingly, DCB has the potential to be used as a treatment for CTO in suitable patients.
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Affiliation(s)
- Yuhao Zhao
- Center for Coronary Artery Disease(CCAD), Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Ping Wang
- Center for Coronary Artery Disease(CCAD), Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Ze Zheng
- Center for Coronary Artery Disease(CCAD), Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Qin Ma
- Center for Coronary Artery Disease(CCAD), Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Yuchen Shi
- Center for Coronary Artery Disease(CCAD), Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
| | - Jinghua Liu
- Center for Coronary Artery Disease(CCAD), Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
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2
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Liu S, Zhou Y, Shen Z, Chen H, Qiu C, Fu G, Li H, Yu Z, Zeng Q, Li Z, Li W, Qiao S. Comparison of Drug-Coated Balloon and Drug-Eluting Stent for the Treatment of Small Vessel Disease (from the Dissolve SVD Randomized Trial). Am J Cardiol 2024; 211:29-39. [PMID: 37995506 DOI: 10.1016/j.amjcard.2023.05.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/16/2023] [Accepted: 05/31/2023] [Indexed: 11/25/2023]
Abstract
The Dissolve drug-coated balloons (DCBs) is a new-generation DCB coated with paclitaxel of balloon surface, with midchain triglyceride excipient. Although the use of DCBs is a promising technique, little is known about the the clinical efficacy of the novel Dissolve DCB in coronary small vessel disease. This study was a prospective, randomized, multicenter, noninferiority trial comparing the Dissolve DCB with the Resolute drug-eluting stent (DES) in patients with a reference vessel diameter ≥2.25 and ≤2.75 mm. Patients with a reference vessel diameter ≥2.00 and <2.25 mm were enrolled in the very small vessel registry. The angiographic and clinical follow-up were planned at 9 months and 1 year in all patients, respectively. The primary end point was 9-month in-segment percentage diameter stenosis. A total of 247 patients with small vessel disease from 10 Chinese sites were included (Dissolve DCB, n = 118; Resolute DES, n = 129); 30 patients were treated with the DCB in the very small vessel cohort. The 9-month in-segment percentage diameter stenosis was 31.2 ± 2.0% with Dissolve DCB versus 26.1 ± 2.1% with Resolute DES; the 1-sided 97.5% upper confidence limit of the difference was 10.3% (p for noninferiority = 0.0002). At 12 months, the DCB and DES groups were associated with similar rates of target lesion failure (8.5% vs 6.1%, p = 0.28) and major adverse cardiac and cerebrovascular events (20.9% vs 13.6%, p = 0.12). In conclusion, the Dissolve DCB was noninferior to the Resolute DES for the primary end point of 9-month in-segment percentage diameter stenosis in this multicenter, head-to-head, randomized trial (a safety and efficacy study of Dissolve In Treatment Of Coronary Small Vessel Disease; NCT03376646).
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Affiliation(s)
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital
| | - Zhujun Shen
- Department of Cardiology, Peking Union Medical College Hospital, Beijing, China
| | - Hui Chen
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Chunguang Qiu
- Department of Cardiology, The First Affiliated Hospital of Zheng Zhou University, Zheng Zhou, China
| | - Guosheng Fu
- Department of Cardiology, Sir Run Run Shaw, Zhejiang University School of Medicine, Zhejiang, China
| | - Hui Li
- Department of Cardiology, Daqing Oilfield General Hospital, Daqing, China
| | - Zaixin Yu
- Department of Cardiology, Xiangya Hospital of Central South University, Changshan, China
| | - Qiutang Zeng
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhanquan Li
- Department of Cardiology, Liaoning Provincial People's Hospital, Shenyang, China
| | - Wei Li
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases of China, Beijing, China
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3
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Wang D, Wang X, Yang T, Tian H, Su Y, Wang Q. Drug-Coated Balloons for De Novo Coronary Artery Lesions: A Meta-Analysis of Randomized Clinical Trials. Yonsei Med J 2023; 64:593-603. [PMID: 37727918 PMCID: PMC10522878 DOI: 10.3349/ymj.2022.0606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 09/21/2023] Open
Abstract
PURPOSE Through meta-analysis, we aimed to assess the efficacy and safety of drug-coated balloons (DCB), compared with drug-eluting stents (DES) or uncoated devices, in the treatment of de novo coronary lesions. MATERIALS AND METHODS Only randomized controlled trials were included. The primary outcomes were late lumen loss (LLL), target lesion revascularization (TLR), and major adverse cardiac events (MACEs). Subgroup analyses were conducted based on clinical indications, whether DCBs were used with a systematic or bailout stent, and types of DESs. RESULTS The present meta-analysis demonstrated that DCBs elicit significantly lower incidences of TLR, MACE, and LLL, compared with uncoated devices, and similar incidences, compared with DESs, in the treatment of de novo coronary lesions. Subgroup analysis indicated that DCBs used with a bailout stent achieved lower incidences of binary restenosis and myocardial infarction, compared with uncoated devices, and provided less LLL than DESs. DCBs showed similar rates of TLR and MACE, with significantly less LLL, than DESs in treating de novo small-vessel diseases. The clinical efficacy of DCBs was similar to that of second-generation DES. CONCLUSION Overall, DCB is favored over bare metal stent alone in treating de novo coronary lesions. DCBs appear to be a promising alternative to DESs in the treatment of de novo coronary lesions.
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Affiliation(s)
- Dejin Wang
- Department of Cardiology, Zibo Central Hospital, Zibo, Shandong, China
| | - Xiqian Wang
- Department of Cardiology, Zibo Central Hospital, Zibo, Shandong, China
| | - Tianxiao Yang
- Department of Cardiology, Zibo Central Hospital, Zibo, Shandong, China
| | - Hongliang Tian
- Department of Cardiology, Zibo Central Hospital, Zibo, Shandong, China
| | - Yuanzhen Su
- Department of Cardiology, Zibo Central Hospital, Zibo, Shandong, China
| | - Qilei Wang
- Department of Cardiology, Zibo Central Hospital, Zibo, Shandong, China.
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Felbel D, Bozic F, Mayer B, Krohn-Grimberghe M, Paukovitsch M, d’Almeida S, Mörike J, Gonska B, Imhof A, Buckert D, Rottbauer W, Markovic S, Stephan T. Drug-coated balloon: an effective alternative to stent strategy in small-vessel coronary artery disease-a meta-analysis. Front Cardiovasc Med 2023; 10:1213992. [PMID: 37671137 PMCID: PMC10475729 DOI: 10.3389/fcvm.2023.1213992] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/31/2023] [Indexed: 09/07/2023] Open
Abstract
Background Small-vessel coronary artery disease (CAD) is frequently observed in coronary angiography and linked to a higher risk of lesion failure and restenosis. Currently, treatment of small vessels is not standardized while having drug-eluting stents (DES) or drug-coated balloons (DCBs) as possible strategies. We aimed to conduct a meta-analytic approach to assess the effectiveness of treatment strategies and outcomes for small-vessel CAD. Methods Comprehensive literature search was conducted using PubMed, Embase, MEDLINE, and Cochrane Library databases to identify studies reporting treatment strategies of small-vessel CAD with a reference diameter of ≤3.0 mm. Target lesion revascularization (TLR), target lesion thrombosis, all-cause death, myocardial infarction (MI), and major adverse cardiac events (MACE) were defined as clinical outcomes. Outcomes from single-arm and randomized studies based on measures by means of their corresponding 95% confidence intervals (CI) were compared using a meta-analytic approach. Statistical significance was assumed if CIs did not overlap. Results Thirty-seven eligible studies with a total of 31,835 patients with small-vessel CAD were included in the present analysis. Among those, 28,147 patients were treated with DES (24 studies) and 3,299 patients with DCB (18 studies). Common baseline characteristics were equally distributed in the different studies. TLR rate was 4% in both treatment strategies [0.04; 95% CI 0.03-0.05 (DES) vs. 0.03-0.07 (DCB)]. MI occurred in 3% of patients receiving DES and in 2% treated with DCB [0.03 (0.02-0.04) vs. 0.02 (0.01-0.03)]. All-cause mortality was 3% in the DES group [0.03 (0.02-0.05)] compared with 1% in the DCB group [0.01 (0.00-0.03)]. Approximately 9% of patients with DES developed MACE vs. 4% of patients with DCB [0.09 (0.07-0.10) vs. 0.04 (0.02-0.08)]. Meta-regression analysis did not show a significant impact of reference vessel diameter on outcomes. Conclusion This large meta-analytic approach demonstrates similar clinical and angiographic results between treatment strategies with DES and DCB in small-vessel CAD. Therefore, DES may be waived in small coronary arteries when PCI is performed with DCB.
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Affiliation(s)
- Dominik Felbel
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Filip Bozic
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Benjamin Mayer
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Marvin Krohn-Grimberghe
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Michael Paukovitsch
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Sascha d’Almeida
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Johannes Mörike
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Birgid Gonska
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Armin Imhof
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Dominik Buckert
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Wolfgang Rottbauer
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Sinisa Markovic
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
| | - Tilman Stephan
- Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany
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5
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Zilio F, Verdoia M, De Angelis MC, Zucchelli F, Borghesi M, Rognoni A, Bonmassari R. Drug Coated Balloon in the Treatment of De Novo Coronary Artery Disease: A Narrative Review. J Clin Med 2023; 12:jcm12113662. [PMID: 37297857 DOI: 10.3390/jcm12113662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/08/2023] [Accepted: 05/17/2023] [Indexed: 06/12/2023] Open
Abstract
Drug coated balloons (DCBs) are currently indicated in guidelines as a first choice option in the management of instant restenosis, whereas their use in de novo lesions is still debated. The concerns raised after the contrasting results of the initial trials with DCBs in de novo lesions have been more recently overcome by a larger amount of data confirming their safety and effectiveness as compared to drug-eluting stents (DES), with potentially greater benefits being achieved, especially in particular anatomical settings, as in very small or large vessels and bifurcations, but also in selected subsets of higher-risk patients, where a 'leave nothing behind' strategy could offer a reduction of the inflammatory stimulus and thrombotic risk. The present review aims at providing an overview of current available DCB devices and their indications of use based on the results of data achieved so far.
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Affiliation(s)
- Filippo Zilio
- Department of Cardiology, Santa Chiara Hospital, 38122 Trento, Italy
| | | | | | | | - Marco Borghesi
- Department of Cardiology, Santa Chiara Hospital, 38122 Trento, Italy
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Otto S, Díaz VAJ, Weilenmann D, Cuculi F, Nuruddin AA, Leibundgut G, Alfonso F, Wan Ahmad WA, Pyxaras S, Rittger H, Steen P, Gaede L, Schulze C, Wöhrle J, Rosenberg M, Waliszewski MW. Crystalline sirolimus-coated balloon (cSCB) angioplasty in an all-comers, patient population with stable and unstable coronary artery disease including chronic total occlusions: rationale, methodology and design of the SCORE trial. BMC Cardiovasc Disord 2023; 23:176. [PMID: 37003986 PMCID: PMC10067287 DOI: 10.1186/s12872-023-03187-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/15/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND A decade ago, the iopromide-paclitaxel coated balloon (iPCB) was added to the cardiologist's toolbox to initially treat in-stent restenosis followed by the treatment of de novo coronary lesions. In the meantime, DES technologies have been substantially improved to address in-stent restenosis and thrombosis, and shortened anti-platelet therapy. Recently, sirolimus-coated balloon catheters (SCB) have emerged to provide an alternative drug to combat restenosis. METHODS The objective of this study is to determine the safety and efficacy of a novel crystalline sirolimus-coated balloon (cSCB) technology in an unselective, international, large-scale patient population. Percutaneous coronary interventions of native stenosis, in-stent stenosis, and chronic total occlusions with the SCB in patients with stable coronary artery disease or acute coronary syndrome were included. The primary outcome variable is the target lesion failure (TLF) rate at 12 months, defined as the composite rate of target vessel myocardial infarction (TV-MI), cardiac death or ischemia-driven target lesion revascularization (TLR). The secondary outcome variables include TLF at 24 months, ischemia driven TLR at 12 and 24 months and all-cause death, cardiac death at 12 and 24 months. DISCUSSION Since there is a wealth of patient-based all-comers data for iPCB available for this study, a propensity-score matched analysis is planned to compare cSCB and iPCB for the treatment of de novo and different types of ISR. In addition, pre-specified analyses in challenging lesion subsets such as chronic total occlusions will provide evidence whether the two balloon coating technologies differ in their clinical benefit for the patient. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT04470934.
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Affiliation(s)
- Sylvia Otto
- Department of Internal Medicine I, Division of Cardiology, Pneumology, Angiology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany.
| | | | | | | | | | | | | | | | | | | | - Philip Steen
- Department of Medical Scientific Affairs, Vascular Systems, Aesculap, B. Braun Melsungen AG, Berlin, Germany
| | - Luise Gaede
- Universitätsklinikum Erlangen, Erlangen, Germany
| | - Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, Pneumology, Angiology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - Jochen Wöhrle
- Klinik für Kardiologie, Angiologie, Pneumologie und internistische Intensivmedizin, Klinikum Friedrichshafen GmbH, Friedrichshafen, Germany
| | - Mark Rosenberg
- Medizinischen Klinik I, Klinikum Aschaffenburg, Aschaffenburg, Germany
| | - Matthias W Waliszewski
- Department of Medical Scientific Affairs, Vascular Systems, Aesculap, B. Braun Melsungen AG, Berlin, Germany
- Internal Medicine and Cardiology, Charité Universitätsmedizin, Campus Virchow, Berlin, Germany
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7
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Wang X, Yang X, Lu W, Pan L, Han Z, Pan S, Shan Y, Wang X, Zheng X, Li R, Zhu Y, Qin P, Shi Q, Zhou S, Zhang W, Guo S, Zhang P, Qin X, Sun G, Qin Z, Huang Z, Qiu C. Long-term outcomes of less drug-eluting stents by the use of drug-coated balloons in de novo coronary chronic total occlusion intervention: A multicenter observational study. Front Cardiovasc Med 2023; 10:1045859. [PMID: 36937919 PMCID: PMC10022494 DOI: 10.3389/fcvm.2023.1045859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Background Data on drug-coated balloons (DCB) for de novo coronary chronic total occlusion (CTO) are limited. We aimed to investigate the long-term outcomes of substitution of drug-eluting stents (DES) by DCB. Methods We compared the outcomes of less DES strategy (DCB alone or combined with DES) and DES-only strategy in treating de novo coronary CTO in this prospective, observational, multicenter study. The primary endpoints were major adverse cardiovascular events (MACE), target vessel revascularization, myocardial infarction, and death during 3-year follow-up. The secondary endpoints were late lumen loss (LLL) and restenosis until 1-year after operation. Results Of the 591 eligible patients consecutively enrolled between January 2015 and December 2019, 281 (290 lesions) were treated with DCB (DCB-only or combined with DES) and 310 (319 lesions) with DES only. In the DCB group, 147 (50.7%) lesions were treated using DCB-only, and the bailout stenting rate was relatively low (3.1%). The average stent length per lesion in the DCB group was significantly shorter compared with the DES-only group (21.5 ± 25.5 mm vs. 54.5 ± 26.0 mm, p < 0.001). A total of 112 patients in the DCB group and 71 patients in the DES-only group (38.6% vs. 22.3%, p < 0.001) completed angiographic follow-up until 1-year, and LLL was much less in the DCB group (-0.08 ± 0.65 mm vs. 0.35 ± 0.62 mm, p < 0.001). There were no significant differences in restenosis occurrence between the two groups (20.5% vs. 19.7%, p > 0.999). The Kaplan-Meier estimates of MACE at 3-year (11.8% vs. 12.0%, log-rank p = 0.688) was similar between the groups. Conclusion Percutaneous coronary intervention with DCB is a potential "stent-less" therapy for de novo CTO lesions with satisfactory long-term clinical results compared to the DES-only approach.
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Affiliation(s)
- Xi Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinyue Yang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenjie Lu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Liang Pan
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhanying Han
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Sancong Pan
- Department of Cardiovascular Medicine, Jincheng People’s Hospital, Jincheng, China
| | - Yingguang Shan
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xule Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaolin Zheng
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ran Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yongjian Zhu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Peng Qin
- Department of Geriatric Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qiangwei Shi
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuai Zhou
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wencai Zhang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Sen Guo
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Peisheng Zhang
- Department of Cardiology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaofei Qin
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guoju Sun
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhongsheng Qin
- Department of Cardiovascular Medicine, Jincheng People’s Hospital, Jincheng, China
| | - Zhenwen Huang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chunguang Qiu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Chunguang Qiu,
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8
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Wang L, Li X, Li T, Liu L, Wang H, Wang C. Novel application of drug-coated balloons in coronary heart disease: A narrative review. Front Cardiovasc Med 2023; 10:1055274. [PMID: 36937937 PMCID: PMC10017483 DOI: 10.3389/fcvm.2023.1055274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
The incidence of coronary heart disease (CAD) has soared over the years, and coronary intervention has become an increasingly important therapeutic approach. The past decade has witnessed unprecedented developments in therapeutic medical instruments. Given that drug-coated balloons bring many benefits, they are indicated for an increasing number of conditions. In this article, we review the results of current clinical trials about drug-coated balloons and summarize their safety and clinical progression in different coronary artery diseases, laying the groundwork for basic research, and clinical therapeutics of this patient population.
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Affiliation(s)
- Lijin Wang
- Department of Cardiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Xiaokang Li
- Department of Cardiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Tian Li
- School of Basic Medicine, Fourth Military Medical University, Xi'an, China
| | - Lin Liu
- Department of Dermatology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Haiyan Wang
- Department of Structural Heart Disease, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- *Correspondence: Haiyan Wang, ; Chiyao Wang,
| | - Chiyao Wang
- Department of Cardiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
- *Correspondence: Haiyan Wang, ; Chiyao Wang,
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9
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Cao Z, Li J, Fang Z, Feierkaiti Y, Zheng X, Jiang X. The factors influencing the efficiency of drug-coated balloons. Front Cardiovasc Med 2022; 9:947776. [PMCID: PMC9602405 DOI: 10.3389/fcvm.2022.947776] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/26/2022] [Indexed: 11/13/2022] Open
Abstract
The drug-coated balloon (DCB) is an emerging percutaneous coronary intervention (PCI) device that delivers drugs to diseased vessels to decrease the rate of vascular stenosis. Recent clinical studies have demonstrated that DCBs tend to have both good safety and efficacy profiles, leading to extended application indications in the clinic, including in-stent restenosis (ISR) for metal stents such as drug-eluting stents (DESs), small vascular disease, bifurcation disease, large vascular disease, acute coronary syndrome (ACS), and high bleeding risk. However, some previous clinical data have suggested that DCBs performed less effectively than DESs. No studies or reviews have systematically discussed the improvement strategies for better DCB performance until now. Drug loss during the process of delivery to the target lesion and inefficient delivery of the coating drug to the diseased vascular wall are two key mechanisms that weaken the efficiency of DCBs. This review is the first to summarize the key influencing factors of DCB efficiency in terms of balloon structure and principles, and then it analyzes how these factors cause outcomes in practice based on current clinical trial studies of DCBs in the treatment of different types of lesions. We also provide some recommendations for improving DCBs to contribute to better DCB performance by improving the design of DCBs and combining other factors in clinical practice.
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Affiliation(s)
- Zheng Cao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Jun Li
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Zhao Fang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Yushanjiang Feierkaiti
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Xiaoxin Zheng
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China,*Correspondence: Xiaoxin Zheng,
| | - Xuejun Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China,Xuejun Jiang,
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10
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Verdoia M, Zilio F, Viola O, Brancati MF, Fanti D, Soldà PL, Rognoni A, Bonmassari R, De Luca G. Long-Term Outcomes With Drug-Eluting Balloon for the Treatment of In-Stent Restenosis and De Novo Lesions: The Novara-Biella-Trento (NOBITRE) Registry. Angiology 2022; 74:488-495. [PMID: 37005331 DOI: 10.1177/00033197221110961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Drug-coated balloons (DCBs) have emerged for percutaneous coronary interventions (PCI) of in-stent restenosis or particular anatomical subsets. We provide a real-world analysis of the prognostic determinants and long-term outcomes of patients treated with DCB for any lesion in a comprehensive multicenter registry. The primary study endpoint was the occurrence of major cardiovascular events (MACE: composite of all-cause death, myocardial infarction, and target vessel revascularization) at the longest available follow-up. We included 267 patients (196 treated for in-stent restenosis and 71 for de novo lesions), with a median follow-up of 616 [368–1025] days. MACE occurred in 70 (26.2%) of the patients and related with higher rates of in-stent restenosis (P = .04), longer and more type C lesions ( P = .05 and P = .04). At multivariate Cox-regression, type C lesions emerged as the only independent predictor of MACE (adjusted OR [95% CI] = 1.83[1.13–2.97], P = .014), mainly driven by target vessel revascularization (adjusted OR[95% CI] = 1.78[1.05–2.95], P = .03) not conditioning survival. In-stent restenosis emerged as major determinant of TLF (adjusted OR[95% CI] = 2.59[1.17–5.75], P = .02). DCBs represent a treatment option for any lesion; however, type C and restenotic lesions are associated with an increased risk of MACE and target lesion failure, where the optimal strategies for patients’ selection and lesion preparation are still undefined.
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Affiliation(s)
- Monica Verdoia
- Division of Cardiology Ospedale degli Infermi, ASL Bi, Biella, Italy
- Department of Translational Medicine, Eastern Piedmont University, Novara, Italy
| | - Filippo Zilio
- Division of Cardiology, Ospedale Santa Chiara, Trento, Italy
| | - Orazio Viola
- Division of Cardiology Ospedale degli Infermi, ASL Bi, Biella, Italy
| | | | - Diego Fanti
- Division of Cardiology, Ospedale Santa Chiara, Trento, Italy
| | - Pier Luigi Soldà
- Division of Cardiology Ospedale degli Infermi, ASL Bi, Biella, Italy
| | - Andrea Rognoni
- Division of Cardiology Ospedale degli Infermi, ASL Bi, Biella, Italy
| | - Roberto Bonmassari
- Division of Cardiology, Ospedale Santa Chiara, Trento, Italy
- Cardiology, Università degli Studi di Verona, Verona, Italy
| | - Giuseppe De Luca
- Department of Translational Medicine, Eastern Piedmont University, Novara, Italy
- Division of Clinical and Experimental Cardiology, Università degli Studi di Sassari, Sassari, Italy
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11
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Jun EJ, Shin ES, Yuan SL, Bhak Y, Garg S, Kang WC, Kim JS, Kim JH, Bae JW, Rha SW, Chae IH. Comparison of 2 Different Paclitaxel-Coated Balloons in Coronary In-Stent Restenosis: A Randomized Controlled Trial. JACC. ASIA 2022; 2:170-179. [PMID: 36339121 PMCID: PMC9627897 DOI: 10.1016/j.jacasi.2021.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/30/2021] [Accepted: 11/04/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND Drug-coated balloons (DCBs) offer an effective treatment for in-stent restenosis (ISR). The Genoss DCB is a novel paclitaxel-coated balloon with a shellac plus vitamin E excipient that enhances drug delivery to the target lesion, minimizing restenosis. OBJECTIVES This study aimed to investigate the angiographic efficacy, clinical safety, and effectiveness of the novel shellac plus vitamin E-based DCB in a randomized controlled trial designed to enable regulatory approval of this new device in South Korea. METHODS This noninferiority trial randomized patients experiencing their first ISR to the novel shellac plus vitamin E-based DCB or the reference SeQuent Please iopromide-based DCB in a 1:1 ratio. All patients underwent planned angiographic and clinical follow-up at 6 months. The study was powered for the primary endpoint of 6 months in-segment late lumen loss (LLL). RESULTS A total of 82 patients from 7 centers were randomized to either the novel shellac plus vitamin E-based DCB group (n = 41) or the reference iopromide-based DCB group (n = 41). The 6-month in-segment LLL was 0.15 ± 0.43 mm with the novel DCB compared with 0.24 ± 0.39 mm with the reference device. The 1-sided 97.5% upper confidence limit of the difference was 0.13 mm, lower than the noninferiority limit of 0.29 mm, achieving noninferiority (P for noninferiority = 0.001). Major cardiovascular events were comparable between 2 groups at 6 months (7.7% for the novel DCB vs 10.3% for the reference DCB; P = 0.692). CONCLUSIONS In this multicenter, head-to-head comparison randomized trial, the novel shellac plus vitamin E-based DCB showed a comparable result to the reference iopromide-based device for the primary endpoint of 6-month in-segment LLL for the treatment of coronary ISR. (Compare the Safety and Efficacy of Genoss® DCB and SeQuent® Please in Korean Patient With Coronary In-stent Restenosis; NCT04405063).
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Affiliation(s)
- Eun Jung Jun
- Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
- Division of Cardiology, Department of Internal Medicine, Ulsan Medical Center, Ulsan, South Korea
| | - Eun-Seok Shin
- Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
- Division of Cardiology, Department of Internal Medicine, Ulsan Medical Center, Ulsan, South Korea
| | - Song Lin Yuan
- Division of Cardiology, Department of Internal Medicine, Ulsan Medical Center, Ulsan, South Korea
- Department of Cardiology, Dong-A University Hospital, Busan, South Korea
| | - Youngjune Bhak
- Department of Biomedical Engineering, College of Information-Bio Convergence Engineering, Ulsan National Institute of Science and Technology, Ulsan, South Korea
| | - Scot Garg
- Department of Cardiology, East Lancashire Hospitals NHS Trust, Blackburn, United Kingdom
| | - Woong Chol Kang
- Cardiology Division, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Je Sang Kim
- Department of Cardiology, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - June-Hong Kim
- Cardiovascular Center, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Jang-Whan Bae
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, South Korea
| | - In-Ho Chae
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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12
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Lee SY, Cho YK, Kim SW, Hong YJ, Koo BK, Bae JW, Lee SH, Yang TH, Park HS, Choi SW, Lim DS, Kim SJ, Jeong YH, Lee HJ, Lee KY, Shin ES, Kim U, Kim MH, Nam CW, Hur SH, Kim DI. Clinical Results of Drug-Coated Balloon Treatment in a Large-Scale Multicenter Korean Registry Study. Korean Circ J 2022; 52:444-454. [PMID: 35491479 PMCID: PMC9160640 DOI: 10.4070/kcj.2021.0261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 01/27/2022] [Accepted: 02/23/2022] [Indexed: 11/24/2022] Open
Abstract
Current percutaneous coronary intervention has significant limitations related to the implanted current metallic stent. The “leave nothing behind” strategy of drug-coated balloon (DCB) treatment has showed potential performance to overcome current treatment. However, studies in this issue are still limited by moderate numbers of patients. Therefore, we performed Stent Failure Research DCB registry study to evaluate the efficacy and safety of DCB treatment for in-stent restenosis or de novo lesions. The registry finally included 2,509 patients treated with DCB and revealed the favorable clinical outcome of DCB treatment. Background and Objectives The aim of this study was to demonstrate the efficacy and safety of treatment with drug-coated balloon (DCB) in a large real-world population. Methods Patients treated with DCBs were included in a multicenter observational registry that enrolled patients from 18 hospitals in Korea between January 2009 and December 2017. The primary outcome was target lesion failure (TLF) defined as a composite of cardiovascular death, target vessel myocardial infarction, and clinically indicated target lesion revascularization at 12 months. Results The study included 2,509 patients with 2,666 DCB-treated coronary artery lesions (1,688 [63.3%] with in-stent restenosis [ISR] lesions vs. 978 [36.7%] with de novo lesions). The mean age with standard deviation was 65.7±11.3 years; 65.7% of the patients were men. At 12 months, the primary outcome, TLF, occurred in 179 (6.7%), 151 (8.9%), 28 (2.9%) patients among the total, ISR, and de novo lesion populations, respectively. A history of hypertension, diabetes, acute coronary syndrome, previous coronary artery bypass graft, reduced left ventricular ejection fraction, B2C lesion and ISR lesion were independent predictors of 12 months TLF in the overall study population. Conclusions This large multicenter DCB registry study revealed the favorable clinical outcome of DCB treatment in real-world practice in patient with ISR lesion as well as small de novo coronary lesion.
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Affiliation(s)
- Sang Yeub Lee
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Yun-Kyeong Cho
- Department of Cardiology, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Sang-Wook Kim
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Young-Joon Hong
- Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University College of Medicine, Gwangju, Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jang-Whan Bae
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Seung-Hwan Lee
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University, Wonju College of Medicine, Wonju, Korea
| | - Tae Hyun Yang
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hun Sik Park
- Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Si Wan Choi
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Do-Sun Lim
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Soo-Joong Kim
- Department of Internal Medicine, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Korea
| | - Young Hoon Jeong
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
| | | | | | - Eun-Seok Shin
- Department of Internal Medicine, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea
| | - Ung Kim
- Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Moo Hyun Kim
- Department of Internal Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Chang-Wook Nam
- Department of Cardiology, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Seung-Ho Hur
- Department of Cardiology, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Doo-Il Kim
- Department of Cardiology, Inje University Haeundae Baek Hospital, Inje University College of Medicine, Busan, Korea
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13
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Tang J, Hou H, Chu J, Chen F, Yao Y, Gao Y, Ye Z, Zhuang S, Lai Y, Liu X. Clinical implication of quantitative flow ratio to predict clinical events after drug-coated balloon angioplasty in patients with in-stent restenosis. Clin Cardiol 2021; 44:978-986. [PMID: 34009672 PMCID: PMC8259159 DOI: 10.1002/clc.23630] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 04/28/2021] [Accepted: 05/05/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The association between the quantitative flow ratio (QFR) and adverse events after drug-coated balloon (DCB) angioplasty for in-stent restenosis (ISR) lesions has not been investigated. HYPOTHESIS Post-procedural QFR is related to adverse events in patients undergoing DCB angioplasty for ISR lesions. METHODS This retrospective study included data from patients undergoing DCB angioplasty for drug-eluting stent (DES) ISR between January 2016 and February 2019. The QFR was measured at baseline and after DCB angioplasty. The endpoint was the vessel-oriented composite endpoint (VOCE), defined as a composite of cardiac death, vessel-related myocardial infarction, and ischemia-driven target vessel revascularization. RESULTS Overall, 177 patients with 185 DES-ISR lesions were included. During 1-year follow-up, 27 VOCEs occurred in 26 patients. The area under curve (AUC) of the post-procedural QFR was statistically greater than that of the in-stent percent diameter stenosis (0.77, 95% confidence interval [CI] 0.67-0.87 vs. 0.64, 95% CI 0.53-0.75; p = .032). Final QFR cutoff of 0.94 has the best predictive accuracy for VOCE. A QFR > 0.94 was associated with a lower risk of VOCE compared to a QFR ≤ 0.94 (log-rank test, p < .0001). Survival analysis using the multivariable Cox model showed that a post-procedural QFR ≤ 0.94 was an independent predictor of 1-year VOCE (hazard ratio 6.53, 95% CI 2.70-15.8, p < .001). CONCLUSIONS A lower QFR value was associated with worse clinical outcomes at 1 year after DCB angioplasty for DES-ISR.
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Affiliation(s)
- Jiani Tang
- Department of CardiologyTongji Hospital, Tongji University School of MedicineShanghaiChina
| | - Hanjing Hou
- Department of CardiologySeventh People's Hospital, Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Jiapeng Chu
- Department of CardiologyTongji Hospital, Tongji University School of MedicineShanghaiChina
| | - Fei Chen
- Department of CardiologyTongji Hospital, Tongji University School of MedicineShanghaiChina
| | - Yian Yao
- Department of CardiologyTongji Hospital, Tongji University School of MedicineShanghaiChina
| | - Yanhua Gao
- Department of CardiologyTongji Hospital, Tongji University School of MedicineShanghaiChina
| | - Zi Ye
- Department of CardiologyTongji Hospital, Tongji University School of MedicineShanghaiChina
| | - Shaowei Zhuang
- Department of CardiologySeventh People's Hospital, Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Yan Lai
- Department of CardiologyTongji Hospital, Tongji University School of MedicineShanghaiChina
| | - Xuebo Liu
- Department of CardiologyTongji Hospital, Tongji University School of MedicineShanghaiChina
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14
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Cortese B, Caiazzo G, Di Palma G, De Rosa S. Comparison Between Sirolimus- and Paclitaxel-Coated Balloon for Revascularization of Coronary Arteries: The SIRPAC (SIRolimus-PAClitaxel) Study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 28:1-6. [PMID: 33888418 DOI: 10.1016/j.carrev.2021.04.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Our study sought to compare the 12-month clinical outcome of patients treated with paclitaxel-coated balloons (PCB) vs. sirolimus-coated balloons (SCB) during coronary angioplasty. BACKGROUND Drug-coated balloons represent an established therapeutic tool for percutaneous coronary interventions (PCI). A comparison between PCB and SCB is still lacking. METHODS We performed an indirect comparison between two cohorts of patients previously included into two investigator-driven registries with clinical primary endpoints, 494 treated with the Elutax SV PCB (AR Baltic, Lithuania) from the DCB RISE registry, and 596 treated with the Magic Touch SCB (Concept Medical, India) from the EASTBOURNE registry. The primary endpoint was the rate of major adverse cardiovascular events (MACE) at 12-month clinical follow-up. RESULTS After propensity score matching, a total of 580 patients were well matched for baseline clinical and procedural characteristics and were analyzed. At 12 months there was no significant difference between the matched DCB RISE and EASTBOURNE cohorts in terms of the primary endpoint MACE (10.3% DCB RISE vs. 10.7% EASTBOURNE, p = 0.892). No significant difference was observed also regarding the rate of TLR (7.9% DCB RISE vs. 8.3% EASTBOURNE; p = 0.879, respectively). By multivariate analysis, insulin-dependent diabetes was the only predictor of MACE. CONCLUSIONS In the SIRPAC study, the first indirect comparison between paclitaxel-coated and sirolimus coated balloons, no significant difference in clinical endpoints were found at 12-month follow-up. Randomized studies are necessary to confirm these findings.
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Affiliation(s)
- Bernardo Cortese
- Cardiovascular Research Team, San Carlo Clinic, Milano, Italy; Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy.
| | | | | | - Salvatore De Rosa
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
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15
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Verdoia M, Negro F, Kedhi E, Suryapranata H, Marcolongo M, De Luca G. Benefits with drug-coated balloon as compared to a conventional revascularization strategy for the treatment of coronary and non-coronary arterial disease: a comprehensive meta-analysis of 45 randomized trials. Vascul Pharmacol 2021; 138:106859. [PMID: 33819672 DOI: 10.1016/j.vph.2021.106859] [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: 02/16/2021] [Revised: 03/11/2021] [Accepted: 03/25/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Drug-coated balloons (DCB) have shown promising results for the percutaneous treatment of de novo and restenotic lesions, involving both the coronary and femoropopliteal district. However, clinical outcomes data associated with the use of this devices are still unclear, with potential warnings on increased mortality being raised from initial studies. We aimed at performing an updated and comprehensive meta-analysis comparing DCB with conventional percutaneous revascularization strategies for the treatment of coronary (CAD) or peripheral artery disease (PAD). METHODS Literature and main scientific session abstracts were searched for studies comparing DCB vs a standard percutaneous revascularization strategy, with or without stenting, for the treatment of CAD and PAD. The primary efficacy endpoint was mortality. Secondary endpoints were recurrent acute ischemic events (myocardial infarction or amputation) or target lesion revascularization (TLR). RESULTS We included 45 randomized trials, (CAD: 27 studies, PAD: 18 studies) with an overall population of 7718 patients, (56.4%) randomized to a DCB strategy. At a mean follow-up of19.3 ± 15.2 months, death occurred in 5.8% of the patients, with no significant difference between DCB or conventionally treated patients (5.9% vs 5.7%, OR[95%CI] = 0.89[0.71,1.11], p = 0.31; phet = 0.43). We observed a non-significant reduction in recurrent acute ischemic events, whereas the use of DCB significantly reduced the rate of TLR, with larger benefits observed in patients with PAD and respect to balloon-only angioplasty, while being lower in comparison with stent implantation. No significant interaction was observed with de novo lesions or in-stent restenosis. CONCLUSIONS Based on the current meta-analysis, the use of drug-coated balloons for the percutaneous treatment of CAD and PAD is associated to a comparable risk of mortality and recurrent acute ischemic events as compared to a conventional revascularization strategy, although offering larger benefits in terms of TLR, especially when compared with balloon-only angioplasty and in femoropopliteal disease.
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Affiliation(s)
- Monica Verdoia
- Division of Cardiology, ASL Biella, Italy; Department of Translational Medicine, Eastern Piedmont University, Novara, Italy
| | - Federica Negro
- Department of Translational Medicine, Eastern Piedmont University, Novara, Italy
| | - Elvin Kedhi
- Department of Cardiology, Erasmus Hospital, Universitè Libre de Bruxelles, Belgium
| | | | | | - Giuseppe De Luca
- Department of Translational Medicine, Eastern Piedmont University, Novara, Italy.
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16
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Lee HS, Kang J, Park KW, Ki Y, Chang M, Han J, Yang H, Kang H, Koo B, Kim H. Procedural optimization of
drug‐coated
balloons in the treatment of coronary artery disease. Catheter Cardiovasc Interv 2021; 98:E43-E52. [DOI: 10.1002/ccd.29492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/15/2020] [Accepted: 01/08/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Hak Seung Lee
- Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Republic of Korea
| | - Jeehoon Kang
- Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Republic of Korea
| | - Kyung Woo Park
- Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Republic of Korea
| | - You‐Jeong Ki
- Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Republic of Korea
| | - Mineok Chang
- Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Republic of Korea
| | - Jung‐Kyu Han
- Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Republic of Korea
| | - Han‐Mo Yang
- Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Republic of Korea
| | - Hyun‐Jae Kang
- Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Republic of Korea
| | - Bon‐Kwon Koo
- Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Republic of Korea
| | - Hyo‐Soo Kim
- Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Republic of Korea
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17
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Wang Y, Ma Y, Gao P, Chen Y, Yang B, Feng Y, Jiao L. Paclitaxel Coated Balloon vs. Bare Metal Stent for Endovascular Treatment of Symptomatic Vertebral Artery Origin Stenosis Patients: Protocol for a Randomized Controlled Trial. Front Neurol 2021; 11:579238. [PMID: 33584491 PMCID: PMC7874044 DOI: 10.3389/fneur.2020.579238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 12/21/2020] [Indexed: 01/30/2023] Open
Abstract
Background: Stenting treatment for refractory symptomatic patients with vertebral artery origin stenosis (VAOS) is safe; however, there is a high rate of in-stent restenosis. Although drug-eluting stents can reduce the incidence of restenosis to some extent, there is still a risk caused by stent fracture. Drug-coated balloon (DCB) has been proven to reduce the rate of restenosis in peripheral and coronary artery disease. DCB can prevent inflammation caused by extraneous material stimulation and allow the subsequent treatment that is characteristic of "leave nothing behind." The purpose of this trial is to compare the efficacy and safety of DCB and bare metal stent (BMS) in the treatment of VAOS. Method/Design: This trial is a 1:1 randomized, controlled, multicenter, non-inferiority trial that compares the DCB to BMS in terms of angiographically assessed target lesion binary restenosis (≥50%) at 12 months in endovascular treatment of symptomatic patients with VAOS. Discussion: A total of 180 patients with symptomatic VAOS who match the trial eligibility criteria will be randomized 1:1 to treatment with DCB (n = 90) or BMS (n = 90). An angiographic core laboratory-adjudicated target lesion binary restenosis (≥50%) at 12 months of follow-up was selected as primary efficacy endpoint to assess the DCB treatment effect. A clinical events committee will assess the safety endpoints of all-cause death, target vessel related transient ischemic attack and ischemic or hemorrhagic stroke events. A data safety monitoring board will periodically review safety data for subject safety, the study conduct, and progress. In this trial, randomization is only allowed after successful pre-dilatation. We anticipate that this trial will provide rigorous data to clarify whether DCBs are beneficial in patients with symptomatic VAOS. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03910166.
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Affiliation(s)
- Yabing Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yan Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Peng Gao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yanfei Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Bin Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yao Feng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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18
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Alfonso F, Del Val D, Cortese B. Paclitaxel-coated balloons: Are all created equal? Int J Cardiol 2020; 322:101-102. [PMID: 33091521 DOI: 10.1016/j.ijcard.2020.10.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain.
| | - David Del Val
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
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19
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Wang Y, Feng Y, Wang T, Ma Y, Gao P, Chen J, Chen Y, Yang B, Jiao L. Drug-coated balloon for vertebral artery origin stenosis: a pilot study. J Neurointerv Surg 2020; 13:827-830. [PMID: 33067258 DOI: 10.1136/neurintsurg-2020-016723] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/12/2020] [Accepted: 09/14/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Drug-coated balloon (DCB) is a potential treatment for patients with low restenosis risk in vertebral artery origin stenosis (VAOS). However, the clinical data of long-term outcome are limited. OBJECTIVE To evaluate the safety and efficacy of a DCB in patients with severe VAOS. METHODS A prospective, non-randomized, single-center pilot study enrolled 30 patients with severe VAOS treated with DCB between 2017 and 2018. The first 20 patients were treated with a balloon-to-vessel ratio of predilation (pBVR)<0.8 (small-size balloon predilation) and the following 10 patients were treated with a pBVR 0.8-1.0 (large-size balloon predilation). Primary safety endpoints included 30-day death, stroke, and transient ischemic attack (TIA). The main efficacy outcome was restenosis at 6 months, defined as a peak systolic velocity >140 cm/s measured by Doppler ultrasound. Long-term outcomes, including TIAs, stroke, death, and modified Rankin Scale score, were followed up to 2 years. RESULTS Technical success (<50% residual stenosis) was achieved in 26 patients (mean age 66.2±7.0; seven women). Four patients received bailout stenting and were excluded. Ultrasound confirmed restenosis at 6 months in 10 (38.5%) of 26, which was significantly less frequent in LSBP (LSBP vs SSBP=10% vs 56.3%, p<0.05). No adverse events occurred within 30 days of treatment. 19 patients were followed up for 2 years, with two deaths due to cancer. CONCLUSION This pilot study suggests that DCB is a safe approach for VAOS. The relatively low restenosis rate indicates the its potential long-term efficacy for VAOS. Future randomized controlled trials to confirm its efficacy are warranted.
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Affiliation(s)
- Yabing Wang
- China International Neuroscience Institute (China-INI), Beijing, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yiding Feng
- China International Neuroscience Institute (China-INI), Beijing, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tao Wang
- China International Neuroscience Institute (China-INI), Beijing, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yan Ma
- China International Neuroscience Institute (China-INI), Beijing, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Peng Gao
- China International Neuroscience Institute (China-INI), Beijing, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jian Chen
- China International Neuroscience Institute (China-INI), Beijing, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yanfei Chen
- China International Neuroscience Institute (China-INI), Beijing, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Bin Yang
- China International Neuroscience Institute (China-INI), Beijing, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liqun Jiao
- China International Neuroscience Institute (China-INI), Beijing, China .,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
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20
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Rathore S, Tehrani S, Prvulovic D, Araya M, Lefèvre T, Banning AP, Burzotta F, Rigatelli G, Gutierrez-Chico JL, Bonaventura K, Chevalier B, Kinoshita Y, Sikic J, Alfonso F, Louvard Y, Stankovic G. Drug coated balloons and their role in bifurcation coronary angioplasty: appraisal of the current evidence and future directions. Expert Rev Med Devices 2020; 17:1021-1033. [PMID: 33000952 DOI: 10.1080/17434440.2020.1831385] [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
INTRODUCTION Coronary Bifurcation lesions are technically more challenging and Bifurcation percutaneous coronary intervention (PCI) remains a challenge with unpredictable and sub-optimal clinical and angiographic results. Drug-Coated Balloons (DCB) are emerging devices in the field of coronary intervention with promising results that may overcome some of drug eluting stents limitations and may have potential advantages in complex bifurcation PCI. AREAS COVERED We have performed a re-appraisal about the issues with current bifurcation PCI techniques and the use of DCB in the treatment of Bifurcation lesions. Several studies performed utilizing DCB are described and critically appraised. Over the recent years, there have been tremendous developments in the DCB technology, lesion preparation, clinical experience, and clinical data during bifurcation PCI. The current review describes the advances in the DCB technology, pharmacokinetics, role of excipients, and optimization of the technique. Special emphasis in lesion preparation and potential pathway of using DCB in bifurcation PCI is proposed. EXPERT OPINION Although different proof of concept and pilot studies have shown promising results in treatment of bifurcation lesions with DCB, larger randomized trials and/or international consensus papers are required to enable worldwide translation of this idea to clinical practice.
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Affiliation(s)
- Sudhir Rathore
- Department of Cardiology, Frimley Health NHS Foundation Trust , Camberley, UK
| | - Shana Tehrani
- Department of Cardiology, Frimley Health NHS Foundation Trust , Camberley, UK
| | - Deiti Prvulovic
- Department of Cardiology, General Hospital "Dr. Josip Benčević" , Slavonski Brod, Croatia
| | - Mario Araya
- Department of Cardiology, Clinica Alemana , Santiago, Chile
| | - Thierry Lefèvre
- Ramsay Générale De Santé - Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier , Massy, France
| | - Adrian P Banning
- Cardiovascular Medicine Division, Radcliffe Department of Medicine, John Radcliffe Hospital , Oxford, England
| | - Francesco Burzotta
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Del Sacro Cuore , Rome, Italy
| | - Gianluca Rigatelli
- Department of Cardiology, Cardiovascular Diagnosis and Endoluminal Interventions Santa Maria Della Misericordia Hospital , Rovigo, Italy
| | | | - Klaus Bonaventura
- Department of Cardiology, Angiology, Heart, Thorax and Vascular Centre , Potsdam, Germany
| | | | | | - Jozica Sikic
- Interventional Cardiologist, School of Medicine University of Zagreb , Zagreb, Croatia
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario La Princesa , Madrid, Spain
| | - Yves Louvard
- Ramsay Générale De Santé - Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier , Massy, France
| | - Goran Stankovic
- Department of Cardiology, Clinical Center of Serbia, and Medical Faculty, University of Belgrade , Belgrade, Serbia
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21
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Wybraniec MT, Bańka P, Bochenek T, Roleder T, Mizia-Stec K. Small vessel coronary artery disease: How small can we go with myocardial revascularization? Cardiol J 2020; 28:767-778. [PMID: 32986235 DOI: 10.5603/cj.a2020.0127] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/21/2020] [Indexed: 11/25/2022] Open
Abstract
The issue of small coronary artery atherosclerosis represents an intriguing aspect of coronary artery disease, which is related with higher rates of peri- and post-procedural complications and impaired long-term outcome. This problem is further complicated by the unclear definition of small coronary vessel. Recent randomized controlled trials have provided new data on possible novel interventional treatment of small coronary vessels with drug-coated balloons instead of traditional new-generation drug-eluting stent implantation. Also, the conservative management represents a therapeutic option in light of the results of the recent ISCHEMIA trial. The current article provides an overview of the most appropriate definition, interventional management, and prognosis of small coronary artery atherosclerosis.
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Affiliation(s)
- Maciej T Wybraniec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland. .,Upper Silesia Medical Center, Katowice, Poland.
| | - Paweł Bańka
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.,Upper Silesia Medical Center, Katowice, Poland
| | - Tomasz Bochenek
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.,Upper Silesia Medical Center, Katowice, Poland
| | - Tomasz Roleder
- Regional Specialist Hospital, Research and Development Center, Wroclaw, Poland
| | - Katarzyna Mizia-Stec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.,Upper Silesia Medical Center, Katowice, Poland
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22
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Ielasi A, Buono A, Pellicano M, Tedeschi D, Loffi M, Donahue M, Regazzoli D, De Angelis G, Danzi G, Reimers B, Tespili M. A HYbrid APproach Evaluating a DRug-Coated Balloon in Combination With a New-Generation Drug-Eluting Stent in the Treatment of De Novo Diffuse Coronary Artery Disease: The HYPER Pilot Study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 28:14-19. [PMID: 32933874 DOI: 10.1016/j.carrev.2020.07.036] [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: 06/10/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To assess feasibility, safety and efficacy of hybrid approach, consisting in a combination of modern drug-eluting stent (DES) and drug-eluting balloon (DCB), for treatment of de-novo diffuse coronary artery disease (CAD). BACKGROUNDS Contemporary DES are associated with a persistent risk of major cardiovascular events, due to in-stent thrombosis and restenosis. The hybrid approach, reducing the permanent metallic cage length, is supposed to mitigate the risk of device-related adverse events, especially in diffuse CAD. METHODS This is a prospective, non-randomized, observational, multicenter study intended to obtain data from 100 consecutive patients affected by de-novo diffuse CAD undergoing percutaneous coronary intervention with a hybrid approach, consisting in the combined use of DES and DCB in contiguous coronary segments. The study is recorded in ClinicalTrials.gov with the identifier: NCT03939468. RESULTS The primary endpoint is a device oriented composite end-point (DOCE) of cardiac death, target vessel myocardial infarction (TV-MI) and ischemia-driven target lesion revascularization (ID-TLR) in DES- and/or DCB-treated segment. DOCE will be assessed at 12-months follow-up. CONCLUSIONS This will be the first study investigating the feasibility, safety and efficacy of hybrid DES/DCB approach for the treatment of de-novo diffuse CAD. Here we describe the rationale and the design of the study.
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Affiliation(s)
- Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Sant'Ambrogio Cardio-Thoracic Center, Milan, Italy.
| | - Andrea Buono
- Clinical and Interventional Cardiology Unit, Sant'Ambrogio Cardio-Thoracic Center, Milan, Italy
| | - Mariano Pellicano
- Clinical and Interventional Cardiology Unit, Sant'Ambrogio Cardio-Thoracic Center, Milan, Italy
| | - Delio Tedeschi
- Catheterization Laboratory, Istituto Clinico S. Anna, Brescia, Italy
| | - Marco Loffi
- Cardiology Division, ASST Cremona, Cremona, Italy
| | | | - Damiano Regazzoli
- Interventional Cardiology Unit, Istituto Clinico Humanitas, Rozzano, MI, Italy
| | | | | | - Bernhard Reimers
- Interventional Cardiology Unit, Istituto Clinico Humanitas, Rozzano, MI, Italy
| | - Maurizio Tespili
- Clinical and Interventional Cardiology Unit, Sant'Ambrogio Cardio-Thoracic Center, Milan, Italy
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23
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Scheller B. Drug-coated balloon angioplasty for in-stent restenosis - a question of the right device or the right patient selection and technique? EUROINTERVENTION 2020; 16:e276-e278. [PMID: 32686651 DOI: 10.4244/eijv16i4a47] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Bruno Scheller
- Clinical and Experimental Interventional Cardiology, University of Saarland, Homburg/Saar, Germany
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24
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Ali RM, Abdul Kader MASK, Wan Ahmad WA, Ong TK, Liew HB, Omar AF, Mahmood Zuhdi AS, Nuruddin AA, Schnorr B, Scheller B. Treatment of Coronary Drug-Eluting Stent Restenosis by a Sirolimus- or Paclitaxel-Coated Balloon. JACC Cardiovasc Interv 2020; 12:558-566. [PMID: 30898253 DOI: 10.1016/j.jcin.2018.11.040] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/18/2018] [Accepted: 11/27/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The aim of this randomized controlled trial was to investigate a novel sirolimus-coated balloon (SCB) compared with the best investigated paclitaxel-coated balloon (PCB). BACKGROUND Treatment of coronary in-stent restenosis (ISR) remains challenging. PCBs are an established treatment option outside the United States with a Class I, Level of Evidence: A recommendation in the European guidelines. However, their efficacy is better in bare-metal stent (BMS) ISR compared with drug-eluting stent (DES) ISR. METHODS Fifty patients with DES ISR were enrolled in a randomized, multicenter trial to compare a novel SCB (SeQuent SCB, 4 μg/mm2) with a clinically proven PCB (SeQuent Please Neo, 3 μg/mm2) in coronary DES ISR. The primary endpoint was angiographic late lumen loss at 6 months. Secondary endpoints included procedural success, major adverse cardiovascular events, and individual clinical endpoints such as stent thrombosis, cardiac death, target lesion myocardial infarction, clinically driven target lesion revascularization, and binary restenosis. RESULTS Quantitative coronary angiography revealed no differences in baseline parameters. After 6 months, in-segment late lumen loss was 0.21 ± 0.54 mm in the PCB group versus 0.17 ± 0.55 mm in the SCB group (p = NS; per-protocol analysis). Clinical events up to 12 months also did not differ between the groups. CONCLUSIONS This first-in-man comparison of a novel SCB with a crystalline coating shows similar angiographic outcomes in the treatment of coronary DES ISR compared with a clinically proven PCB. (Treatment of Coronary In-Stent Restenosis by a Sirolimus [Rapamycin] Coated Balloon or a Paclitaxel Coated Balloon [FIM LIMUS DCB]; NCT02996318).
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Affiliation(s)
- Rosli Mohd Ali
- Cardiac Vascular Sentral Kuala Lumpur, Kuala Lumpur, Malaysia
| | | | - Wan Azman Wan Ahmad
- Cardiology Department, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Tiong Kiam Ong
- Cardiology Department, Sarawak Heart Centre, Kota Samarahan, Malaysia
| | - Houng Bang Liew
- Cardiology Department and Clinical Research Center, Queen Elizabeth Hospital II, Kota Kinabalu, Malaysia
| | - Al-Fazir Omar
- Cardiology Department, National Heart Institute Malaysia, Kuala Lumpur, Malaysia
| | | | - Amin Ariff Nuruddin
- Cardiology Department, National Heart Institute Malaysia, Kuala Lumpur, Malaysia
| | | | - Bruno Scheller
- Cardiology Department, University Hospital of Saarland, Homburg/Saar, Germany.
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25
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Alfonso F, Elgendy IY, Cortese B. Drug-coated balloons for acute myocardial infarction. Ready for prime time? EUROINTERVENTION 2020; 15:1479-1482. [PMID: 32301710 DOI: 10.4244/eijv15i17a270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
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26
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Silverio A, Buccheri S, Venetsanos D, Alfredsson J, Lagerqvist B, Persson J, Witt N, James S, Sarno G. Percutaneous Treatment and Outcomes of Small Coronary Vessels. JACC Cardiovasc Interv 2020; 13:793-804. [DOI: 10.1016/j.jcin.2019.10.062] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/25/2019] [Accepted: 10/15/2019] [Indexed: 10/25/2022]
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27
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Alfonso F, Rivero F, Granada JF. Safety of Paclitaxel-Coated Balloons in the Coronary Arteries. J Am Coll Cardiol 2020; 75:1029-1032. [DOI: 10.1016/j.jacc.2019.12.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 12/17/2019] [Indexed: 10/24/2022]
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28
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Scheller B, Vukadinovic D, Jeger R, Rissanen TT, Scholz SS, Byrne R, Kleber FX, Latib A, Clever YP, Ewen S, Böhm M, Yang Y, Lansky A, Mahfoud F. Survival After Coronary Revascularization With Paclitaxel-Coated Balloons. J Am Coll Cardiol 2020; 75:1017-1028. [DOI: 10.1016/j.jacc.2019.11.065] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/14/2019] [Accepted: 11/24/2019] [Indexed: 10/24/2022]
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29
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Drug-coated balloon versus drug-eluting stent in small coronary artery lesions: angiographic analysis from the BASKET-SMALL 2 trial. Clin Res Cardiol 2020; 109:1114-1124. [PMID: 31993736 DOI: 10.1007/s00392-020-01603-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 01/16/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The randomized BASKET-SMALL 2 trial showed non-inferiority for treatment with drug-coated balloon (DCB) compared with drug-eluting stents (DES) in patients undergoing percutaneous coronary intervention (PCI) for de novo lesions in small coronary arteries regarding clinical endpoints at 1 year. In this predefined substudy, we investigated the angiographic findings in patients undergoing a clinically indicated follow-up angiography during the study phase. METHODS Eight-hundred and eighty-three patients underwent PCI with either DES or DCB in a culprit vessel < 3 mm in diameter for stable coronary artery disease or acute coronary syndrome. Event-driven re-angiographies and the corresponding images at baseline were analyzed for angiographic endpoints. RESULTS One-hundred and eleven patients (117 lesions, 66 DES versus 51 DCB) presented for an unscheduled re-angiography at median 5.7 months after the index procedure. At baseline, mean reference vessel diameter was 2.05 mm and the residual in-segment stenosis after the index procedure was less in DES compared to DCB (23.7% vs 33.8%, p = 0.001). At follow-up angiography, diameter stenosis in the DES group (29.0%) was still somewhat smaller than after DCB angioplasty (35.8%) when adjusting for time since PCI (p = 0.047), whereas lumen loss (LL) did not differ between the two treatment arms (LL-DES 0.06 mm vs LL-DCB 0.10 mm, p = 0.20). Eight patients following DES implantation presented with a complete occlusion of the target lesion compared to no occlusion in the DCB group (p = 0.009). CONCLUSIONS The clinically indicated follow-up angiography within 1 year showed no difference in LL. Complete thrombotic vessel occlusions were found only in the DES group. CLINICAL TRIAL REGISTRATION www.clinicaltrials.gov ; number, NCT01574534.
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30
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Nestelberger T, Kaiser C, Jeger R. Drug-coated balloons in cardiovascular disease: benefits, challenges, and clinical applications. Expert Opin Drug Deliv 2020; 17:201-211. [DOI: 10.1080/17425247.2020.1714590] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Thomas Nestelberger
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christoph Kaiser
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Raban Jeger
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
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31
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Nestelberger T, Jeger R. Drug-coated Balloons for Small Coronary Vessel Interventions: A Literature Review. ACTA ACUST UNITED AC 2019; 14:131-136. [PMID: 31867057 PMCID: PMC6918480 DOI: 10.15420/icr.2019.06.r3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 09/30/2019] [Indexed: 12/13/2022]
Abstract
Newer-generation drug-eluting stents (DES) are the standard of care for the treatment of symptomatic coronary artery disease. However, some lack of efficacy has been reported in small coronary arteries based on higher rates of target lesion restenosis, thrombosis and MI resulting in repeated interventions. Drug-coated balloons (DCBs) are an established treatment option for in-stent restenosis in both bare metal stents and DES and they can deliver an anti-proliferative drug into the vessel wall without implanting a stent. DCBs are a promising technique for selected de novo coronary lesions, especially in small vessel disease. In this article, the current evidence for the treatment of small vessel disease with DCBs will be reviewed.
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Affiliation(s)
- Thomas Nestelberger
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel University of Basel, Switzerland
| | - Raban Jeger
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel University of Basel, Switzerland
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32
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Lansky A, Grubman D, Scheller B. Paclitaxel-coated balloons: a safe alternative to drug-eluting stents for coronary in-stent restenosis. Eur Heart J 2019; 41:3729-3731. [DOI: 10.1093/eurheartj/ehz731] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Abstract
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Affiliation(s)
- Alexandra Lansky
- Section of Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Daniel Grubman
- Section of Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Bruno Scheller
- Clinical and Experimental Interventional Cardiology, University of Saarland, Homburg/Saar, Germany
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33
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Bienek S, Kusmierczuk M, Mittag A, Bettink S, Scheller B. Novel, vessel anatomy adjusting drug-coated balloon-Preclinical evaluation in peripheral porcine arteries. Catheter Cardiovasc Interv 2019; 95:319-328. [PMID: 31696642 DOI: 10.1002/ccd.28592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/06/2019] [Accepted: 10/26/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND The diameter of balloons or stents is selected according to the estimated reference vessel diameter and do not adapt to the vessel anatomy. The aim of the present preclinical studies was to investigate a novel, vessel anatomy adjusting hypercompliant drug-coated balloon catheter (HCDCB). METHODS Hypercompliant balloon membranes were coated in a constricted state with high drug density. Drug adherence was investigated in vitro, transfer to the porcine peripheral arteries and longitudinal distribution in vivo. In young domestic swine, neointimal proliferation was induced by vessel overstretch and continuous irritation by permanent stents. Uncoated hypercompliant balloons (HCB), and standard uncoated balloons and drug-coated balloons (DCB) served as controls. Efficacy was assessed by angiography, optical coherence tomography (OCT), and histomorphometry. RESULTS HCDCB lost 18.0 ± 3.9% of dose during in vitro simulated delivery to the lesion. Drug transfer to the vessel wall was 13.9 ± 6.4% and drug concentration was 1,044 ± 529 ng/mg tissue. Four weeks after treatment, the histomorphometric neointimal area was smaller with HCDCB versus uncoated HCB (2.39 ± 0.55 mm2 vs. 3.26 ± 0.72 mm2 , p = .038) and area stenosis (OCT) was less (11.6 ± 6.9% vs. 24.7 ± 9.7%, p = .022). No premature death occurred and no in-life clinical symptoms or treatment-associated thrombi were observed. CONCLUSIONS HCDCB were found to inhibit excessive neointimal proliferation. Balloon adaption to different vessel diameters and shapes may provide drug-delivery in irregular lumen and facilitate balloon selection.
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Affiliation(s)
| | | | - Antje Mittag
- Institute of Medical Technology and Research GmbH, Rottmersleben, Germany
| | - Stephanie Bettink
- Clinical and Experimental Interventional Cardiology, University of Saarland, Homburg, Saarland, Germany
| | - Bruno Scheller
- Clinical and Experimental Interventional Cardiology, University of Saarland, Homburg, Saarland, Germany
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34
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Scheller B. Drug-coated balloons for patients with increased risk of bleeding. Lancet 2019; 394:190-192. [PMID: 31204111 DOI: 10.1016/s0140-6736(19)31144-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 05/01/2019] [Indexed: 11/22/2022]
Affiliation(s)
- Bruno Scheller
- Clinical and Experimental Interventional Cardiology, University of Saarland, 66421 Homburg, Germany.
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35
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Scheller B. Treatment of in-Stent Restenosis - What is Important in the Interest of the Patient? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:544-545. [PMID: 31109878 DOI: 10.1016/j.carrev.2019.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 05/07/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Bruno Scheller
- Clinical and Experimental Interventional Cardiology, University of Saarland, Germany.
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36
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Li M, Guo C, Lv YH, Zhang MB, Wang ZL. Drug-coated balloon versus drug-eluting stent in de novo small coronary vessel disease: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e15622. [PMID: 31124941 PMCID: PMC6571399 DOI: 10.1097/md.0000000000015622] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Drug-coated balloon as a novel therapeutic strategy has been used to treat restenosis in cases of bare metal and drug-eluting stents. However, evidence of its safety and efficacy is scarce in de novo small coronary artery vessel disease. This meta-analysis aimed to compare the safety and efficacy of the drug-coated balloon and the drug-eluting stent. METHODS The PubMed, EMBASE, Web of Science, and Cochrane library databases were searched for studies published up to October 17, 2018. Studies comparing the drug-coated balloon with the drug-eluting stent strategy in patients with de novo small coronary artery vessel disease (reference diameter, <3 mm) were identified. The clinical outcomes were nonfatal myocardial infarction, cardiac death, all-cause death, target lesion revascularization, and target-vessel revascularization. Data were analyzed using the statistical software RevMan (version 5.3). Fixed effects models were performed to calculate the pooled odds ratios (ORs) and 95% confidence intervals (95% CIs). Sensitivity analyses were used to detect potential sources of heterogeneity, while subgroup analyses were implemented to assess the differential effects. RESULTS Three randomized controlled trials and 3 nonrandomized controlled studies were identified. Six studies including a total of 1800 patients compared the differences between the drug-coated balloon and the drug-eluting stent strategies in patients with de novo small coronary artery vessel disease. The results indicated that the drug-coated balloon strategy was associated with a significant reduction in nonfatal myocardial infarction (OR 0.53, 95% CI 0.31-0.90, P = .02) compared with the drug-eluting stent strategy, while insignificant inter-strategy differences were observed in cardiac death (OR 1.56, 95% CI 0.73-3.33, P = .25), all-cause death (OR 0.56, 95% CI 0.25-1.23, P = .15), target lesion revascularization (OR 1.24, 95% CI 0.73-2.1, P = .43), and target-vessel revascularization (OR 0.95, 95% CI 0.59-1.52, P = .84). CONCLUSIONS This meta-analysis suggests that the drug-coated balloon strategy is noninferior to the drug-eluting stent strategy, delivering a good outcome in nonfatal myocardial infarction, and can be recommended as an optimal treatment strategy in patients with de novo small coronary artery vessel disease. Larger randomized controlled studies with longer follow-up periods are needed to further confirm the benefits of the drug-coated balloon strategy.
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Affiliation(s)
- Min Li
- The First Clinical Medical College of Lanzhou University
| | - Chen Guo
- The First Clinical Medical College of Lanzhou University
| | - Yong-Hui Lv
- The First Clinical Medical College of Lanzhou University
| | - Ming-Bo Zhang
- The First Clinical Medical College of Lanzhou University
| | - Zhi-Lu Wang
- Department of Cardiology, The First Hospital of Lanzhou University, China
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Byrne RA, Capodanno D, Mylotte D, Serruys PW. State of the art: 40 years of percutaneous cardiac intervention. EUROINTERVENTION 2018; 13:621-624. [PMID: 28844023 DOI: 10.4244/eijv13i6a98] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Jeger RV, Farah A, Ohlow MA, Mangner N, Möbius-Winkler S, Leibundgut G, Weilenmann D, Wöhrle J, Richter S, Schreiber M, Mahfoud F, Linke A, Stephan FP, Mueller C, Rickenbacher P, Coslovsky M, Gilgen N, Osswald S, Kaiser C, Scheller B. Drug-coated balloons for small coronary artery disease (BASKET-SMALL 2): an open-label randomised non-inferiority trial. Lancet 2018; 392:849-856. [PMID: 30170854 DOI: 10.1016/s0140-6736(18)31719-7] [Citation(s) in RCA: 236] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 07/18/2018] [Accepted: 07/23/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Drug-coated balloons (DCB) are a novel therapeutic strategy for small native coronary artery disease. However, their safety and efficacy is poorly defined in comparison with drug-eluting stents (DES). METHODS BASKET-SMALL 2 was a multicentre, open-label, randomised non-inferiority trial. 758 patients with de-novo lesions (<3 mm in diameter) in coronary vessels and an indication for percutaneous coronary intervention were randomly allocated (1:1) to receive angioplasty with DCB versus implantation of a second-generation DES after successful predilatation via an interactive internet-based response system. Dual antiplatelet therapy was given according to current guidelines. The primary objective was to show non-inferiority of DCB versus DES regarding major adverse cardiac events (MACE; ie, cardiac death, non-fatal myocardial infarction, and target-vessel revascularisation) after 12 months. The non-inferiority margin was an absolute difference of 4% in MACE. This trial is registered with ClinicalTrials.gov, number NCT01574534. FINDINGS Between April 10, 2012, and February 1, 2017, 382 patients were randomly assigned to the DCB group and 376 to DES group. Non-inferiority of DCB versus DES was shown because the 95% CI of the absolute difference in MACE in the per-protocol population was below the predefined margin (-3·83 to 3·93%, p=0·0217). After 12 months, the proportions of MACE were similar in both groups of the full-analysis population (MACE was 7·5% for the DCB group vs 7·3% for the DES group; hazard ratio [HR] 0·97 [95% CI 0·58-1·64], p=0·9180). There were five (1·3%) cardiac-related deaths in the DES group and 12 (3·1%) in the DCB group (full analysis population). Probable or definite stent thrombosis (three [0·8%] in the DCB group vs four [1·1%] in the DES group; HR 0·73 [0·16-3·26]) and major bleeding (four [1·1%] in the DCB group vs nine [2·4%] in the DES group; HR 0·45 [0·14-1·46]) were the most common adverse events. INTERPRETATION In small native coronary artery disease, DCB was non-inferior to DES regarding MACE up to 12 months, with similar event rates for both treatment groups. FUNDING Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung, Basel Cardiovascular Research Foundation, and B Braun Medical AG.
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Affiliation(s)
- Raban V Jeger
- University Hospital Basel, University of Basel, Basel, Switzerland.
| | - Ahmed Farah
- Knappschaftskrankhenhaus, Klinikum Westfalen, Dortmund, Germany
| | | | - Norman Mangner
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany; Heart Center Leipzig, University Hospital, Leipzig, Germany
| | | | | | | | | | | | | | | | - Axel Linke
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany; Heart Center Leipzig, University Hospital, Leipzig, Germany
| | | | | | | | | | - Nicole Gilgen
- University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefan Osswald
- University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christoph Kaiser
- University Hospital Basel, University of Basel, Basel, Switzerland
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