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Nakamura M, Isawa T, Nakamura S, Ando K, Namiki A, Shibata Y, Shinke T, Ito Y, Fujii K, Shite J, Kozuma K, Saito S, Yamaguchi J, Yamazaki S, Underwood P, Allocco DJ. One-year safety and effectiveness of the Agent paclitaxel-coated balloon for the treatment of small vessel disease and in-stent restenosis. Cardiovasc Interv Ther 2024; 39:47-56. [PMID: 37642826 PMCID: PMC10764532 DOI: 10.1007/s12928-023-00953-8] [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: 06/05/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023]
Abstract
The Agent device consists of a semi-compliant balloon catheter, which is coated with a therapeutic low-dose formulation of paclitaxel (2 µg/mm2) blended with an inactive excipient acetyl-tri-n-butyl citrate (ATBC). AGENT Japan SV is a randomized controlled study that enrolled 150 patients from 14 Japanese sites treated with Agent or SeQuent Please paclitaxel-coated balloon. This study also includes a single-arm substudy evaluating the safety and effectiveness of Agent in patients with in-stent restenosis (ISR). Patients with a single de novo native lesion (lesion length ≤ 28 mm and reference diameter ≥ 2.00 to < 3.00 mm) were randomized 2:1 to receive either Agent (n = 101) or SeQuent Please (n = 49). The ISR substudy enrolled 30 patients with lesion length ≤ 28 mm and reference diameter ≥ 2.00 to ≤ 4.00 mm. In the SV RCT, target lesion failure (TLF) at 1 year occurred in four patients treated with Agent (4.0%) versus one patient with SeQuent Please (2.0%; P = 1.00). None of the patients in either treatment arm died. There were no significant differences in the rates of myocardial infarction, target lesion revascularization and target lesion thrombosis through 1 year. In the ISR substudy, the 1-year rates of TLF and target lesion thrombosis were 6.7% and 0.0%, respectively. These data support the safety and effectiveness of the Agent paclitaxel-coated balloon in patients with small vessels and ISR.
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Affiliation(s)
- Masato Nakamura
- Division of Minimally Invasive Treatment in Cardiovascular Medicine, Toho University Ohashi Medical Center, 2-22-36, Ohashi Meguro-ku, Tokyo, 153-8515, Japan.
| | - Tsuyoshi Isawa
- Department of Cardiology, Sendai Kousei Hospital, Sendai, Miyagi, Japan
| | | | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Atsuo Namiki
- Department of Cardiology, Kanto Rosai Hospital, Kawasaki, Kanagawa, Japan
| | - Yoshisato Shibata
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Toshiro Shinke
- Department of Cardiology, Showa University Hospital, Tokyo, Japan
| | - Yoshiaki Ito
- Department of Cardiology, Saiseikai Yokohama-City Eastern Hospital, Kawasaki, Kanagawa, Japan
| | - Kenshi Fujii
- Department of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Junya Shite
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Ken Kozuma
- Department of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Shigeru Saito
- Heart Center, Shonan Kamakura General Hospital, Kawasaki, Kanagawa, Japan
| | - Junichi Yamaguchi
- Department of Cardiology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Seiji Yamazaki
- Department of Cardiology, Sapporo Higashi Tokushukai Hospital, Sapporo, Hokkaido, Japan
| | - Paul Underwood
- Interventional Cardiology, Boston Scientific Corporation, Marlborough, MA, USA
| | - Dominic J Allocco
- Interventional Cardiology, Boston Scientific Corporation, Marlborough, MA, USA
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Basavarajaiah S, Kalkat H, Bhatia G, Cortese B. How to perform a successful drug-coated balloon angioplasty? Tips and tricks. Catheter Cardiovasc Interv 2023; 102:1238-1257. [PMID: 37948409 DOI: 10.1002/ccd.30851] [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: 07/05/2023] [Accepted: 09/30/2023] [Indexed: 11/12/2023]
Abstract
Drug-coated balloons (DCB) offer an excellent alternative to stents as the antiproliferative drugs are delivered via balloons and hence there is no permanent implant of metal or polymer. This rationale applies perfectly in in-stent restenosis (ISR) as we want to avoid another layer of metal in a previously failed stent. However, their use has also been extended to de novo lesions especially in patients and lesion subsets where stents are not ideal. There is an increased desire toward expanding this further and studies are now being done which are testing DCB in large-caliber vessels. As the use of DCB is escalating, we felt the importance of writing this article whereby we aim to provide important tips and tricks when using DCB especially for the operators who are in the early phase or have the desire of embarking this technology. From our experience, the DCB-angioplasty substantially differs on several aspects from DES-angioplasty. We have provided several case bases examples including algorithm when using DCB in ISR and de novo lesions.
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Affiliation(s)
| | - Harkaran Kalkat
- Heartlands Hospital, University Hospital Birmingham, Birmingham, UK
| | - Gurbir Bhatia
- Heartlands Hospital, University Hospital Birmingham, Birmingham, UK
| | - Bernardo Cortese
- Clinica Polispecialistica San Carlo, Paderno Dugnano-Milano, Italy
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Yang H, Song Y, Cao J, Chen J, Zhang F, Huang Z, Qian J, Ge J. A novel hybrid strategy of drug coated balloon and stent for coronary bifurcation lesions. SCAND CARDIOVASC J 2023; 57:2161620. [PMID: 36573618 DOI: 10.1080/14017431.2022.2161620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background. Provisional side branch (SB) stenting strategy is the default approach for the majority of bifurcation lesions, but outcomes of SB is suboptimal. Though drug coated balloon (DCB) improving SB outcomes attracts an increasing attention, sequence of DCB hasn't yet been determined. We presented a novel hybrid strategy of DCB and stent for bifurcation lesions. Methods. With lesion preparation, DCB was persistently inflated in SB kissing with main branch (MB) stent deployment and balloon post-dilation of the bifurcation core. Proximal optimization technique was performed strictly not exceeding the bifurcation. Procedural and clinical adverse events were evaluated. Canadian Cardiovascular Society (CCS) angina classification was assessed at baseline and clinical follow-up. Results. Fourteen patients undergoing the hybrid technique from August 2020 to July 2021 were enrolled. The technique was successfully performed in all patients without rewiring or SB compromise. Minimal lumen diameter of SB increased from 0.60 ± 0.40 mm to 2.1 ± 0.2 mm while the percent stenosis decreased from 72.4 ± 17.9% to 19.6 ± 4.7%. In addition, intravascular ultrasound indicated comparable stent symmetry index and incomplete stent apposition between proximal and distal segments of stent. No further intervention was performed, and mean fractional flow reserve of SB (n = 12) was 0.88 ± 0.05. No major adverse cardiac events was noted in hospital and 12-month follow up. The mean CCS angina score was reduced by 84% (2.2 vs 0.4, p < .001). Conclusion. The hybrid strategy facilitates treatment of DCB and stent for bifurcation lesions, which appears to be feasible and acceptable in a short-term follow-up.
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Affiliation(s)
- Hongbo Yang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China.,Shanghai Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China
| | - Yanan Song
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China.,Shanghai Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China
| | - Jiatian Cao
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China.,Shanghai Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China
| | - Jing Chen
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China.,Shanghai Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China
| | - Feng Zhang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China.,Shanghai Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China
| | - Zheyong Huang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China.,Shanghai Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China
| | - Juying Qian
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China.,Shanghai Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China.,Shanghai Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China
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Effect of Paclitaxel-Coated Balloon Angioplasty on Side Branch Lesion and Cardiovascular Outcomes in Patients with De Novo True Coronary Bifurcation Lesions Undergoing Percutaneous Coronary Intervention. Cardiovasc Drugs Ther 2021; 36:859-866. [PMID: 34241730 DOI: 10.1007/s10557-021-07225-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To compare the effects of paclitaxal-coated balloon (PCB) versus conventional balloon (CB) on side branch (SB) lesion and cardiovascular outcomes in patients with de novo true bifurcation lesions. METHODS In total, 219 patients with de novo true bifurcation lesions were enrolled and divided into PCB group (102 cases) and CB group (117 cases) according to angioplasty strategy in SB. Drug-eluting stent (DES) was implanted in main vessel (MV) for each subject. All subjects underwent a 12-month follow-up for late lumen loss (LLL), restenosis, and major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI). MACEs included cardiac death, nonfatal myocardial infarction, and unstable angina requiring admission. RESULTS There were no differences in diameter, minimum lumen diameter (MLD), and stenosis for bifurcation lesions between the two groups before and immediately after PCI (P > 0.05). After 12-month follow-up, no differences occurred in MV-MLD and MV-LLL between the two groups (P > 0.05); SB-MLD in PCB group was higher than that in CB group (1.97 ± 0.36 mm vs. 1.80 ± 0.43 mm, P = 0.007); SB-LLL in PCB group was lower than that in CB group (0.11 ± 0.18 mm vs. 0.19 ± 0.25 mm, P = 0.024). Multivariate COX analyses indicated that PCB group had lower MACE risk than CB group (HR = 0.480, 95%CI 0.244-0.941, P = 0.033). CONCLUSION PCB could decrease SB-LLL and MACE risk in patients with de novo true coronary bifurcation lesion 12 months after single-DES intervention.
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Ang H, Koppara TR, Cassese S, Ng J, Joner M, Foin N. Drug-coated balloons: Technical and clinical progress. Vasc Med 2020; 25:577-587. [PMID: 32634046 DOI: 10.1177/1358863x20927791] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The advancement of drug-coated balloons (DCB) presents an alternative nonstent method in the percutaneous treatment of atherosclerotic lesions. While the current generation of drug-eluting stents (DES) are the device of choice, especially in coronary artery disease (CAD), DCB has potential applications in the treatment of de novo lesions, in-stent restenosis (ISR), bifurcations, and in peripheral artery disease (PAD). In terms of coronary clinical experience, DCB is used most in ISR scenarios and more data are collected to support the use of DCB in de novo lesions compared to best-in-class DES. The use of DCB in bifurcation side branch treatment has demonstrated safety, and with good angiographic and clinical outcomes, but more data from randomized trials will be required to assess its clinical value. For PAD, the clinical outcomes of DCB with and without debulking devices in diseased femoropopliteal arteries and treatment of below-the-knee (BTK) vessels with DCB are discussed. Current data demonstrated conflicting long-term safety outcomes in the use of paclitaxel devices in the femoral and/or popliteal arteries, while the role of DCB in BTK disease remains uncertain due to a lack of randomized controlled trial data. In summary, this review provides an overall view of current DCB technologies and progress, followed by an update on DCB clinical data in the treatment of CAD and PAD.
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Affiliation(s)
- Huiying Ang
- National Heart Centre Singapore, Singapore.,Biomedical Engineering, National University of Singapore, Singapore
| | - Tobias R Koppara
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Jaryl Ng
- National Heart Centre Singapore, Singapore.,Biomedical Engineering, National University of Singapore, Singapore
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Nicolas Foin
- National Heart Centre Singapore, Singapore.,Duke-NUS Medical School, Singapore
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Elwany M, Zaki A, Latib A, Testa L, Ielasi A, Piraino D, Geraci S, El Zawawy T, Cortese B. The impact of the use of bioresorbable vascular scaffolds and drug-coated balloons in coronary bifurcation lesions. Egypt Heart J 2019; 71:31. [PMID: 31845098 PMCID: PMC6914751 DOI: 10.1186/s43044-019-0033-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/19/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the improvement in techniques and tools, coronary lesions involving a bifurcation are still challenging and the outcome with drug-eluting stents is not always optimal. The role of bioresorbable vascular scaffolds (BVS) and drug-coated balloons (DCB) in this setting has not been adequately investigated yet. RESULTS From the databases of 6 italian centers with high proficiencies in newer technologies, we retrospectively collected all consecutive cases of coronary bifurcations managed or attempted with the implantation of at least one BVS in the main vessel and the use of one DCB in the side branch (SB). Primary study endpoint was the occurrence of major adverse cardiovascular events (MACE) at the longest available follow-up. Fourty patients fulfilled the enrollment criterion, 22.5% had diabetes and 50% an acute coronary syndrome. Average syntax score was 15.04 ± 7.18, all lesions were de novo, and 27 patients (67.5%) had a type 1,1,1 Medina lesion. Twenty-three lesions (57.5%) involved the proximal left anterior-descending artery/first diagonal branch. Only 32.5% of patients underwent an intravascular imaging-guided angioplasty. Average lesion length was 21.4 mm in the main vessel and 11.49 mm in the SB. MV was always predilated and BVS received a postdilation in 100% of the cases. In 42.5% of the cases, the DCB was used during final kissing balloon inflation, and in no cases, a stent/BVS was required in the SB. Procedural success was achieved in 100% of the cases. After an average follow-up of 15.5 (± 11.5) months, we observed no MACE with only one case of target vessel revasularization (2.5%). CONCLUSIONS Management of coronary bifurcation lesions with the use of newer technologies including BVS and DCB seems feasible and effective at mid-term and long-term clinical follow-up.
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Affiliation(s)
- Mostafa Elwany
- Interventional Cardiology, San Carlo Clinic, Milano, Italy. .,Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
| | - Amr Zaki
- Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | | | | | | | | | | | - Tarek El Zawawy
- Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Bernardo Cortese
- Interventional Cardiology, San Carlo Clinic, Milano, Italy.,Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Massa, Italy
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Buccheri D, Lombardo RM, Cortese B. Drug-coated balloons for coronary artery disease: current concepts and controversies. Future Cardiol 2019; 15:437-454. [DOI: 10.2217/fca-2019-0009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Drug-coated balloons (DCBs) are a novel development for percutaneous coronary intervention. The first successful application was in-stent restenosis but in recent years, strong evidence has been released for its use in native small-vessels disease. Additional applications such as acute myocardial infarction, chronic total occlusion and bifurcation lesions are still under investigation. This article reviews the key studies evaluating the role of DCBs in several settings and reports on interesting cases where DCBs showed positive results for high-risk patients with neoplasm, as well as with high bleeding risk, planned surgery or renal injury. We also highlight a new biodegradable therapy for coronary bifurcation treatment, in which a bioresorbable vascular scaffold is implanted in the main branch, completed with a DCB angioplasty in the side branch when a treatment is deemed necessary.
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Affiliation(s)
- Dario Buccheri
- Department of Cardiology, S. Antonio Abate Hospital, Interventional Cardiology Unit, Via Cosenza 80, 91016, Erice, TP, Italy
| | - Renzo M Lombardo
- Department of Cardiology, S. Antonio Abate Hospital, Interventional Cardiology Unit, Via Cosenza 80, 91016, Erice, TP, Italy
| | - Bernardo Cortese
- Interventional Cardiology Unit, San Carlo Clinic, Via Ospedale, 21, 20037, Paderno Dugnano, MI, Italy
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Merinopoulos I, Gunawardena T, Wickramarachchi U, Ryding A, Eccleshall S, Vassiliou VS. Percutaneous Coronary Intervention in the Elderly: Are Drug-coated Balloons the Future? Curr Cardiol Rev 2018; 14:45-52. [PMID: 29278215 PMCID: PMC5872262 DOI: 10.2174/1573403x14666171226144120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 12/08/2017] [Accepted: 12/11/2017] [Indexed: 11/22/2022] Open
Abstract
Background: Balloon angioplasty revolutionised percutaneous treatment for coronary ar-tery disease four decades ago, but vessel-threatening dissections, elastic recoil and restenosis were major drawbacks to an otherwise successful long-lasting intervention. Subsequent advances with bare metal stents and then drug eluting stents followed, aiming to mitigate the risks of acute vessel closure and restenosis. However, stent implantation often necessitates dual antiplatelet therapy for a pro-longed period of time, which in itself can lead to adverse outcomes, especially in the frail elderly pop-ulation at higher risk of bleeding. More recently, bioabsorbable stents have been implemented in clini-cal practice enabling earlier intimal coverage of the stent and apposition. However, another addition to the armamentarium of percutaneous coronary intervention is the use of drug-coated balloons without the need for deploying any coronary stents or scaffolds. Drug-coated balloons are semi-compliant balloons coated with an antiproliferative agent that is rapidly released on contact with the vessel intima exerting an anti-restenotic effect. The absence of a metallic scaffold means that the need for antiplatelet therapy can potentially be negated in the longer term if required. In this article, we will review the history of percutaneous coronary intervention and the available evi-dence for the appropriate use of drug-coated balloons especially in the elderly population. Conclusion: We will conclude this review by demonstrating the potential use of drug-coated balloon rather percutaneous stenting through case examples.
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Affiliation(s)
- Ioannis Merinopoulos
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | | | - Upul Wickramarachchi
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Alisdair Ryding
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Simon Eccleshall
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Vassilios S Vassiliou
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, United Kingdom.,Norwich Medical School, University of East Anglia and Royal Brompton Hospital and Imperial College London, London, United Kingdom
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9
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Jongsma H, Bekken JA, de Vries JPP, Verhagen HJ, Fioole B. Drug-eluting balloon angioplasty versus uncoated balloon angioplasty in patients with femoropopliteal arterial occlusive disease. J Vasc Surg 2016; 64:1503-1514. [DOI: 10.1016/j.jvs.2016.05.084] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 05/31/2016] [Indexed: 11/30/2022]
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10
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Kleber FX, Rittger H, Ludwig J, Schulz A, Mathey DG, Boxberger M, Degenhardt R, Scheller B, Strasser RH. Drug eluting balloons as stand alone procedure for coronary bifurcational lesions: results of the randomized multicenter PEPCAD-BIF trial. Clin Res Cardiol 2016; 105:613-21. [DOI: 10.1007/s00392-015-0957-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 12/22/2015] [Indexed: 01/17/2023]
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Berland J, Lefèvre T, Brenot P, Fajadet J, Motreff P, Guerin P, Dupouy P, Schandrin C. DANUBIO - a new drug-eluting balloon for the treatment of side branches in bifurcation lesions: six-month angiographic follow-up results of the DEBSIDE trial. EUROINTERVENTION 2015; 11:868-76. [DOI: 10.4244/eijv11i8a177] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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McCutcheon K, Garda R, Mkhwanazi L, Vachiat A, Ramjee R, Moosa J, Tsabedze N, Karolia S, Manga P. Provisional main branch stenting with drug-eluting stents after drug-eluting balloon treatment of the side branch: a simple and durable technique for treating bifurcation lesions. Int J Cardiol 2015; 182:294-6. [PMID: 25585366 DOI: 10.1016/j.ijcard.2014.12.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 12/29/2014] [Indexed: 11/15/2022]
Affiliation(s)
- Keir McCutcheon
- Division of Cardiology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.
| | - Riaz Garda
- Division of Cardiology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Lance Mkhwanazi
- Division of Cardiology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Ahmed Vachiat
- Division of Cardiology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Rohan Ramjee
- Division of Cardiology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Jameel Moosa
- Division of Cardiology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Nqoba Tsabedze
- Division of Cardiology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Saffiyah Karolia
- Department of Radiology, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Pravin Manga
- Division of Cardiology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
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Ng VG, Mena C, Pietras C, Lansky AJ. Local delivery of paclitaxel in the treatment of peripheral arterial disease. Eur J Clin Invest 2015; 45:333-45. [PMID: 25615282 DOI: 10.1111/eci.12407] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 01/19/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite advancements from balloon angioplasty to drug-eluting stents, primary patency rates after endovascular revascularization of peripheral artery disease have remained inferior compared to surgery. Endovascular revascularization has been limited by restenosis and mechanical stent failure. Thus, there is increased research into other nonstent-based local drug delivery modalities, which can provide an active drug to inhibit restenosis focally and avoid the risk of systemic adverse effects. METHODS This review will summarize the unique properties of paclitaxel and studies on paclitaxel local delivery for the treatment of peripheral artery disease. A MEDLINE search for relevant peer-reviewed scientific literature published in English was conducted. Search terms included but were not limited to paclitaxel pharmacodynamics, paclitaxel local drug delivery, and drug eluting balloons, with a focus on the use of paclitaxel in the context of coronary and peripheral vascular disease. RESULTS The primary search produced 182 results of which 51 papers were relevant. Of the 51 relevant papers, 27 were original research papers and 24 were either review papers, commentary or opinion papers. CONCLUSIONS Paclitaxel has several chemical properties, which make it ideal for local drug delivery including its hydrophobicity, ability to concentrate into the arterial intima layer and prolonged effect on cells even after brief exposure periods. Local delivery of paclitaxel via injection catheters, balloon catheters and coated balloons has shown encouraging results in terms of efficacy and safety in small-scale animal and clinical studies. Additional preclinical and clinical studies are needed to determine the long-term efficacy and safety of these treatments in humans.
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Affiliation(s)
- Vivian G Ng
- Yale Cardiovascular Research Group, Yale University Medical Center, New Haven, CT, USA
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14
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Schulz A, Hauschild T, Kleber FX. Treatment of coronary de novo bifurcation lesions with DCB only strategy. Clin Res Cardiol 2014; 103:451-6. [PMID: 24522798 DOI: 10.1007/s00392-014-0671-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 01/14/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This observational study investigated the value of drug-coated balloons (DCB) only strategy in bifurcation lesions in a consecutive series of all comer percutaneous coronary intervention. BACKGROUND Local application of paclitaxcel by DCB has clinical benefits in various settings including coronary bifurcations. While so far most bifurcation studies investigated sequential application of DCBs to the main (MB) and side branch (SB) with stenting of the MB, we report first results after DCB intervention without additional stenting of the MB or SB. METHODS We performed 39 consecutive DCB only interventions in de novo bifurcation lesions with SB ≥ 2 mm and scheduled follow-up angiography after 4 months. Patients refusing angiography had telephone follow-up. RESULTS Follow-up angiograms were obtained in 30 out of 39 DCB only interventions. 33.3 % were located in the left main (LM) bifurcation, 28.2 % in left anterior descending (LAD), 20.5 % in left circumflex (LCX) and 17.9 % in the right coronary artery. Four months after index procedure no patient had died, experienced myocardial infarction or stroke. Follow-up angiograms showed restenosis in 3 out of 30 interventions (10 %), 2 developing in the distal main (6.7 %) and 1 in the SB (3.3 %). All three patients had been treated for LM/LAD/LCX bifurcations and suffered from most severe coronary artery disease, but had not been eligible for CABG for various reasons. Target lesion revascularization was performed in 3 out of 39 patients consistent with a MACE rate of 7.7 %. CONCLUSION Treatment of de novo bifurcation lesions with DCB only intervention without additional stenting is a safe therapy with low rates of restenosis and TLR.
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HERRADOR JUANA, FERNANDEZ JUANC, GUZMAN MANUEL, ARAGON VICTOR. Drug-Eluting vs. Conventional Balloon for Side Branch Dilation in Coronary Bifurcations Treated by Provisional T Stenting. J Interv Cardiol 2013; 26:454-62. [DOI: 10.1111/joic.12061] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- JUAN A. HERRADOR
- Unidad de Hemodinámica; Servicio de Cardiología; Complejo Hospitalario de Jaén; Jaén Spain
| | - JUAN C. FERNANDEZ
- Unidad de Hemodinámica; Servicio de Cardiología; Complejo Hospitalario de Jaén; Jaén Spain
| | - MANUEL GUZMAN
- Unidad de Hemodinámica; Servicio de Cardiología; Complejo Hospitalario de Jaén; Jaén Spain
| | - VICTOR ARAGON
- Unidad de Hemodinámica; Servicio de Cardiología; Complejo Hospitalario de Jaén; Jaén Spain
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16
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Cortese B, Berti S, Biondi-Zoccai G, Colombo A, Limbruno U, Bedogni F, Cremonesi A, Silva PL, Sgueglia GA. Drug-coated balloon treatment of coronary artery disease: a position paper of the Italian Society of Interventional Cardiology. Catheter Cardiovasc Interv 2013; 83:427-35. [PMID: 23934956 DOI: 10.1002/ccd.25149] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 07/30/2013] [Indexed: 02/05/2023]
Abstract
Drug-coated balloons are a new tool for the treatment of patients with coronary artery disease. The main feature of this technology is a rapid and homogenous transfer of an antiproliferative drug (paclitaxel) to the vessel wall just at the time of balloon inflation, when neointimal proliferation, in response to angioplasty, is the highest. Moreover, drug-coated balloons share adjuntive advantages over stents: the absence of permanent scaffold and polymer, the respect of the original coronary anatomy, and limited inflammatory stimuli, thereby allowing for short-term dual antiplatelet therapy. To this day, a lot of devices are available in the market, with limited scientific data for the vast majority of them. Thus, the Italian scientific society of interventional cardiologists GISE decided to coordinate the efforts of a group of reknown experts on the field, in order to obtain a Position Paper on the correct use of drug-coated balloons in all the settings of coronary artery disease, giving a class of indication to each one, based on the clinical evidence. This Position Paper represents a quick reference for operators, investigators, and manufactures to promote the understanding and the correct use of the drug-coated balloon technology in everyday clinical practice.
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17
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Yu CM, Kwong JS, Sanderson JE. Drug-eluting balloons for coronary artery disease: A meta-analysis of randomized controlled trials. Int J Cardiol 2013; 168:197-206. [DOI: 10.1016/j.ijcard.2012.09.094] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 06/11/2012] [Accepted: 09/15/2012] [Indexed: 02/06/2023]
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18
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Balones liberadores de medicamento: Una alternativa. REVISTA COLOMBIANA DE CARDIOLOGÍA 2013. [DOI: 10.1016/s0120-5633(13)70026-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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19
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Angioi M. [Use of drug-eluting balloons for coronary interventions: current indications and perspectives]. Ann Cardiol Angeiol (Paris) 2012; 61:413-6. [PMID: 23062818 DOI: 10.1016/j.ancard.2012.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The paclitaxel-eluting balloon is an emerging percutaneous coronary angioplasty tool which aim is to prevent restenosis by delivering a high intravessel paclitaxel dose during balloon inflation. It has been already approved in the treatment of bare metal stent restenosis and is being investigated in drug-eluting stent restenosis. For the treatment of de novo lesions, it could be used alone or in combination with bare metal stent implantation. Most interesting results were obtained by a drug-eluting balloon alone strategy in small vessels angioplasty. Current and upcoming results of this evolving technology are reviewed.
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Affiliation(s)
- M Angioi
- Unité d'hémodynamique diagnostique et interventionnelle, Institut Lorrain du coeur et des vaisseaux Louis-Mathieu, hôpitaux de Brabois, CHU de Nancy, allée du Morvan, 54511 Vandoeuvre-lès-Nancy, France.
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20
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Spencer JA, Hermiller JB. Evaluation and treatment of coronary bifurcation disease: current strategies and new technologies. Interv Cardiol 2012. [DOI: 10.2217/ica.12.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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21
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Sgueglia GA, Todaro D, Pucci E. Drug-eluting balloon offers a new opportunity in percutaneous bifurcation interventions. EUROINTERVENTION 2011; 7:764-6; author reply 766-7. [DOI: 10.4244/eijv7i6a120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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22
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