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Tufaro V, Jaffer FA, Serruys PW, Onuma Y, van der Steen AFW, Stone GW, Muller JE, Marcu L, Van Soest G, Courtney BK, Tearney GJ, Bourantas CV. Emerging Hybrid Intracoronary Imaging Technologies and Their Applications in Clinical Practice and Research. JACC Cardiovasc Interv 2024; 17:1963-1979. [PMID: 39260958 DOI: 10.1016/j.jcin.2024.07.007] [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: 11/13/2023] [Revised: 06/24/2024] [Accepted: 07/02/2024] [Indexed: 09/13/2024]
Abstract
Intravascular ultrasound and optical coherence tomography are used with increasing frequency for the care of coronary patients and in research studies. These imaging tools can identify culprit lesions in acute coronary syndromes, assess coronary stenosis severity, guide percutaneous coronary intervention (PCI), and detect vulnerable plaques and patients. However, they have significant limitations that have stimulated the development of multimodality intracoronary imaging catheters, which provide improvements in assessing vessel wall pathology and guiding PCI. Prototypes combining 2 or even 3 imaging probes with complementary attributes have been developed, and several multimodality systems have already been used in patients, with near-infrared spectroscopy intravascular ultrasound-based studies showing promising results for the identification of high-risk plaques. Moreover, postmortem histology studies have documented that hybrid imaging catheters can enable more accurate characterization of plaque morphology than standalone imaging. This review describes the evolution in the field of hybrid intracoronary imaging; presents the available multimodality catheters; and discusses their potential role in PCI guidance, vulnerable plaque detection, and the assessment of endovascular devices and emerging pharmacotherapies targeting atherosclerosis.
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Affiliation(s)
- Vincenzo Tufaro
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
| | - Farouc A Jaffer
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, Galway, Ireland
| | | | - Gregg W Stone
- Department of Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai, New York, New York, USA
| | - James E Muller
- Brigham and Women's Hospital, Division of Cardiovascular Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Laura Marcu
- Department of Biomedical Engineering, University of California, Davis, California, USA
| | - Gijs Van Soest
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Brian K Courtney
- Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada; Conavi Medical Inc, Toronto, Ontario, Canada
| | - Guillermo J Tearney
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard-MIT Health Sciences and Technology, Cambridge, Massachusetts, USA
| | - Christos V Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom; Institute of Cardiovascular Sciences, University College London, London, United Kingdom.
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Luo J, Yang R, Wang T, Chen J, Lu X, Yang B, Gao P, Wang Y, Chen Y, Dmytriw AA, Zheng J, Regenhardt RW, Li Z, Xu H, Ma Y, Zhao J, Jiao L. First-in-human experience of sirolimus coated balloon for symptomatic intracranial artery stenosis. J Neurointerv Surg 2024:jnis-2023-021177. [PMID: 38378241 DOI: 10.1136/jnis-2023-021177] [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: 12/08/2023] [Accepted: 01/22/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND The drug coated balloon is a promising endovascular therapy for intracranial atherosclerosis (ICAS), potentially combining the advantages of primary angioplasty and antiproliferative drugs. Previous studies have focused on the paclitaxel coated balloon, revealing promising outcomes in the treatment of ICAS, while concerns about the neurotoxicity of paclitaxel were reported. Sirolimus was shown to have less neurotoxicity in the canine cerebral vasculature. The feasibility and safety of a sirolimus coated balloon (SCB) for ICAS have never been evaluated in humans. We assessed the first-in-human feasibility and safety of SCBs for treating symptomatic patients with severe ICAS. METHODS This prospective, open label, single arm cohort study was designed to enroll patients with transient ischemic attacks or non-disabling, non-perforator territory ischemic stroke caused by severe ICAS (70-99%) and following at least 3 weeks after the onset of ischemic symptoms. The primary outcome was stroke or death within 30 days. All patients were followed up to detect restenosis at 6 months. RESULTS A total of 60 eligible patients were enrolled with an average age of 59.4±10.8 years. The technical success rate of SCBs for ICAS was 100%. Seven patients (11.7%) required stenting because of flow limited dissections or elastic retraction. Three patients (5.0%) had 30 day strokes, including two ischemic strokes and one hemorrhagic stroke. An additional three patients had recurrent stroke or death during follow-up. Ten patients had restenosis but only two had symptoms. CONCLUSIONS SCBs may be feasible and safe in selected patients with symptomatic ICAS, with high grade stenosis (70-99%). Further studies are warranted.
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Affiliation(s)
- Jichang Luo
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Renjie Yang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Tao Wang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Jian Chen
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Xia Lu
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Bin Yang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Peng Gao
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
- Interventional Neuroradiology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yabing Wang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Yanfei Chen
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Adam A Dmytriw
- Neurointerventional Program, Departments of Medical Imaging & Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, Ontario, Canada
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jiamin Zheng
- Neurointerventional Program, Departments of Medical Imaging & Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Robert W Regenhardt
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Zheng Li
- Zylox-Tonbridge Medical Technology, HangZhou, ZheJiang, China
| | - Han Xu
- R&D Center, Zylox-Tonbridge Medical Technology, Hangzhou, Zhejiang, China
| | - Yan Ma
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Jonathon Zhao
- Zylox-Tonbridge Medical Technology, HangZhou, ZheJiang, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
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Zhang W, Zhang M, Tian J, Zhang M, Zhou Y, Song X. Drug-Coated Balloon-Only Strategy for De Novo Coronary Artery Disease: A Meta-analysis of Randomized Clinical Trials. Cardiovasc Ther 2023; 2023:3121601. [PMID: 37588774 PMCID: PMC10427238 DOI: 10.1155/2023/3121601] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 06/19/2023] [Accepted: 07/07/2023] [Indexed: 08/18/2023] Open
Abstract
Backgrounds Many clinical trials have demonstrated the value of drug-coated balloons (DCB) for in-stent restenosis. However, their role in de novo lesions is not well documented. The aim of this study is to evaluate the safety and efficacy of the DCB-only strategy compared to other percutaneous coronary intervention strategies for de novo coronary lesions. Methods The PubMed, Embase, Web of Science, and Cochrane Library Central Register of Controlled Trials (CENTRAL) electronic databases were searched for randomized controlled trials published up to May 6, 2023. The primary outcomes were major adverse cardiac events and late lumen loss. Results A total of eighteen trials with 3336 participants were included. Compared with drug-eluting stents, the DCB-only strategy was associated with a similar risk of major adverse cardiac events (risk ratio (RR) = 0.90; 95% confidence interval (CI): 0.59 to 1.37, P = 0.631) and a significant decrease in late lumen loss (standardized mean difference (SMD) = -0.29, 95% CI: -0.53 to -0.04, P = 0.021). This effect was consistent in subgroup analysis regardless of indication, follow-up time, drug-eluting stent type, and dual antiplatelet therapy duration. However, DCBs were inferior to DESs for minimum lumen diameter and percentage diameter stenosis. The DCB-only strategy showed significantly better outcomes for most endpoints compared to plain-old balloon angioplasty or bare metal stents. Conclusions Interventions with a DCB-only strategy are comparable to those of drug-eluting stents and superior to plain-old balloon angioplasty or bare metal stents for the treatment of selected de novo coronary lesions. Additional evidence is still warranted to confirm the value of DCB before widespread clinical utilization can be recommended.
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Affiliation(s)
- Wenyi Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Mingduo Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Jinfan Tian
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Min Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Yuan Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Xiantao Song
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
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Claessen B, Henriques JP, Dangas GD. Specialized Balloons in Percutaneous Coronary Intervention. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Yerasi C, Case BC, Forrestal BJ, Torguson R, Weintraub WS, Garcia-Garcia HM, Waksman R. Drug-Coated Balloon for De Novo Coronary Artery Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 75:1061-1073. [PMID: 32138967 DOI: 10.1016/j.jacc.2019.12.046] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/23/2019] [Accepted: 12/30/2019] [Indexed: 02/07/2023]
Abstract
Percutaneous coronary intervention with a drug-eluting stent is the most common mode of revascularization for coronary artery disease. However, restenosis rates remain high. Non-stent-based local drug delivery by a drug-coated balloon (DCB) has been investigated, as it leaves no metallic mesh. A DCB consists of a semicompliant balloon coated with antiproliferative agents encapsulated in a polymer matrix, which is released into the wall after inflation and contact with the intima. DCB have demonstrated effectiveness in treating in-stent restenosis. Clinical studies using DCB in de novo coronary artery disease have shown mixed results, with a major benefit in small-vessel disease. Differences in study results are not only due to variations in DCB technology but also to disparity in procedural approach, "leave nothing behind" or "combination therapy," and vessel size. This review focuses on the available evidence from randomized trials and proposes a design for future clinical trials.
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Affiliation(s)
- Charan Yerasi
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Brian J Forrestal
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Rebecca Torguson
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - William S Weintraub
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Hector M Garcia-Garcia
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
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Kassam HA, Gillis DC, Dandurand BR, Karver MR, Tsihlis ND, Stupp SI, Kibbe MR. Development of Fractalkine-Targeted Nanofibers that Localize to Sites of Arterial Injury. NANOMATERIALS 2020; 10:nano10030420. [PMID: 32121105 PMCID: PMC7152859 DOI: 10.3390/nano10030420] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 12/22/2022]
Abstract
Atherosclerosis is the leading cause of death and disability around the world, with current treatments limited by neointimal hyperplasia. Our goal was to synthesize, characterize, and evaluate an injectable, targeted nanomaterial that will specifically bind to the site of arterial injury. Our target protein is fractalkine, a chemokine involved in both neointimal hyperplasia and atherosclerosis. We showed increased fractalkine staining in rat carotid arteries 24 h following arterial injury and in the aorta of low-density lipoprotein receptor knockout (LDLR-/-) mice fed a high-fat diet for 16 weeks. Three peptide amphiphiles (PAs) were synthesized: fractalkine-targeted, scrambled, and a backbone PA. PAs were ≥90% pure on liquid chromatography/mass spectrometry (LCMS) and showed nanofiber formation on transmission electron microscopy (TEM). Rats systemically injected with fractalkine-targeted nanofibers 24 h after carotid artery balloon injury exhibited a 4.2-fold increase in fluorescence in the injured artery compared to the scrambled nanofiber (p < 0.001). No localization was observed in the non-injured artery or with the backbone nanofiber. Fluorescence of the fractalkine-targeted nanofiber increased in a dose dependent manner and was observed for up to 48 h. These data demonstrate the presence of fractalkine after arterial injury and the localization of our fractalkine-targeted nanofiber to the site of injury and serve as the foundation to develop this technology further.
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Affiliation(s)
- Hussein A. Kassam
- Department of Surgery, Center for Nanotechnology in Drug Delivery, University of North Carolina, Chapel Hill, NC 27599, USA; (H.A.K.); (D.C.G.); (B.R.D.); (N.D.T.)
| | - David C. Gillis
- Department of Surgery, Center for Nanotechnology in Drug Delivery, University of North Carolina, Chapel Hill, NC 27599, USA; (H.A.K.); (D.C.G.); (B.R.D.); (N.D.T.)
| | - Brooke R. Dandurand
- Department of Surgery, Center for Nanotechnology in Drug Delivery, University of North Carolina, Chapel Hill, NC 27599, USA; (H.A.K.); (D.C.G.); (B.R.D.); (N.D.T.)
| | - Mark R. Karver
- Simpson Querrey Institute, Northwestern University, Chicago, IL 60611, USA; (M.R.K.); (S.I.S.)
| | - Nick D. Tsihlis
- Department of Surgery, Center for Nanotechnology in Drug Delivery, University of North Carolina, Chapel Hill, NC 27599, USA; (H.A.K.); (D.C.G.); (B.R.D.); (N.D.T.)
| | - Samuel I. Stupp
- Simpson Querrey Institute, Northwestern University, Chicago, IL 60611, USA; (M.R.K.); (S.I.S.)
- Department of Chemistry, Northwestern University, Evanston, IL 60208, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Melina R. Kibbe
- Department of Surgery, Center for Nanotechnology in Drug Delivery, University of North Carolina, Chapel Hill, NC 27599, USA; (H.A.K.); (D.C.G.); (B.R.D.); (N.D.T.)
- Department of Biomedical Engineering, University of North Carolina, Chapel Hill, NC 27599, USA
- Correspondence: ; Tel.: +001-919-445-0369
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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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Her AY, Shin ES, Bang LH, Nuruddin AA, Tang Q, Hsieh IC, Hsu JC, Kiam OT, Qiu C, Qian J, Ahmad WAW, Ali RM. Drug-coated balloon treatment in coronary artery disease: Recommendations from an Asia-Pacific Consensus Group. Cardiol J 2019; 28:136-149. [PMID: 31565793 DOI: 10.5603/cj.a2019.0093] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 09/17/2019] [Indexed: 01/21/2023] Open
Abstract
Coronary artery disease (CAD) is currently the leading cause of death globally, and the prevalence of this disease is growing more rapidly in the Asia-Pacific region than in Western countries. Although the use of metal coronary stents has rapidly increased thanks to the advancement of safety and efficacy of newer generation drug eluting stent (DES), patients are still negatively affected by some the inherent limitations of this type of treatment, such as stent thrombosis or restenosis, including neoatherosclerosis, and the obligatory use of dual antiplatelet therapy (DAPT) with unknown optimal duration. Drug-coated balloon (DCB) treatment is based on a leave-nothing-behind concept and therefore it is not limited by stent thrombosis and long-term DAPT; it directly delivers an anti-proliferative drug which is coated on a balloon after improving coronary blood flow. At present, DCB treatment is recommended as the first-line treatment option in metal stent-related restenosis linked to DES and bare metal stent. For de novo coronary lesions, the application of DCB treatment is extended further, for conditions such as small vessel disease, bifurcation lesions, and chronic total occlusion lesions, and others. Recently, several reports have suggested that fractional flow reserve guided DCB application was safe for larger coronary artery lesions and showed good long-term outcomes. Therefore, the aim of these recommendations of the consensus group was to provide adequate guidelines for patients with CAD based on objective evidence, and to extend the application of DCB to a wider variety of coronary diseases and guide their most effective and correct use in actual clinical practice.
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Affiliation(s)
- Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | | | | | | | | | | | | | | | - ChunGuang Qiu
- the first affiliated hospital of Zhengzhou university, No. 1 Jianshe East Road, 450003 Zhengzhou, China
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Liu L, Liu B, Ren J, Hui G, Qi C, Wang J. Comparison of drug-eluting balloon versus drug-eluting stent for treatment of coronary artery disease: a meta-analysis of randomized controlled trials. BMC Cardiovasc Disord 2018; 18:46. [PMID: 29499651 PMCID: PMC5834842 DOI: 10.1186/s12872-018-0771-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 02/07/2018] [Indexed: 12/15/2022] Open
Abstract
Background Drug-eluting balloons (DEB) have significant value for treating coronary artery disease (CAD). However, the merits of using DEB versus drug-eluting stents (DES) to treat CAD remain controversial. Herein, we conducted a meta-analysis to compare the safety and efficacy of DEB and DES for treatment of CAD. Methods We searched MEDLINE, EMBASE, and CENTRAL databases for eligible trials comparing DEB with DES for treatment of CAD. The primary endpoint was major adverse cardiac events (MACE); the secondary endpoints included in-lesion late lumen loss (LLL), binary restenosis (BR), myocardial infarction (MI), target lesion revascularization (TLR) and mortality. Results Twenty-three trials with a total of 2712 patients were included. There were no significant differences in the primary endpoint of MACE between the DEB and DES groups (Risk Ratio (RR) 1.19; 95% confidence interval (CI) (0.87, 1.63); P = 0.27), or in the clinical outcomes of each of MACE’s components, including TLR, MI and mortality. However, efficacy was significantly different between the DEB and DES groups, especially when we compared DEB to second-generation DES: in-lesion LLL (Mean Difference (MD) 0.11; (0.01, 0.22); P = 0.03); binary restenosis (RR 1.46; (1.00, 2.13); P = 0.05). Conclusions DEB is equivalent to DES in terms of safety for managing CAD, and DEB may be considered as an alternative choice for treatment of CAD. Electronic supplementary material The online version of this article (10.1186/s12872-018-0771-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lulu Liu
- Department of Cardiology, Second Hospital of Jilin University, No. 218 Ziqiang Street, Changchun, 130041, China
| | - Bin Liu
- Department of Cardiology, Second Hospital of Jilin University, No. 218 Ziqiang Street, Changchun, 130041, China
| | - Jiajun Ren
- Department of Cardiology, Second Hospital of Jilin University, No. 218 Ziqiang Street, Changchun, 130041, China
| | - Gang Hui
- Department of Cardiology, Second Hospital of Jilin University, No. 218 Ziqiang Street, Changchun, 130041, China
| | - Chao Qi
- Department of Cardiology, Second Hospital of Jilin University, No. 218 Ziqiang Street, Changchun, 130041, China
| | - Junnan Wang
- Department of Cardiology, Second Hospital of Jilin University, No. 218 Ziqiang Street, Changchun, 130041, China.
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Lunardi M, Zivelonghi C, van den Brink FS, Ghione M, Vinco G, Benfari G, Scarsini R, Ribichini F, Agostoni P. Drug eluting balloon for the treatment of patients with coronary artery disease: Current perspectives. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:215-220. [DOI: 10.1016/j.carrev.2017.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/03/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
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Chae IH, Yoon CH, Park JJ, Oh IY, Suh JW, Cho YS, Youn TJ, Choi DJ. Comparison of Drug-Eluting Balloon Followed by Bare Metal Stent with Drug-Eluting Stent for Treatment of de Novo Lesions: Randomized, Controlled, Single-Center Clinical Trial. J Korean Med Sci 2017; 32:933-941. [PMID: 28480650 PMCID: PMC5426232 DOI: 10.3346/jkms.2017.32.6.933] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 03/19/2017] [Indexed: 01/03/2023] Open
Abstract
The combined use of a drug-eluting balloon (DEB) and a bare metal stent (BMS) for the treatment of de novo non-small vessel coronary artery diseases (CAD) remains to be evaluated. We investigated the efficacy of a sequential treatment using a DEB together with a BMS implantation in comparison to a zotarolimus-eluting stent (ZES). This study was a prospective, randomized, open-label study. We designed it to demonstrate the non-inferiority of a sequential treatment using a DEB first followed by a BMS (DEB + BMS) compared with the use of a ZES. The primary endpoint was in-segment late loss (LL) at 9 months measured by quantitative coronary angiography (QCA). A total of 180 patients were enrolled in the study. The 9-month follow-up angiography was performed in 72 patients with DEB + BMS and 74 patients with ZES. When comparing the DEB + BMS results with the ZES ones, LL was 0.50 ± 0.46 mm in DEB + BMS patients vs. 0.21 ± 0.44 mm in ZES patients (P < 0.001). The mean difference of the LL was 0.31 mm, which was larger than the prespecified non-inferiority margin of 0.19 mm, and the 2-sided 95% confidence interval was 0.15-0.48. The clinical outcomes were not significantly different. In conclusion, the DEB + BMS strategy is inferior to the ZES one in terms of the LL result at 9 months. The DEB strategy for de novo coronary artery lesions needs to be improved for it to become an alternative treatment option.
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Affiliation(s)
- In Ho Chae
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chang Hwan Yoon
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Jin Joo Park
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Il Young Oh
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Won Suh
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Seok Cho
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae Jin Youn
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Ju Choi
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
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Cui K, Lyu S, Song X, Yuan F, Xu F, Zhang M, Wang W, Zhang D, Dai J. Drug-eluting balloon versus bare-mental stent and drug-eluting stent for de novo coronary artery disease: A systematic review and meta-analysis of 14 randomized controlled trials. PLoS One 2017; 12:e0176365. [PMID: 28445555 PMCID: PMC5405921 DOI: 10.1371/journal.pone.0176365] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 04/10/2017] [Indexed: 12/30/2022] Open
Abstract
Background Drug-eluting balloon (DEB) has become an alternative option to drug-eluting stent (DES) for the treatment of in-stent restenosis (ISR). However, the effect of drug-eluting balloon with regular bare-mental stent (BMS) in de novo coronary artery disease (CAD) is unclear. This meta-analysis aimed to evaluate the efficacy of DEB with regular BMS compared to BMS or DES in de novo CAD. Methods Randomized controlled trials (RCTs) assessing the efficacy of DEB+BMS in comparison with BMS or DES were obtained by searching the PubMed, EMBASE, and Cochrane Library databases through January 2016. Primary endpoints were major adverse cardiac events (MACEs) and late lumen loss (LLL). Secondary endpoints included death, myocardial infarction (MI), target lesion revascularization (TLR), stent thrombosis (ST), binary restenosis, and minimum lumen diameter (MLD). Dichotomous and continuous data were presented as odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs), respectively, and analyzed using a random-effects model. Results A total of 14 RCTs involving 2281 patients were included in this meta-analysis. DEB+BMS showed significantly less MACEs (OR: 0.67, 95%CI 0.45 to 0.99, P = 0.04) and reduced LLL (MD: -0.30 mm, 95%CI: -0.48 mm to -0.11 mm, P = 0.001) compared with BMS. Meanwhile, treatment with DEB+BMS had disadvantages over DES in terms of MACEs (OR: 1.94, 95%CI 1.24 to 3.05, P = 0.004), LLL (MD: 0.20 mm, 95%CI: 0.07 mm to 0.33 mm, P = 0.003), TLR (OR: 2.53, 95% CI 1.36 to 4.72, P = 0.003), and MLD (MD: -0.25 mm, 95%CI: -0.42 mm to -0.09 mm, P = 0.003). Conclusions This limited evidence demonstrated that treatment with DEB+BMS appears to be effective in de novo CAD. In addition, DEB+ BMS clearly showed superiority to BMS, but is inferior to DES in the treatment of patients with de novo CAD. Hence, DES (especially new generation DES) should be recommended for patients with de novo CAD.
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Affiliation(s)
- Kongyong Cui
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Shuzheng Lyu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
- * E-mail:
| | - Xiantao Song
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Fei Yuan
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Feng Xu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Min Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Wei Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Dongfeng Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jing Dai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
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Lu W, Zhu Y, Han Z, Wang X, Wang X, Qiu C. Drug-coated balloon in combination with bare metal stent strategy for de novo coronary artery disease: A PRISMA-compliant meta-analysis of randomized clinical trials. Medicine (Baltimore) 2017; 96:e6397. [PMID: 28328833 PMCID: PMC5371470 DOI: 10.1097/md.0000000000006397] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Studies examining the efficiency of drug-coated balloon (DCB) + bare metal stent (BMS) compared with stents alone for de novo lesions have reported inconsistent results. The present comprehensive meta-analysis of randomized controlled trials (RCTs) assessed and compared the clinical efficacy and safety of DCB + BMS with those of stents alone for de novo coronary artery disease. METHODS We formally searched electronic databases before September 2016 to identify potential studies. All RCTs were eligible for inclusion if they compared DCB + BMS with a control treatment (drug-eluting stent [DES] alone or BMS alone) in patients with de novo coronary artery disease. RESULTS Eleven RCTs with a total of 2196 patients met the inclusion criteria were included in our meta-analysis. Subgroup analysis indicated DCB plus BMS was associated with poorer outcomes when compared with DES alone in primary endpoint {(in-segment late lumen loss [LLL]: mean difference [MD], 0.19; 95% confidence interval [CI], 0.06-0.32; P = 0.0042) and (major adverse cardiovascular events [MACEs]: risk ratio [RR], 1.88; 95% CI, 1.44-2.45; P < 0.0001)}. However, DCB + BMS had nonsignificantly lower LLL than BMS alone (in-segment LLL: MD, -0.14; 95% CI, -0.33-0.04; P = 0.24), and was more advantageous in reducing MACE incidence, with borderline significance (MACEs: RR, 0.67; 95% CI, 0.45-0.99; P = 0.05). CONCLUSIONS In summary, the present results do not favor the DCB + BMS strategy as an alternative therapeutic method to DES implantation for de novo coronary artery lesions in percutaneous coronary intervention (PCI). Additional well-designed large RCTs with long-follow-up periods are required to clarify the inconsistent results.
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Claessen BE, Henriques JP, Dangas GD. Specialized Balloons in Percutaneous Coronary Intervention. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Bimmer E.P.M. Claessen
- Department of Cardiology; Academic Medical Center-University of Amsterdam; Amsterdam the Netherlands
| | - José P.S. Henriques
- Department of Cardiology; Academic Medical Center-University of Amsterdam; Amsterdam the Netherlands
| | - George D. Dangas
- Department of Cardiology; Mount Sinai Medical Center; New York NY USA
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15
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Safety of bailout stenting after paclitaxel-coated balloon angioplasty. Herz 2016; 42:684-689. [PMID: 27858114 DOI: 10.1007/s00059-016-4502-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 10/19/2016] [Accepted: 10/19/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND Bailout stenting after suboptimal paclitaxel-coated balloon (PCB) angioplasty is required in up to 28% of cases. We sought to compare the safety of bailout stenting with drug-eluting stents (DES) compared with the more established combination of PCB with bare metal stents (BMS). METHODS We retrospectively evaluated all patients who had stents implanted owing to suboptimal PCB angioplasty results between January 2010 and April 2015. Endpoints analyzed were major adverse cardiac events (MACE) - defined as cardiovascular death, nonfatal myocardial infarction (MI), and target lesion revascularization (TLR) - as well as major and minor bleeding. RESULTS Baseline clinical characteristics were comparable with a high proportion of diabetics in both groups (50.0% vs. 45.8%, p = 0.74). BMS and DES sizes were similar (mean diameter 2.72 ± 0.50 mm vs. 2.89 ± 0.56 mm, p = 0.20, length 25.22 ± 13.47 mm vs. 28.08 ± 9.08 mm, p = 0.47). Outcomes were comparable at the end of 1 year (MACE 12.2% vs. 9.5%, p = 1.00, TLR 6.1% vs. 4.8%, p = 1.00, MI 0% vs. 4.8%, p = 0.30). There was no case of stent thrombosis or major bleeding, and the rates of minor bleeding were similar (4.2% vs. 4.8%, p = 1.00). CONCLUSION Our initial experience using DES instead of BMS as a bailout after suboptimal PCB results shows that the procedure is safe and effective at 1 year.
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Alfonso F, García-Guimaraes M, Navarrete G, Cuesta J, Bastante T, Benedicto A, Rivero F, Cortese B. Drug-eluting balloons in coronary interventions: the quiet revolution? Expert Opin Drug Deliv 2016; 14:841-850. [DOI: 10.1080/17425247.2017.1245291] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Gonzalo Navarrete
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Javier Cuesta
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Teresa Bastante
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Amparo Benedicto
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Fernando Rivero
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
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Richelsen RKB, Overvad TF, Jensen SE. Drug-Eluting Balloons in the Treatment of Coronary De Novo Lesions: A Comprehensive Review. Cardiol Ther 2016; 5:133-160. [PMID: 27384194 PMCID: PMC5125107 DOI: 10.1007/s40119-016-0064-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Indexed: 01/03/2023] Open
Abstract
Drug-eluting balloons (DEBs) have emerged as a new application in percutaneous coronary intervention. DEBs have proven successful in the treatment of in-stent restenosis, but their role in de novo lesions is less clear. This paper provides a review of the current studies where DEBs have been used in coronary de novo lesions, either as part of a DEB-only strategy or in combination with another device, mainly a bare metal stent (BMS). By searching Pubmed and Embase we were able to identify 52 relevant studies, differing in design, intervention, and clinical setting, including patients with small vessel disease, bifurcation lesions, complex long lesions, acute myocardial infarction, diabetes mellitus, and elderly. In 23 studies, a DEB was combined with a BMS, 25 studies used a DEB-only strategy with only provisional BMS implantation, and four studies combined a DEB with a drug-eluting stent (DES). In the vast majority of studies, DEB in combination with BMS does not seem to improve clinical or angiographic outcome compared with DES, whereas a DEB-only strategy seems promising, especially when predilatation and geographical mismatch are taken into account. A lower risk of recurrent thrombosis with DEB compared with DES is not evident from the current studies. In conclusion, the main indication for DEB seems to be small vessel disease, especially in clinical scenarios in which a contraindication to dual antiplatelet therapy exists. The main approach should be a DEB-only strategy with only provisional bailout stenting, which has shown interesting results in different clinical scenarios. In general, larger randomized controlled studies with prolonged follow-up comparing DEB with best in class DES are warranted. Technical developments of DEBs including the use of different drugs might potentially improve the efficacy of such treatment.
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Affiliation(s)
| | - Thure Filskov Overvad
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Svend Eggert Jensen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Drug-eluting balloons in the treatment of de-novo coronary lesions: a meta-analysis of randomized-controlled trials. Coron Artery Dis 2016; 27:467-77. [PMID: 27100660 DOI: 10.1097/mca.0000000000000372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM The aim of this meta-analysis was to evaluate the efficacy of drug-eluting balloons (DEBs) plus bare-metal stents (BMS) for the treatment of de-novo coronary lesions. METHODS AND RESULTS Eleven trials involving 1279 patients were included in this study. The main endpoints were as follows: late lumen loss (LLL), binary restenosis, stent thrombosis (ST), and major adverse cardiovascular events (MACEs). The definition of MACEs was a composite of death, myocardial infarction (MI), and target lesion revascularization (TLR). Compared with BMS alone, DEB plus BMS showed a lower risk for LLL (P=0.007) and MACEs (P=0.010). There were no significant differences in binary restenosis (P=0.212), ST (P=0.199), death (P=0.141), MI (P=0.439), and TLR (P=0.340). Compared with drug-eluting stents (DES), DEB plus BMS could increase the risk of LLL (P=0.002) and MACEs (P=0.026). The risks of binary restenosis (P=0.113), ST (P=0.832), death (P=0.115), MI (P=0.831), and TLR (P=0.111) were similar between DEB plus BMS and DES. CONCLUSION DEB plus BMS was better than BMS alone in reducing LLL and MACEs, especially when dilatation was performed after stenting for de-novo coronary lesions, but it was inferior to DES. Therefore, the treatment strategy with DEB plus BMS should not be recommended for de-novo coronary lesions, except for patients who have contraindications for DES.
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Clever YP, Peters D, Calisse J, Bettink S, Berg MC, Sperling C, Stoever M, Cremers B, Kelsch B, Böhm M, Speck U, Scheller B. Novel Sirolimus–Coated Balloon Catheter. Circ Cardiovasc Interv 2016; 9:e003543. [DOI: 10.1161/circinterventions.115.003543] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 03/06/2016] [Indexed: 11/16/2022]
Abstract
Background—
Limus-eluting stents are dominating coronary interventions, although paclitaxel is the only drug on balloon catheters with proven inhibition of restenosis. Neointimal inhibition by limus-coated balloons has been shown in few animal studies, but data from randomized clinical trials are not available. The aim of the present preclinical studies was to achieve high and persistent sirolimus levels in the vessel wall after administration by a coated balloon.
Methods and Results—
Different coating formulations and doses were studied in the porcine coronary model to investigate sirolimus tissue levels at different time points as well as efficacy at 1 month using quantitative coronary angiography and histomorphometry. Loss of the selected coating in the valve, guiding catheter, and blood was low (2±14% of dose). Acute drug transfer to the vessel wall was 14.4±4.6% with the crystalline coating, whereas the amorphous coatings were less effective in this respect. Persistence of sirolimus in the vessel wall until 1 month was 40% to 50% of the transferred drug. At 1-month follow-up, a modest but significant reduction of neointimal growth was demonstrated in a dose range from 4 μg/mm
2
to 2×7 μg/mm
2
, for example, maximum neointimal thickness of 0.38±0.13 versus 0.65±0.21 mm in the uncoated control group.
Conclusions—
Various sirolimus-coated balloons effectively reduce neointimal proliferation in the porcine coronary model but differ considerably in retention time in the vessel wall. It has to be determined if such a formulation with persistent high vessel concentration will result in a relevant clinical effect.
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Affiliation(s)
- Yvonne Patricia Clever
- From the Klinik für Innere Medizin III, Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (Y.P.C., S.B., B.C., M.B., B.S.); Institut für Radiologie, Charité—Universitätsmedizin Berlin, Campus Mitte, Humboldt Universität zu Berlin, Germany (D.P., B.K., U.S.); and B. Braun Melsungen AG, Berlin, Germany (J.C., M.-C.B., C.S., M.S.)
| | - Daniel Peters
- From the Klinik für Innere Medizin III, Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (Y.P.C., S.B., B.C., M.B., B.S.); Institut für Radiologie, Charité—Universitätsmedizin Berlin, Campus Mitte, Humboldt Universität zu Berlin, Germany (D.P., B.K., U.S.); and B. Braun Melsungen AG, Berlin, Germany (J.C., M.-C.B., C.S., M.S.)
| | - Jorge Calisse
- From the Klinik für Innere Medizin III, Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (Y.P.C., S.B., B.C., M.B., B.S.); Institut für Radiologie, Charité—Universitätsmedizin Berlin, Campus Mitte, Humboldt Universität zu Berlin, Germany (D.P., B.K., U.S.); and B. Braun Melsungen AG, Berlin, Germany (J.C., M.-C.B., C.S., M.S.)
| | - Stephanie Bettink
- From the Klinik für Innere Medizin III, Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (Y.P.C., S.B., B.C., M.B., B.S.); Institut für Radiologie, Charité—Universitätsmedizin Berlin, Campus Mitte, Humboldt Universität zu Berlin, Germany (D.P., B.K., U.S.); and B. Braun Melsungen AG, Berlin, Germany (J.C., M.-C.B., C.S., M.S.)
| | - Madeleine-Caroline Berg
- From the Klinik für Innere Medizin III, Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (Y.P.C., S.B., B.C., M.B., B.S.); Institut für Radiologie, Charité—Universitätsmedizin Berlin, Campus Mitte, Humboldt Universität zu Berlin, Germany (D.P., B.K., U.S.); and B. Braun Melsungen AG, Berlin, Germany (J.C., M.-C.B., C.S., M.S.)
| | - Christian Sperling
- From the Klinik für Innere Medizin III, Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (Y.P.C., S.B., B.C., M.B., B.S.); Institut für Radiologie, Charité—Universitätsmedizin Berlin, Campus Mitte, Humboldt Universität zu Berlin, Germany (D.P., B.K., U.S.); and B. Braun Melsungen AG, Berlin, Germany (J.C., M.-C.B., C.S., M.S.)
| | - Michael Stoever
- From the Klinik für Innere Medizin III, Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (Y.P.C., S.B., B.C., M.B., B.S.); Institut für Radiologie, Charité—Universitätsmedizin Berlin, Campus Mitte, Humboldt Universität zu Berlin, Germany (D.P., B.K., U.S.); and B. Braun Melsungen AG, Berlin, Germany (J.C., M.-C.B., C.S., M.S.)
| | - Bodo Cremers
- From the Klinik für Innere Medizin III, Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (Y.P.C., S.B., B.C., M.B., B.S.); Institut für Radiologie, Charité—Universitätsmedizin Berlin, Campus Mitte, Humboldt Universität zu Berlin, Germany (D.P., B.K., U.S.); and B. Braun Melsungen AG, Berlin, Germany (J.C., M.-C.B., C.S., M.S.)
| | - Bettina Kelsch
- From the Klinik für Innere Medizin III, Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (Y.P.C., S.B., B.C., M.B., B.S.); Institut für Radiologie, Charité—Universitätsmedizin Berlin, Campus Mitte, Humboldt Universität zu Berlin, Germany (D.P., B.K., U.S.); and B. Braun Melsungen AG, Berlin, Germany (J.C., M.-C.B., C.S., M.S.)
| | - Michael Böhm
- From the Klinik für Innere Medizin III, Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (Y.P.C., S.B., B.C., M.B., B.S.); Institut für Radiologie, Charité—Universitätsmedizin Berlin, Campus Mitte, Humboldt Universität zu Berlin, Germany (D.P., B.K., U.S.); and B. Braun Melsungen AG, Berlin, Germany (J.C., M.-C.B., C.S., M.S.)
| | - Ulrich Speck
- From the Klinik für Innere Medizin III, Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (Y.P.C., S.B., B.C., M.B., B.S.); Institut für Radiologie, Charité—Universitätsmedizin Berlin, Campus Mitte, Humboldt Universität zu Berlin, Germany (D.P., B.K., U.S.); and B. Braun Melsungen AG, Berlin, Germany (J.C., M.-C.B., C.S., M.S.)
| | - Bruno Scheller
- From the Klinik für Innere Medizin III, Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (Y.P.C., S.B., B.C., M.B., B.S.); Institut für Radiologie, Charité—Universitätsmedizin Berlin, Campus Mitte, Humboldt Universität zu Berlin, Germany (D.P., B.K., U.S.); and B. Braun Melsungen AG, Berlin, Germany (J.C., M.-C.B., C.S., M.S.)
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Cheng Y, Leon MB, Granada JF. An update on the clinical use of drug-coated balloons in percutaneous coronary interventions. Expert Opin Drug Deliv 2016; 13:859-72. [PMID: 26924794 DOI: 10.1517/17425247.2016.1154530] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Drug-coated balloons (DCB) promise to deliver anti-proliferative drugs and prevent restenosis leaving nothing behind. Although, randomized clinical trials have demonstrated their efficacy for the treatment of in-stent restenosis, clinical evidence supporting their use in other coronary applications is still lacking. AREAS COVERED This review summarizes the development status of clinically available DCB technologies and provides an update on the current data for their coronary use. EXPERT OPINION Current generation DCB prevent restenosis by delivering paclitaxel particles on the surface of the vessel wall. Although clinically available technologies share a common mechanism of action, important differences in pharmacokinetic behavior and safety profiles do exist. Future technological improvements include the development of coatings displaying: high transfer efficiency; low particle embolization potential; and alternative drug formulations. Optimized balloon-based delivery systems and drug encapsulation technologies also promise to improve the technical limitations of current generation DCB. Although proving clinical superiority against DES may prove to be difficult in mainstream applications (i.e., de novo), new generation DCB technologies have the potential to achieve a strong position in the interventional field in clinical settings in which the efficacy of DES use is not proven or justified (i.e., bifurcations).
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Affiliation(s)
- Yanping Cheng
- a CRF-Skirball Center for Innovation , Orangeburg , NY , USA
| | - Martin B Leon
- b Center for Interventional Vascular Therapy , Columbia University Medical Center , New York , NY , USA
| | - Juan F Granada
- a CRF-Skirball Center for Innovation , Orangeburg , NY , USA
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21
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Cortese B, Silva Orrego P, Agostoni P, Buccheri D, Piraino D, Andolina G, Seregni RG. Effect of Drug-Coated Balloons in Native Coronary Artery Disease Left With a Dissection. JACC Cardiovasc Interv 2015; 8:2003-2009. [PMID: 26627997 DOI: 10.1016/j.jcin.2015.08.029] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 06/30/2015] [Accepted: 08/17/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The authors sought to understand the clinical and angiographic outcomes of dissections left after drug-coated balloon (DCB) angioplasty. BACKGROUND Second-generation DCB may be an alternative to stents in selected populations for the treatment of native coronary lesions. However, the use of these devices may be hampered by a certain risk of acute vessel recoil or residual coronary dissection. Moreover, stenting after DCB has shown limited efficacy. Little is known about when a non-flow-limiting dissection is left after DCB angioplasty. METHODS This was a prospective observational study whose aim was to investigate the outcome of a consecutive series of patients with native coronary artery disease treated with second-generation DCB and residual coronary dissection at 2 Italian centers. We evaluated patient clinical conditions at 1 and 9 months, and angiographic follow up was undertaken at 6 months. RESULTS Between July 2012 and July 2014, 156 patients were treated with DCB for native coronary artery disease. Fifty-two patients had a final dissection, 4 of which underwent prosthesis implantation and 48 were left untreated and underwent angiographic follow-up after 201 days (interquartile range: 161 to 250 days). The dissections were all type A to C, and none determined an impaired distal flow. Complete vessel healing at angiography was observed in 45 patients (93.8%), whereas 3 patients had persistent but uncomplicated dissections, and 3 had binary restenosis (6.2%). Late lumen loss was 0.14 mm (-0.14 to 0.42). Major adverse cardiovascular events occurred in 11 patients in the entire cohort and in 4 of the dissection cohort (7.2% vs. 8.1%; p = 0.48). We observed 8 and 3 target lesion revascularizations, respectively (5.3% vs. 6.2%; p = 0.37). CONCLUSIONS In this cohort of consecutive patients treated with new-generation DCB and left with a final dissection, this strategy of revascularization seemed associated with the sealing of most of dissections and without significant neointimal hyperplasia.
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Affiliation(s)
| | | | | | - Dario Buccheri
- Cardiac Department, A.O. Fatebenefratelli, Milano, Italy; Cardiac Department, A.O.U.P. Paolo Giaccone, Palermo, Italy
| | - Davide Piraino
- Cardiac Department, A.O. Fatebenefratelli, Milano, Italy; Cardiac Department, A.O.U.P. Paolo Giaccone, Palermo, Italy
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Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A. 2014 ESC/EACTS guidelines on myocardial revascularization. EUROINTERVENTION 2015; 10:1024-94. [PMID: 25187201 DOI: 10.4244/eijy14m09_01] [Citation(s) in RCA: 211] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Stephan Windecker
- Cardiology, Bern University Hospital, Freiburgstrasse 4, CH-3010 Bern, Switzerland
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23
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De Maria GL, Porto I, Burzotta F, Brancati MF, Trani C, Pirozzolo G, Leone AM, Niccoli G, Prati F, Crea F. Dual role of circulating endothelial progenitor cells in stent struts endothelialisation and neointimal regrowth: A substudy of the IN-PACT CORO trial. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 16:20-6. [DOI: 10.1016/j.carrev.2014.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 10/15/2014] [Accepted: 10/22/2014] [Indexed: 11/13/2022]
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Poerner TC, Otto S, Gassdorf J, Nitsche K, Janiak F, Scheller B, Goebel B, Jung C, Figulla HR. Stent coverage and neointimal proliferation in bare metal stents postdilated with a Paclitaxel-eluting balloon versus everolimus-eluting stents: prospective randomized study using optical coherence tomography at 6-month follow-up. Circ Cardiovasc Interv 2014; 7:760-7. [PMID: 25371536 DOI: 10.1161/circinterventions.113.001146] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND In this randomized trial, strut coverage and neointimal proliferation of a therapy of bare metal stents (BMSs) postdilated with the paclitaxel drug-eluting balloon (DEB) was compared with everolimus drug-eluting stents (DESs) at 6-month follow-up using optical coherence tomography. We hypothesized sufficient stent coverage at follow-up. METHODS AND RESULTS A total of 105 lesions in 90 patients were treated with either XIENCE V DES (n=51) or BMS postdilated with the SeQuent Please DEB (n=54). At follow-up, comparable results on the primary optical coherence tomography end point (percentage uncovered struts 5.64±9.65% in BMS+DEB versus 4.93±9.29% in DES; P=0.366) were found. Thus, BMS+DEB achieved the prespecified noninferiority margin of 5% uncovered struts versus DES (difference between treatment means, 0.71%; one-sided upper 95% confidence interval, 4.14%; noninferiority P=0.04). Optical coherence tomography analysis showed significantly more global neointimal proliferation in the BMS+DEB group (15.7±7.8 versus 11.0±5.2 mm(3) proliferation volume/cm stent length; P=0.002). No significant focal in-stent stenosis analyzed with angiography (percentage diameter stenosis at follow-up, 22.8±11.9 versus 16.9±10.4; P=0.014) and optical coherence tomography (peak local area stenosis, 39.5±13.8% versus 36.8±15.6%; P=0.409) was found. CONCLUSIONS Good stent strut coverage of >94% was found in both therapy groups. Despite greater suppression of global neointimal growth in DES, both DES and BMS+DEB effectively prevented clinically relevant focal restenosis at 6-month follow-up. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT01056744.
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Affiliation(s)
- Tudor C Poerner
- From the 1st Department of Medicine, Division of Cardiology, University Hospital of Jena, Jena, Germany (T.C.P., S.O., J.G., K.N., F.J., B.G., C.J., H.R.F.); and Clinical and Experimental Interventional Cardiology, Internal Medicine III, University of Saarland, Saarbrücken, Germany (B.S.)
| | - Sylvia Otto
- From the 1st Department of Medicine, Division of Cardiology, University Hospital of Jena, Jena, Germany (T.C.P., S.O., J.G., K.N., F.J., B.G., C.J., H.R.F.); and Clinical and Experimental Interventional Cardiology, Internal Medicine III, University of Saarland, Saarbrücken, Germany (B.S.).
| | - Johannes Gassdorf
- From the 1st Department of Medicine, Division of Cardiology, University Hospital of Jena, Jena, Germany (T.C.P., S.O., J.G., K.N., F.J., B.G., C.J., H.R.F.); and Clinical and Experimental Interventional Cardiology, Internal Medicine III, University of Saarland, Saarbrücken, Germany (B.S.)
| | - Kristina Nitsche
- From the 1st Department of Medicine, Division of Cardiology, University Hospital of Jena, Jena, Germany (T.C.P., S.O., J.G., K.N., F.J., B.G., C.J., H.R.F.); and Clinical and Experimental Interventional Cardiology, Internal Medicine III, University of Saarland, Saarbrücken, Germany (B.S.)
| | - Florian Janiak
- From the 1st Department of Medicine, Division of Cardiology, University Hospital of Jena, Jena, Germany (T.C.P., S.O., J.G., K.N., F.J., B.G., C.J., H.R.F.); and Clinical and Experimental Interventional Cardiology, Internal Medicine III, University of Saarland, Saarbrücken, Germany (B.S.)
| | - Bruno Scheller
- From the 1st Department of Medicine, Division of Cardiology, University Hospital of Jena, Jena, Germany (T.C.P., S.O., J.G., K.N., F.J., B.G., C.J., H.R.F.); and Clinical and Experimental Interventional Cardiology, Internal Medicine III, University of Saarland, Saarbrücken, Germany (B.S.)
| | - Björn Goebel
- From the 1st Department of Medicine, Division of Cardiology, University Hospital of Jena, Jena, Germany (T.C.P., S.O., J.G., K.N., F.J., B.G., C.J., H.R.F.); and Clinical and Experimental Interventional Cardiology, Internal Medicine III, University of Saarland, Saarbrücken, Germany (B.S.)
| | - Christian Jung
- From the 1st Department of Medicine, Division of Cardiology, University Hospital of Jena, Jena, Germany (T.C.P., S.O., J.G., K.N., F.J., B.G., C.J., H.R.F.); and Clinical and Experimental Interventional Cardiology, Internal Medicine III, University of Saarland, Saarbrücken, Germany (B.S.)
| | - Hans R Figulla
- From the 1st Department of Medicine, Division of Cardiology, University Hospital of Jena, Jena, Germany (T.C.P., S.O., J.G., K.N., F.J., B.G., C.J., H.R.F.); and Clinical and Experimental Interventional Cardiology, Internal Medicine III, University of Saarland, Saarbrücken, Germany (B.S.)
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Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2014; 35:2541-619. [PMID: 25173339 DOI: 10.1093/eurheartj/ehu278] [Citation(s) in RCA: 3320] [Impact Index Per Article: 332.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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26
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López Mínguez JR, Nogales Asensio JM, Doncel Vecino LJ, Sandoval J, Romany S, Martínez Romero P, Fernández Díaz JA, Fernández Portales J, González Fernández R, Martínez Cáceres G, Merchán Herrera A, Alfonso Manterola F. A prospective randomised study of the paclitaxel-coated balloon catheter in bifurcated coronary lesions (BABILON trial): 24-month clinical and angiographic results. EUROINTERVENTION 2014; 10:50-7. [DOI: 10.4244/eijv10i1a10] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Liistro F, Porto I, Angioli P, Grotti S, Ducci K, Falsini G, Bolognese L. Elutax paclitaxel-eluting balloon followed by bare-metal stent compared with Xience V drug-eluting stent in the treatment of de novo coronary stenosis: a randomized trial. Am Heart J 2013; 166:920-6. [PMID: 24176449 DOI: 10.1016/j.ahj.2013.08.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 08/07/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Paclitaxel-eluting balloons (PEBs) are a promising alternative to drug-eluting stent (DES) in the treatment of coronary stenoses. The aim of our study was to compare the 9-month restenosis rates of a strategy of predilatation with PEB followed by bare-metal CoCr stent (PEB + BMS group) versus implantation of everolimus DES (DES group). METHODS This randomized, single-center study planned to enroll 366 patients with stable angina (183 patients per arm) undergoing percutaneous coronary intervention of a de novo, native coronary artery stenosis ≤ 15 mm in length. Primary end point, in a noninferiority study design, was 9-month binary angiographic restenosis. A frequency-domain optical coherence tomography substudy investigated the percentage of uncovered stent struts per lesion, the percentage of malapposed/uncovered struts per lesion, and the percentage of net volume obstruction at 9-month follow-up among the first consecutive 30 patients enrolled in the PEB + BMS group. RESULTS The study was prematurely halted after enrollment of 125 patients, 59 in the PEB + BMS group and 66 in the DES group, because of excess of ischemia-driven target lesion revascularization in the PEB + BMS group. When all the enrolled patients completed their follow-up, IDLTR rates were 14% in the PEB + BMS versus 2% in DES group (P = .001). Binary restenosis, either in-stent or in-segment, was significantly higher in the PEB + BMS compared with DES group (17% vs 3% [P = .01] and 25% vs 4% [P = .009] respectively). Frequency-domain optical coherence tomography demonstrated important neointimal regrowth in the PEB + BMS group, similar to historical BMS data. CONCLUSION In the treatment of de novo coronary stenosis, a strategy of predilatation with PEB before BMS implantation was significantly inferior to implantation of an everolimus DES stent in terms of 9-month target lesion revascularization. Frequency-domain optical coherence tomography data confirm the lack of efficacy of this strategy.
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Affiliation(s)
- Francesco Liistro
- Cardiovascular and Neurologic Department, San Donato Hospital, Arezzo, Italy
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28
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Clever YP, Cremers B, Speck U, Dietz U, Böhm M, Scheller B. Influence of a paclitaxel coated balloon in combination with a bare metal stent on restenosis and endothelial function: Comparison with a drug eluting stent and a bare metal stent. Catheter Cardiovasc Interv 2013; 84:323-31. [DOI: 10.1002/ccd.25184] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 07/12/2013] [Accepted: 08/25/2013] [Indexed: 12/17/2022]
Affiliation(s)
- Yvonne P. Clever
- Klinik für Innere Medizin III; Universitätsklinikum des Saarlandes; Homburg/Saar Germany
| | - Bodo Cremers
- Klinik für Innere Medizin III; Universitätsklinikum des Saarlandes; Homburg/Saar Germany
| | - Ulrich Speck
- Institut für Radiologie, Charité; Campus Mitte, Humboldt-Universität zu Berlin; Berlin Germany
| | - Ulrich Dietz
- Deutsche Klinik für Diagnostik; Kardiologie; Wiesbaden Germany
| | - Michael Böhm
- Klinik für Innere Medizin III; Universitätsklinikum des Saarlandes; Homburg/Saar Germany
| | - Bruno Scheller
- Klinik für Innere Medizin III; Universitätsklinikum des Saarlandes; Homburg/Saar Germany
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Cassese S, Kastrati A. Not all drug-eluting balloons are equally good for patients, not all patients are equally suitable for drug-eluting balloons. EUROINTERVENTION 2012; 8:417-21. [DOI: 10.4244/eijv8i4a65] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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