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Khawaja M, Britt M, Rizwan A, Abraham J, Nguyen T, Munaf U, Khan MA, Arshad H, Munye M, Newman N, Ielasi A, Eccleshall S, Vassiliou VS, Merinopoulos I, Cortese B, Krittanawong C. Coronary Drug-Coated Balloons: A Comprehensive Review of Clinical Applications and Controversies. Trends Cardiovasc Med 2024:S1050-1738(24)00079-3. [PMID: 39243831 DOI: 10.1016/j.tcm.2024.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 08/27/2024] [Accepted: 08/28/2024] [Indexed: 09/09/2024]
Abstract
Drug-coated balloons have emerged as a promising therapeutic option in the treatment of cardiovascular disease. This review article provides an overview of the concept of drug-coated balloons and their clinical applications in both de novo and treated coronary artery disease. A summary of key clinical trials and registry studies evaluating drug-coated balloons is presented for reference. Overall, this article aims to provide clinicians and researchers with a comprehensive understanding of the current state of drug-coated balloon technology and its implications in clinical practice.
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Affiliation(s)
- Muzamil Khawaja
- Department of Cardiology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Michael Britt
- Department of Internal Medicine, Emory University, Atlanta, GA, 30322, USA
| | - Affan Rizwan
- Department of Internal Medicine, The University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Jocelyn Abraham
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, 75390 USA
| | - Taylor Nguyen
- Division of Hospital Medicine, Northwestern Memorial Hospital; Chicago, IL, 60611
| | - Uzair Munaf
- Department of Internal Medicine, Dow Medical College, 75300, Karachi, Pakistan
| | - Muhammad Asad Khan
- Department of Family Medicine, West Chicago Immediate Care, West Chicago, IL, 60185-2847, USA
| | - Hassaan Arshad
- Department of Internal Medicine, Capital Health Regional Medical Centre, Trenton, NJ, 08638-4143, USA
| | - Muhamed Munye
- Department of Internal Medicine, Emory University, Atlanta, GA, 30322, USA
| | - Noah Newman
- Department of Internal Medicine, Emory University, Atlanta, GA, 30322, USA
| | - Alfonso Ielasi
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Simon Eccleshall
- Department of Cardiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, United Kingdom
| | - Vassilios S Vassiliou
- Department of Cardiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, United Kingdom; Norfolk and Norwich University Hospital NHS Foundation Trust and University of East Anglia, Norwich
| | - Ioannis Merinopoulos
- Department of Cardiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, United Kingdom; Norfolk and Norwich University Hospital NHS Foundation Trust and University of East Anglia, Norwich
| | | | - Chayakrit Krittanawong
- Department of Cardiology, NYU Langone Health and NYU School of Medicine, New York, NY, 10016, USA.
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Lu K, Ye X, Chen Y, Wang P, Gong M, Xuan B, Tang Z, Li M, Hou J, Peng K, Pei H. Research progress of drug eluting balloon in arterial circulatory system. Front Cardiovasc Med 2024; 11:1287852. [PMID: 38601040 PMCID: PMC11005962 DOI: 10.3389/fcvm.2024.1287852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 03/04/2024] [Indexed: 04/12/2024] Open
Abstract
The arterial circulatory system diseases are common in clinical practice, and their treatment options have been of great interest due to their high morbidity and mortality. Drug-eluting balloons, as a new type of endovascular interventional treatment option, can avoid the long-term implantation of metal stents and is a new type of angioplasty without stents, so drug-eluting balloons have better therapeutic effects in some arterial circulatory diseases and have been initially used in clinical practice. In this review, we first describe the development, process, and mechanism of drug-eluting balloons. Then we summarize the current studies on the application of drug-eluting balloons in coronary artery lesions, in-stent restenosis, and peripheral vascular disease. As well as the technical difficulties and complications in the application of drug-eluting balloons and possible management options, in order to provide ideas and help for future in-depth studies and provide new strategies for the treatment of more arterial system diseases.
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Affiliation(s)
- Keji Lu
- Department of Cardiology, The Affiliated Hospital, Southwest Medical University, Luzhou, China
- School of Medical and Life Sciences, Chengdu University of TCM, Chengdu, China
| | - Xianglin Ye
- Department of Cardiology, The Affiliated Hospital, Southwest Medical University, Luzhou, China
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Yaoxuan Chen
- School of Medical and Life Sciences, Chengdu University of TCM, Chengdu, China
| | - Peng Wang
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Meiting Gong
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Bing Xuan
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Zhaobing Tang
- Department of Rehabilitation, The General Hospital of Western Theater Command, Chengdu, China
| | - Meiling Li
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Jun Hou
- Department of Cardiology, Chengdu Third People's Hospital, Chengdu, China
| | - Ke Peng
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Haifeng Pei
- Department of Cardiology, The Affiliated Hospital, Southwest Medical University, Luzhou, China
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
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Giacoppo D, Saucedo J, Scheller B. Coronary Drug-Coated Balloons for De Novo and In-Stent Restenosis Indications. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:100625. [PMID: 39130710 PMCID: PMC11308150 DOI: 10.1016/j.jscai.2023.100625] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 02/20/2023] [Accepted: 02/24/2023] [Indexed: 08/13/2024]
Abstract
Drug-coated balloons are approved outside the United States, not only for the treatment of peripheral arteries but also for coronary arteries. This review describes the technological basics, the scenarios of clinical application, and the current available data from clinical trials for the different coronary indications.
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Affiliation(s)
- Daniele Giacoppo
- Cardiology Department, Alto Vicentino Hospital, Santorso, Italy
- Cardiovascular Research Institute, Mater Private Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
- ISAResearch Center, Deutsches Herzzentrum München, Technisches Universität München, Munich, Germany
| | - Jorge Saucedo
- Cardiology Department, Froedtert Hospital, Medical College of Wisconsin, Milwaukee, Illinois
| | - Bruno Scheller
- Clinical and Experimental Interventional Cardiology, University of Saarland, Homburg/Saar, Germany
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Madaka S, Maddury J, Cader FA. Small-vessel Coronary Angioplasty – Past, Present, and Future. INDIAN JOURNAL OF CARDIOVASCULAR DISEASE IN WOMEN 2023. [DOI: 10.25259/ijcdw_17_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Small-vessel disease (SVD) is an important subset of the population with coronary artery disease which may account for up to 30–70% according to different series. The challenges of SVD interventions are first to detect the true small-vessel size along with the true length of the lesion by intravascular imaging, then to decide about the interventional strategies as there is difficulty in delivering the stent to the lesion, dissections, under expansions of the stent during percutaneous coronary intervention with increased incidence of restenosis, and need for revascularization on the long term as well. Special attention is to be paid to this subset of patients of SVD as the treatment strategies need to be improvised than simple balloon dilatation or stenting with drug-eluting stents. At present, drug-coated or eluting balloon emerging as an improvised strategy for treating these patients with intravascular imaging. This article concentrates on the latest updates in SVD treatment.
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Affiliation(s)
- Sheshidhar Madaka
- Department of Cardiology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India,
| | - Jyotsna Maddury
- Department of Cardiology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India,
| | - F. Aaysha Cader
- Department of Cardiology, Ibrahim Cardiac Hospital and Research Institute, Dhaka, Bangladesh,
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Qian J, Wu Y, Li C, Yin J, Fu G, Wang J, He Y, Ma G, Chen Y, Xia Y, Li L, Ji F, Zeng H, Wei M, Nie S, Jin H, He B, Chen Y, Liu F, Wang H, Sun Y, Xu B, Ge J. Drug-coated balloon for the treatment of small vessel disease: 9 months of angiographic results and 12 months of clinical outcomes of the PEPCAD China SVD study. Catheter Cardiovasc Interv 2023; 101:33-43. [PMID: 36480798 DOI: 10.1002/ccd.30472] [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] [Received: 07/05/2022] [Revised: 09/20/2022] [Accepted: 10/24/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Whether the drug-coated balloons (DCBs)-alone strategy was superior to plain old balloon angioplasty (POBA) in treating SVD remains unknown. AIMS We aimed to evaluate the efficacy and safety of DCBs for the treatment of coronary de novo small vessel disease (SVD) and provide further evidence for extending the clinical indications of DCBs. (ChiCTR1800014966). METHODS Eligible patients were randomized at a 2:1 ratio to receive DCB treatment or POBA in this prospective, multicenter clinical trial. The reference vessel diameter of lesions was visually assessed to be 2.0 to 2.75 mm. The primary endpoint of the study was angiographic in-segment late luminal loss (LLL) at the 9-month follow-up to demonstrate the superiority of DCB treatment to POBA in SVD. The composite clinical endpoints included clinically driven target lesion revascularization (CD-TLR), target lesion failure (TLF), major adverse cardiac events (MACEs), and thrombosis at the 12-month follow-up. RESULTS A total of 270 patients were enrolled (181 for DCB, 89 for POBA) at 18 centers in China. The primary endpoint of 9-month in-segment LLL in the intention-to-treat population was 0.10 ± 0.33 mm with DCB and 0.25 ± 0.38 mm with POBA (p = 0.0027). This difference indicated significant superiority of DCB treatment (95% CI: -0.22, -0.04, psuperiority = 0.0068). The rates of the clinical endpoints-CD-TLR, TLF, and MACEs-were comparable between groups. No thrombosis events were reported. CONCLUSIONS DCB treatment of de novo SVD was superior to POBA with lower 9-month in-segment LLL. The rates of clinical events were comparable between the two devices.
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Affiliation(s)
- Juying Qian
- Department of Cardiology, Zhongshan Hospital Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yizhe Wu
- Department of Cardiology, Zhongshan Hospital Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Chenguang Li
- Department of Cardiology, Zhongshan Hospital Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Jiasheng Yin
- Department of Cardiology, Zhongshan Hospital Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Guosheng Fu
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhenjiang University School of Medicine, Hangzhou, China
| | - Jian'an Wang
- Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Yong He
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Genshan Ma
- Department of Cardiology, Zhongda Hospital Southeast University, Nanjing, China
| | - Yundai Chen
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Yong Xia
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Lang Li
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Fusui Ji
- Department of Cardiology, Beijing Hospital of the Ministry of Health, Beijing, China
| | - Hesong Zeng
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Meng Wei
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Shaoping Nie
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Huigen Jin
- Department of Cardiology, Central Hospital of Putuo District, Shanghai, China
| | - Ben He
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yuguo Chen
- Department of Cardiology, Qilu Hospital of Shandong University, Ji'nan, China
| | - Fan Liu
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hui Wang
- Department of Cardiology, Jiangsu Province Hospital, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yingxian Sun
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, China
| | - Bo Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
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Impact of post physiological assessment after treatment for de novo coronary lesions using drug-coated balloons. Int J Cardiol 2022; 363:11-19. [DOI: 10.1016/j.ijcard.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/28/2022] [Accepted: 06/03/2022] [Indexed: 11/18/2022]
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Kang WC, Park SM, Jang AY, Oh PC, Shin ES, Yu CW, Oh SJ, Kim YH, Won H, Lee SR, Lee SY, Hong YJ, Lee SY, Kim BO, Kim SW. Predictors of Favorable Angiographic Outcomes After Drug-Coated Balloon Use for de novo Small Vessel Coronary Disease (DCB-ONLY). Angiology 2021; 72:986-993. [PMID: 33982603 DOI: 10.1177/00033197211015534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We evaluated the angiographic parameter and clinical outcomes of drug-coated balloon (DCB) to assess the optimal angiographic criteria in de novo small vessel disease (SVD). Patients (n = 424, mean age: 64.4 ± 11.2 years, men: 69.8%) at 20 sites in Korea were prospectively enrolled. The primary end point was late luminal loss (LLL) at 9-month follow-up angiography. Secondary end points included restenosis rates, target lesion failure (TLF), and DCB-related thrombosis during the 12-month follow-up period. We included 403 patients for analysis excluding 21 patients who required bailout stenting. Baseline mean reference vessel .diameter was 2.52 ± 0.39 mm and mean minimal luminal diameter (MLD) was 0.71 ± 0.40 mm. The mean MLD was 1.54 ± 0.37 mm after DCB. Late luminal loss was -0.01 ± 0.43 mm and restenosis was noted in 26 patients (12.2%). Minimal luminal diameter >1.6 mm and %diameter stenosis (DS) <45% after DCB was associated maintenance of MLD without LLL at 9-months. Multivariate analysis demonstrated that %DS at baseline and post-MLD was associated with the restenosis. During 12-month follow-up, TLF was 2.6% including 1 cardiac death, 1 myocardial infarction, and 10 ischemia-driven target lesion revascularizations. Drug-coated balloon showed a low restenosis and lower LLL despite high in-segment DS. Post-MLD and % DS may be helpful to get optimal results in de novo SVD after DCB.
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Affiliation(s)
- Woong Chol Kang
- Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Sang Min Park
- Eulji University Hospital, College of Medicine, Seoul, Republic of Korea
| | - Albert Youngwoo Jang
- Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Pyung Chun Oh
- Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Eun-Seok Shin
- Ulsan Medical Center, Ulsan Hospital, Ulsan, Republic of Korea
| | - Cheol Woong Yu
- Korea University Anam Hospital, Seoul, Republic of Korea
| | | | - Yong Hoon Kim
- Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Hoyoun Won
- Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Sang-Rok Lee
- Chonbuk National University, School of Medicine, Jeonju, Republic of Korea
| | - Sang Yeub Lee
- Chungbuk National University, School of Medicine, Cheongju, Republic of Korea
| | - Young Joon Hong
- Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung Yun Lee
- Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Byung Ok Kim
- Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
| | - Sang-Wook Kim
- Chung-Ang University Hospital, Seoul, Republic of Korea
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Ito R, Ishii H, Oshima S, Nakayama T, Sakakibara T, Kakuno M, Murohara T. Outcomes after drug-coated balloon interventions for de novo coronary lesions in the patients on chronic hemodialysis. Heart Vessels 2021; 36:1646-1652. [PMID: 33895872 DOI: 10.1007/s00380-021-01858-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
The impact of drug-coated balloon (DCB) on hemodialysis (HD) patients with coronary lesions remains unclear. This study aimed to compare outcomes after DCB treatment between HD and non-HD patients with de novo coronary lesions. A total of 235 consecutive patients who electively underwent DCB treatment for de novo coronary lesions were included (HD group: n = 100; non-HD group: n = 135). Angiographic follow-up was performed 6 months after the procedure. Patients were clinically followed up for 2 years. The incidence rates of target lesion revascularization (TLR) and major adverse cardiac events (MACE) were investigated. Diabetes and a history of coronary bypass grafting were more frequent in the HD group than in the non-HD group (69.0% vs. 50.7%, p = 0.007, and 24.0% vs 9.1%, p = 0.013, respectively). The reference diameter and pre-procedural diameter stenosis were greater in the HD group than in the non-HD group (2.49 mm vs. 2.24 mm, p = 0.007, and 65.9% vs. 59.6%, p = 0.015, respectively). Calcification was observed in 65.5% of all lesions, and rotational atherectomy was performed in 30.2% patients. The average diameter of the DCB was 2.51 mm (2.57 mm, HD group vs. 2.47 mm, non-HD group, p = 0.14). Although post-procedural diameter stenosis was similar between the groups, late lumen loss on follow-up angiography was larger in HD patients than in non-HD patients (0.27 mm vs. - 0.03 mm, p = 0.0009). The 2-year rates of freedom from TLR and MACE were lower in HD patients than in non-HD patients [79.3% vs. 91.7%, hazard ratio (HR) 2.76, 95% confidence interval (CI) 1.23-6.77, p = 0.014; and 61.6% vs. 89.4%, HR 4.60, 95% CI 2.30-10.2, p < 0.001, respectively]. In conclusion, the rates of TLR and MACE after DCB treatment were higher in HD patients than in non-HD patients.
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Affiliation(s)
- Ryuta Ito
- Department of Cardiology, Nagoya Kyoritsu Hospital, 1-172 Hokke, Nakagawa-ku, Nagoya, Aichi, 454-0933, Japan.
| | - Hideki Ishii
- Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan.,Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoru Oshima
- Department of Cardiology, Nagoya Kyoritsu Hospital, 1-172 Hokke, Nakagawa-ku, Nagoya, Aichi, 454-0933, Japan
| | - Takuya Nakayama
- Department of Cardiovascular Surgery, Nagoya Kyoritsu Hospital, Nagoya, Japan
| | - Takashi Sakakibara
- Department of Cardiology, Nagoya Kyoritsu Hospital, 1-172 Hokke, Nakagawa-ku, Nagoya, Aichi, 454-0933, Japan
| | - Motohiko Kakuno
- Department of Cardiology, Nagoya Kyoritsu Hospital, 1-172 Hokke, Nakagawa-ku, Nagoya, Aichi, 454-0933, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Yu X, Wang X, Ji F, Zhang W, Yang C, Xu F, Wang F. A Non-inferiority, Randomized Clinical Trial Comparing Paclitaxel-Coated Balloon Versus New-Generation Drug-Eluting Stents on Angiographic Outcomes for Coronary De Novo Lesions. Cardiovasc Drugs Ther 2021; 36:655-664. [PMID: 33713211 PMCID: PMC9270292 DOI: 10.1007/s10557-021-07172-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 11/24/2022]
Abstract
Background Drug-coated balloon (DCB) has been proved efficacy for coronary small vessel disease, but data regarding outcomes of DCB in common de novo lesions (including reference vessel diameter more than 3.0mm) compared with new-generation drug-eluting stent (DES) are lacking. We hypothesized that a DCB-only strategy for coronary de novo lesions would be non-inferior to DES treatment on angiographic outcomes. Methods In this randomized controlled trial, we compared the effect of DCB with DES on late lumen loss (LLL) at 9-month angiographic follow-up and 12-month major adverse cardiac events (MACEs), including death, non-fatal myocardial infarction, target lesion revascularization (TLR), and target vessel revascularization (TVR). Results From July 2017 to July 2018, 288 consecutive patients with reference vessel diameter (RVD) between 2.25 and 4.0mm were screened. After proper pre-dilation, 170 patients were enrolled and randomized to the DCB and the DES groups at 1:1 ratio. Seven patients withdrew the consent forms during hospital stay (1 in DCB group, 6 in DES group). Two patients in DCB group underwent bailout stenting due to severe dissection after DCB release. The primary endpoint of 9-month LLL was −0.19±0.49mm with the DCB versus 0.03±0.64mm with the DES. The one-sided 97.5% upper confidence limit of the difference was −0.04mm, achieving non-inferiority of the DCB compared with the DES (P=0.019). The 12-month cumulative MACE rate was similar in the DCB and DES groups (2.44% vs. 6.33%, P=0.226). Conclusions In this prospective study, the DCB only strategy for de novo lesion was non-inferior to the new-generation DES in terms of 9-month late lumen loss. Supplementary Information The online version contains supplementary material available at 10.1007/s10557-021-07172-4.
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Affiliation(s)
- Xue Yu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100730, Beijing, P. R. China
| | - Xinyue Wang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100730, Beijing, P. R. China
| | - Fusui Ji
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100730, Beijing, P. R. China.
| | - Wenduo Zhang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100730, Beijing, P. R. China
| | - Chenguang Yang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100730, Beijing, P. R. China
| | - Feng Xu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100730, Beijing, P. R. China
| | - Fang Wang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100730, Beijing, P. R. China
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10
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Funayama N, Kayanuma K, Sunaga D, Yamamoto T. Serial assessment of de novo coronary lesions after drug-coated balloon treatment analyzed by intravascular ultrasound: A comparison between acute coronary syndrome and stable angina pectoris. Int J Cardiol 2021; 330:35-40. [PMID: 33539851 DOI: 10.1016/j.ijcard.2021.01.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/19/2020] [Accepted: 01/24/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND This study aimed to assess the serial changes in de novo coronary lesions, including acute coronary syndrome (ACS), treated with a drug-coated balloon (DCB). METHODS In this retrospective single-center study, the intravascular changes in patients with de novo lesions treated with DCB were evaluated with serial intravascular ultrasound (IVUS) pre-procedure, post-procedure, and at follow-up. A two-dimensional IVUS measurement was performed with slices at 1 mm intervals in the treated lesion. RESULTS This study comprised 40 lesions, including 27 lesions with stable angina pectoris (SAP) and 13 ACS. IVUS showed that the median vessel and lumen area increased significantly from pre-procedure to post-procedure and from post-procedure to follow-up. The median plaque area decreased significantly from pre-procedure to post-procedure and follow-up. The IVUS between ACS and SAP demonstrated that the total vessel volume and the total lumen volume increased, and the total atheroma volume decreased significantly from pre- to follow-up in both groups. The percent change in the lumen area increased, and the plaque area decreased significantly in ACS compared to SAP from pre- to post-procedure and follow-up. CONCLUSION The findings of this study suggest that DCB treatment for de novo coronary lesions in patients with ACS and SAP may maintain anatomical patency and increase lumen with positive vessel remodeling and regression of plaque.
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Affiliation(s)
- Naohiro Funayama
- Hokkaido Cardiovascular Hospital, Division of Cardiovascular Medicine, West 13, South 27, Chuou-ku, Sapporo, Hokkaido 064-8622, Japan.
| | - Keigo Kayanuma
- Hokkaido Cardiovascular Hospital, Division of Cardiovascular Medicine, West 13, South 27, Chuou-ku, Sapporo, Hokkaido 064-8622, Japan
| | - Dasiuke Sunaga
- Hokkaido Cardiovascular Hospital, Division of Cardiovascular Medicine, West 13, South 27, Chuou-ku, Sapporo, Hokkaido 064-8622, Japan
| | - Tadashi Yamamoto
- Hokkaido Cardiovascular Hospital, Division of Cardiovascular Medicine, West 13, South 27, Chuou-ku, Sapporo, Hokkaido 064-8622, Japan
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11
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Yamamoto T, Sawada T, Uzu K, Takaya T, Kawai H, Yasaka Y. Possible mechanism of late lumen enlargement after treatment for de novo coronary lesions with drug-coated balloon. Int J Cardiol 2020; 321:30-37. [PMID: 32710988 DOI: 10.1016/j.ijcard.2020.07.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/26/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Drug-coated balloon (DCB) treatment for de novo coronary artery disease has demonstrated late lumen enlargement (LLE) in mid-term follow-up and it was considered as clinical benefit; however, its mechanism and the predictive factor remains unclear. METHODS This study enrolled 46 consecutive patients (54 lesions) treated with DCB, using intravascular ultrasound (IVUS) at the index procedure and at the 9-month follow-up. We measured IVUS parameters at 1-mm intervals and calculated the mean volume of the external elastic membrane (EEM), lumen, and plaque. We calculated the dissection index (DI) defined as summation of the following points, 2: dissection over EEM, 1: intra-EEM dissection, 0: no dissection at every 1-mm interval, and divided by lesion length. RESULTS IVUS showed that there was no flow limiting dissection just after DCB treatment, the mean EEM and lumen volume (LV) had significantly increased while mean plaque volume had significantly decreased at 9 months, and 74.1% lesions exhibited LLE. We divided the patients into three groups according to delta mean LV. Mean EEM volume significantly increased and mean plaque volume significantly decreased in the larger and smaller LLE groups, but not in the non-LLE group. The DI was higher in a descending order in the three groups. The multiple regression analysis demonstrated that the DI was the strongest predictor of the change in mean LV. CONCLUSIONS LLE after DCB treatment may be caused by vessel enlargement and plaque regression. The non-flow limiting larger dissection just after DCB treatment may strongly associate with the intending LLE.
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Affiliation(s)
- Tetsuya Yamamoto
- Hyogo Prefectural Himeji Cardiovascular Center, Division of Cardiovascular Medicine, 520, Saisho-Kou, Himeji, Hyogo 670-0981, Japan
| | - Takahiro Sawada
- Hyogo Prefectural Himeji Cardiovascular Center, Division of Cardiovascular Medicine, 520, Saisho-Kou, Himeji, Hyogo 670-0981, Japan.
| | - Kenzo Uzu
- Hyogo Prefectural Himeji Cardiovascular Center, Division of Cardiovascular Medicine, 520, Saisho-Kou, Himeji, Hyogo 670-0981, Japan
| | - Tomofumi Takaya
- Hyogo Prefectural Himeji Cardiovascular Center, Division of Cardiovascular Medicine, 520, Saisho-Kou, Himeji, Hyogo 670-0981, Japan
| | - Hiroya Kawai
- Hyogo Prefectural Himeji Cardiovascular Center, Division of Cardiovascular Medicine, 520, Saisho-Kou, Himeji, Hyogo 670-0981, Japan
| | - Yoshinori Yasaka
- Hyogo Prefectural Himeji Cardiovascular Center, Division of Cardiovascular Medicine, 520, Saisho-Kou, Himeji, Hyogo 670-0981, Japan
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12
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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: 98] [Impact Index Per Article: 24.5] [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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13
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Cortese B, Di Palma G, Guimaraes MG, Piraino D, Orrego PS, Buccheri D, Rivero F, Perotto A, Zambelli G, Alfonso F. Drug-Coated Balloon Versus Drug-Eluting Stent for Small Coronary Vessel Disease. JACC Cardiovasc Interv 2020; 13:2840-2849. [DOI: 10.1016/j.jcin.2020.08.035] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/28/2020] [Accepted: 08/19/2020] [Indexed: 12/19/2022]
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Laksono S, Setianto B, Surya SP. Drug-eluting balloon: is it useful? Egypt Heart J 2020; 72:80. [PMID: 33175218 PMCID: PMC7658274 DOI: 10.1186/s43044-020-00116-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/30/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Coronary artery disease is one of the major issues in the medical world around the globe. The prevalence tends to increase. The use of coronary intervention is one of the ways often used in the management of coronary artery disease due to its satisfying result from earlier studies. Nowadays, there are several different techniques in coronary intervention: balloon vs stent. MAIN BODY The stent-based vascular interventions are increasingly being used over balloon-based coronary intervention. However, revascularization intervention using stent often have undesirable long-term effects compared to balloon. Besides, stent-based interventions are also considered more expensive, use more complicated techniques, and use more drug regimens. On the other hand, percutaneous coronary intervention techniques using balloons coated by anti-proliferation drugs have begun to be glimpsed by many interventionists. Studies have found many benefits that cannot be given by stent-based intervention therapy. CONCLUSIONS Angioplasty using percutaneous coronary intervention techniques reveals satisfying result compared to conservative medical treatment. The indication and technique of percutaneous coronary intervention is still evolving until now. Currently, percutaneous coronary intervention using stent, either bare-metal stent or drug-eluting stent, is preferred by interventionist. Nevertheless, recent clinical trial favors the using of drug-eluting balloon for percutaneous coronary intervention in terms of both clinical outcome and complication in several scenarios.
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Affiliation(s)
- Sidhi Laksono
- Cardiac Catheterization Laboratory, Department of Cardiology and Vascular Medicine, RSUD Pasar Rebo, Jakarta, Indonesia
- Faculty of Medicine, Universitas Muhammadiyah Prof. DR. Hamka, Tangerang, Indonesia
| | - Budhi Setianto
- Department of Cardiology and Vascular Medicine of National Cardiovascular Center of Harapan Kita, Faculty of Medicine of Universitas Indonesia, Jakarta, Indonesia
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15
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Jeger RV, Farah A, Ohlow MA, Mangner N, Möbius-Winkler S, Weilenmann D, Wöhrle J, Stachel G, Markovic S, Leibundgut G, Rickenbacher P, Osswald S, Cattaneo M, Gilgen N, Kaiser C, Scheller B. Long-term efficacy and safety of drug-coated balloons versus drug-eluting stents for small coronary artery disease (BASKET-SMALL 2): 3-year follow-up of a randomised, non-inferiority trial. Lancet 2020; 396:1504-1510. [PMID: 33091360 DOI: 10.1016/s0140-6736(20)32173-5] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND In the treatment of de-novo coronary small vessel disease, drug-coated balloons (DCBs) are non-inferior to drug-eluting stents (DESs) regarding clinical outcome up to 12 months, but data beyond 1 year is sparse. We aimed to test the long-term efficacy and safety of DCBs regarding clinical endpoints in an all-comer population undergoing percutaneous coronary intervention. METHODS In this prespecified long-term follow-up of a multicentre, randomised, open-label, non-inferiority trial, patients from 14 clinical sites in Germany, Switzerland, and Austria with de-novo lesions in coronary vessels <3 mm and an indication for percutaneous coronary intervention were randomly assigned 1:1 to DCB or second-generation DES and followed over 3 years for major adverse cardiac events (ie, cardiac death, non-fatal myocardial infarction, and target-vessel revascularisation [TVR]), all-cause death, probable or definite stent thrombosis, and major bleeding (Bleeding Academic Research Consortium bleeding type 3-5). Analyses were performed on the full analysis set according to the modified intention-to-treat principle. Dual antiplatelet therapy was recommended for 1 month after DCB and 6 months after DES with stable symptoms, but 12 months with acute coronary syndromes. The study is registered with ClinicalTrials.gov, NCT01574534 and is ongoing. FINDINGS Between April 10, 2012, and Feb 1, 2017, of 883 patients assessed, 758 (86%) patients were randomly assigned to the DCB group (n=382) or the DES group (n=376). The Kaplan-Meier estimate of the rate of major adverse cardiac events was 15% in both the DCB and DES groups (hazard ratio [HR] 0·99, 95% CI 0·68-1·45; p=0·95). The two groups were also very similar concerning the single components of adverse cardiac events: cardiac death (Kaplan-Meier estimate 5% vs 4%, HR 1·29, 95% CI 0·63-2·66; p=0·49), non-fatal myocardial infarction (both Kaplan-Meier estimate 6%, HR 0·82, 95% CI 0·45-1·51; p=0·52), and TVR (both Kaplan-Meier estimate 9%, HR 0·95, 95% CI 0·58-1·56; p=0·83). Rates of all-cause death were very similar in DCB versus DES patients (both Kaplan-Meier estimate 8%, HR 1·05, 95% CI 0·62-1·77; p=0·87). Rates of probable or definite stent thrombosis (Kaplan-Meier estimate 1% vs 2%; HR 0·33, 95% CI 0·07-1·64; p=0·18) and major bleeding (Kaplan-Meier estimate 2% vs 4%, HR 0·43, 95% CI 0·17-1·13; p=0·088) were numerically lower in DCB versus DES, however without reaching significance. INTERPRETATION There is maintained efficacy and safety of DCB versus DES in the treatment of de-novo coronary small vessel disease up to 3 years. FUNDING Swiss National Science Foundation, Basel Cardiovascular Research Foundation, and B Braun Medical.
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Affiliation(s)
- Raban V Jeger
- University Hospital Basel, University of Basel, Basel, Switzerland.
| | - Ahmed Farah
- Knappschaftskrankenhaus, Klinikum Westfalen, Dortmund, Germany
| | | | - Norman Mangner
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | | | | | - Jochen Wöhrle
- Klinikum Friedrichshafen, Medical Campus Lake Constance, Friedrichshafen, Germany
| | - Georg Stachel
- Heart Center Leipzig, University Hospital, Leipzig, Germany
| | | | | | | | - Stefan Osswald
- University Hospital Basel, University of Basel, Basel, Switzerland
| | - Marco Cattaneo
- University Hospital Basel, University of Basel, Basel, Switzerland
| | - Nicole Gilgen
- University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christoph Kaiser
- University Hospital Basel, University of Basel, Basel, Switzerland
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16
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Wang AYC, Chang CH, Chen CC, Wu YM, Lin CM, Chen CT, Hsieh PC. Leave Nothing Behind: Treatment of Intracranial Atherosclerotic Disease with Drug-Coated Balloon Angioplasty. Clin Neuroradiol 2020; 31:35-44. [PMID: 32720067 DOI: 10.1007/s00062-020-00935-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Intracranial atherosclerosis disease (ICAD) is an essential cause of stroke. The characteristics of effective treatment include low periprocedural risk and a sustained treatment effect. Angioplasty with a conventional balloon for ICAD is safe but has a dauntingly high restenosis rate. Drug-coated balloon (DCB) angioplasty might reduce the risk of restenosis while maintaining the overall safety of the procedure. METHODS This study included symptomatic ICAD patients with more than 70% stenosis. Intermediate catheters were placed distally, and the lesions were predilated with a conventional balloon, followed by a DCB (SeQuent Please, B Braun, Melsungen, Germany). The primary endpoint was any stroke or death within 30 days or ipsilateral ischemic stroke thereafter. The secondary endpoint was arterial restenosis of more than 50% during follow-up. RESULTS A total of 39 sessions of DCB angioplasty were performed for 39 lesions in 35 patients between October 2015 and April 2018 in a single center. All of the DCBs could be navigated to the lesions. Major periprocedural complications were noted in two patients (5.7%, 2/35), and minor periprocedural complications were also noted in two patients (5.7%, 2/35). The average percentages of stenosis of the lesions were 76.6% ± 7% before treatment, 32.4% ± 11.2% after DCB angioplasty, and 25% ± 16% at follow-up. Stenosis over 50% was present in 3 lesions during the follow-up period (8.3%, 3/36). CONCLUSION In this study, the application of DCBs to treat ICAD patients was feasible and safe. A larger scale clinical trial is warranted to further evaluate the safety and efficacy of this treatment.
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Affiliation(s)
- Alvin Yi-Chou Wang
- Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine, 111 Dade Road, 510120, Guangzhou, Guangdong, China.
| | - Chien-Hung Chang
- Department of Neurology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan, China
| | - Ching-Chang Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan, China
| | - Yi-Ming Wu
- Department of Medical imaging and intervention, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan, China
| | - Chuan-Min Lin
- Department of Neurology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan, China
| | - Chun-Ting Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan, China
| | - Po-Chuan Hsieh
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan, China
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17
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Yu D, Cai J, Wang K, Li T, Liu L, Shi L, Wang X. Comparing efficacy of drug-coated balloon-only approach and stent approach in treating de novo coronary artery lesions: A meta-analysis of randomized controlled trials. A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e21295. [PMID: 32791712 PMCID: PMC7387010 DOI: 10.1097/md.0000000000021295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Drug-coated balloons (DCB) have been a novel alternative therapeutic strategy in de novo coronary artery diseases. However, the clinical feasibility of the DCB-only approach in treating small vessel disease remains controversial, while study aimed to assess the efficacy and safety of the DCB-only approach versus stent approaches in treating large vessel disease is limited. METHODS From February 2020 to May 2020, we will search Cochrane Library, PubMed, EMBASE, ScienceDirect, Scopus, Chinese Biomedical Literature Database, Chinese National Knowledge Infrastructure (CNKI), Wanfang Database, and Chongqing VIP Database for eligible trials comparing DCB with drug-eluting stents for treatment of de novo lesions in both small vessel disease and large vessel disease. The primary endpoint is major adverse cardiac events (MACE); the secondary endpoints include in-lesion late lumen loss, binary restenosis, myocardial infarction, target lesion revascularization (TLR), mortality and target vessel thrombosis. Meta-analysis will be conducted using Review Manager software (V.5.3). RESULTS The results will be presented as risk ratios for dichotomous data, and weighted mean differences for continuous data. CONCLUSION We will assess outcomes of the DCB-only approach in the treatment of de novo lesions compared with the stent approach. PROSPERO REGISTRATION NUMBER CRD42020164484.
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Affiliation(s)
- Deshuai Yu
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing
| | - Junjun Cai
- Department of Hepatology, Tianjin Third Central Hospital, Tianjin
| | - Kai Wang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing
| | - Tianli Li
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing
| | | | | | - Xian Wang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing
- Institute for Cardiovascular Disease, Beijing University of Chinese Medicine, Beijing, People's Republic of China
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18
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Jeger RV, Eccleshall S, Wan Ahmad WA, Ge J, Poerner TC, Shin ES, Alfonso F, Latib A, Ong PJ, Rissanen TT, Saucedo J, Scheller B, Kleber FX. Drug-Coated Balloons for Coronary Artery Disease. JACC Cardiovasc Interv 2020; 13:1391-1402. [DOI: 10.1016/j.jcin.2020.02.043] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 12/19/2022]
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19
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Shibui T, Tsuchiyama T, Masuda S, Nagamine S. Excimer laser coronary atherectomy prior to paclitaxel-coated balloon angioplasty for de novo coronary artery lesions. Lasers Med Sci 2020; 36:111-117. [PMID: 32304003 PMCID: PMC7785529 DOI: 10.1007/s10103-020-03019-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 04/06/2020] [Indexed: 12/12/2022]
Abstract
This study aimed to evaluate the efficacy and safety of excimer laser coronary atherectomy (ELCA) prior to paclitaxel-coated balloon angioplasty for de novo coronary artery lesions. This retrospective observational study analyzed 118 eligible patients with de novo coronary artery disease whose only percutaneous coronary intervention was a drug-coated balloon angioplasty (i.e., no subsequent stent placement). Data related to our primary outcomes of interest—incidence of major adverse cardiovascular and cerebral events (MACCE), and incidence of procedural complications (bailout stenting and minor complications)—were collected and retrospectively analyzed. ELCA was used significantly more often in the cases of main branch and ostial lesions (i.e., of the circumflex, right coronary, or left anterior descending arteries, or high lateral branch), normally associated with poor treatment outcomes (55.6% vs. 14.3%, p < 0.0005). However, the two groups were not different in terms of cumulative incidence as estimated by the Kaplan–Meier method (log-rank test, p = 0.603) and a causal relationship between ELCA and MACCE was not identified (OR, 2.223; 95% CI, 0.614–8.047; p = 0.223). This study confirms the safety of ELCA prior to paclitaxel DCB angioplasty to treat de novo coronary artery lesions. While difficult-to-treat lesions were significantly more prevalent in the group treated by ELCA, the study revealed similar efficiency as conventional pre-dilation methods. Our findings provide grounds for a prospective randomized trial with consistent lesion and procedural characteristics to evaluate the potential benefits of combining paclitaxel DCB angioplasty following ELCA for de novo coronary artery lesions.
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Affiliation(s)
- Takashi Shibui
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, Tokyo, 150-0013, Japan.
| | - Takaaki Tsuchiyama
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, Tokyo, 150-0013, Japan
| | - Shinichiro Masuda
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, Tokyo, 150-0013, Japan
| | - Sho Nagamine
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, Tokyo, 150-0013, Japan
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20
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Silverio A, Buccheri S, Venetsanos D, Alfredsson J, Lagerqvist B, Persson J, Witt N, James S, Sarno G. Percutaneous Treatment and Outcomes of Small Coronary Vessels. JACC Cardiovasc Interv 2020; 13:793-804. [DOI: 10.1016/j.jcin.2019.10.062] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/25/2019] [Accepted: 10/15/2019] [Indexed: 10/25/2022]
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21
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Tian J, Tang Y, Qiao S, Su X, Chen Y, Jin Z, Chen H, Xu B, Kong X, Pang W, Liu Y, Yu Z, Li X, Li H, Zhao Y, Wang Y, Li W, Guan C, Gao R, Xu B. Two‐year follow‐up of a randomized multicenter study comparing a drug‐coated balloon with a drug‐eluting stent in native small coronary vessels: The RESTORE Small Vessel Disease China trial. Catheter Cardiovasc Interv 2020; 95 Suppl 1:587-597. [PMID: 31943693 DOI: 10.1002/ccd.28705] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 12/29/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Jian Tian
- Department of CardiologyFu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Yi‐da Tang
- Department of CardiologyFu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Shubin Qiao
- Department of CardiologyFu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Xi Su
- Department of CardiologyWuhan Asia Heart Hospital Wuhan China
| | - Yundai Chen
- Department of CardiologyChinese PLA General Hospital Beijing China
| | - Zening Jin
- Department of CardiologyBeijing Anzhen Hospital, Capital Medical University Beijing China
| | - Hui Chen
- Department of CardiologyBeijing Friendship Hospital, Capital Medical University Beijing China
| | - Biao Xu
- Department of CardiologyAffiliated Nanjing Drum Tower Hospital of Nanjing University School of Medicine Nanjing China
| | - Xiangqing Kong
- Department of CardiologyJiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University Nanjing China
| | - Wenyue Pang
- Department of CardiologyShengjing Hospital of China Medical University Shenyang China
| | - Yong Liu
- Department of CardiologyThe Fourth Central Hospital of Tianjin Tianjin China
| | - Zaixin Yu
- Department of CardiologyXiangya Hospital of Central South University Changsha China
| | - Xue Li
- Department of CardiologyTangdu Hospital of the Fourth Military Medical University Xi'an China
| | - Hui Li
- Department of CardiologyDaqing Oilfield General Hospital Daqing China
| | - Yanyan Zhao
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases of China Beijing China
| | - Yang Wang
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases of China Beijing China
| | - Wei Li
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases of China Beijing China
| | - Changdong Guan
- Catheterization LaboratoriesFu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences Beijing China
| | - Runlin Gao
- Department of CardiologyFu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Bo Xu
- Catheterization LaboratoriesFu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences Beijing China
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22
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Cortese B. The role of optimal lesion preparation for de-novo coronary vessels when a stentless intervention strategy is planned. Minerva Cardioangiol 2019; 68:51-56. [PMID: 31789010 DOI: 10.23736/s0026-4725.19.05091-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Drug-coated balloons (DCB) are widely used for several types of coronary artery disease, especially in-stent restenosis and de-novo small vessel disease. The role of correct lesion preparation is of paramount importance before DCB use. In the last years, the use of scoring balloons to achieve this goal has emerged as an alternative to semi- or non-compliant balloons, in order to improve the "cracking" of the lesion, with the aim of preparing the way for an improved drug penetration. In this paper it is examined how to improve the quality of lesion preparation before DCB use, and the role of this therapy especially for small vessel disease management, in light of the recent BASKET SMALL II study, where DCB was found non-inferior to drug-eluting stents in terms of hard clinical endpoints.
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23
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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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Baseline Serum sLOX-1 Concentrations Are Associated with 2-Year Major Adverse Cardiovascular and Cerebrovascular Events in Patients after Percutaneous Coronary Intervention. DISEASE MARKERS 2019; 2019:4925767. [PMID: 31772687 PMCID: PMC6854229 DOI: 10.1155/2019/4925767] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/16/2019] [Accepted: 09/07/2019] [Indexed: 11/18/2022]
Abstract
Background Soluble lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1) may be a potential biomarker of coronary artery disease (CAD) and stroke. Objective We aimed to investigate the association and prognostic value of elevated sLOX-1 concentrations with regard to long-term major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with CAD undergoing primary percutaneous coronary intervention (PCI). Methods A total of 1011 patients were enrolled. Serum sLOX-1 concentrations were detected by the enzyme-linked immunosorbent assay (ELISA). Patients were followed for 2 years. Multivariate Cox regression and Kaplan-Meier survival curve were explored to assess the association between sLOX-1 and MACCEs. A receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of sLOX-1. Results Two-year MACCEs were associated with serum sLOX-1 concentrations (HR 1.278, 95% CI 1.019-1.604, P = 0.034), left main disease (HR 2.938, 95% CI 1.246-6.925, P = 0.014), small-caliber stents used (HR 2.207, 95% CI 1.189-4.095, P = 0.012), and total stent length (HR 1.057, 95% CI 1.005-1.112, P = 0.030). Serum sLOX-1 concentration ≥ 1.10 ng/ml had maximum sensitivity and specificity in predicting the occurrence of 2-year MACCEs (P < 0.001). Patients with higher serum sLOX-1 concentrations showed a significantly higher incidence of MACCEs in the Kaplan-Meier curve (P < 0.001). The combination of any of the risk factors identified in multiple Cox regression was associated with a stepwise increase in MACCE rate (P < 0.001). Conclusions High baseline serum sLOX-1 concentration predicts 2-year MACCEs and shows an additional prognostic value to conventional risk factors in patients after primary PCI. sLOX-1 determination might play a complementary role in the risk stratification of patients with CAD treated with PCI.
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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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Clinical outcomes of SeQuent Please paclitaxel-coated balloons for de novo small coronary artery lesion in a Japanese multicenter post-approval registry. Coron Artery Dis 2019; 31:35-39. [PMID: 31524670 DOI: 10.1097/mca.0000000000000782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Drug-coated balloon (DCB) angioplasty has emerged as an effective management strategy worldwide. In June 2016, DCB became available for the treatment of de novo small coronary lesions in Japan; however, there has been no multicenter analysis in a post-approval real-world clinical setting to date. The aim of this study was to evaluate the efficacy of DCB for de novo small coronary lesions based on a Japanese multicenter registry. METHODS AND RESULTS From June 2016 to July 2017, a total of 111 lesions (102 patients) treated with DCB for de novo small coronary lesions were enrolled at six Japanese institutions. The primary endpoint was the rate of target lesion revascularization (TLR) at 12 months. Angiographic follow-up endpoints were binary restenosis and late lumen loss (LLL). Clinical follow-up data at 12 months were available for 106 lesions, excluding five lesions that required bailout stenting. The TLR rate was 5.7% (6/106 lesions). No cardiac death or target lesion thrombosis was observed. The binary restenosis rate was 14.4% and LLL was 0.0017 ± 0.37 mm. CONCLUSIONS DCB angioplasty for de novo small coronary lesions in the real-world environment in Japan is effective with acceptable 12-month outcomes.
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Li M, Guo C, Lv YH, Zhang MB, Wang ZL. Drug-coated balloon versus drug-eluting stent in de novo small coronary vessel disease: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e15622. [PMID: 31124941 PMCID: PMC6571399 DOI: 10.1097/md.0000000000015622] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Drug-coated balloon as a novel therapeutic strategy has been used to treat restenosis in cases of bare metal and drug-eluting stents. However, evidence of its safety and efficacy is scarce in de novo small coronary artery vessel disease. This meta-analysis aimed to compare the safety and efficacy of the drug-coated balloon and the drug-eluting stent. METHODS The PubMed, EMBASE, Web of Science, and Cochrane library databases were searched for studies published up to October 17, 2018. Studies comparing the drug-coated balloon with the drug-eluting stent strategy in patients with de novo small coronary artery vessel disease (reference diameter, <3 mm) were identified. The clinical outcomes were nonfatal myocardial infarction, cardiac death, all-cause death, target lesion revascularization, and target-vessel revascularization. Data were analyzed using the statistical software RevMan (version 5.3). Fixed effects models were performed to calculate the pooled odds ratios (ORs) and 95% confidence intervals (95% CIs). Sensitivity analyses were used to detect potential sources of heterogeneity, while subgroup analyses were implemented to assess the differential effects. RESULTS Three randomized controlled trials and 3 nonrandomized controlled studies were identified. Six studies including a total of 1800 patients compared the differences between the drug-coated balloon and the drug-eluting stent strategies in patients with de novo small coronary artery vessel disease. The results indicated that the drug-coated balloon strategy was associated with a significant reduction in nonfatal myocardial infarction (OR 0.53, 95% CI 0.31-0.90, P = .02) compared with the drug-eluting stent strategy, while insignificant inter-strategy differences were observed in cardiac death (OR 1.56, 95% CI 0.73-3.33, P = .25), all-cause death (OR 0.56, 95% CI 0.25-1.23, P = .15), target lesion revascularization (OR 1.24, 95% CI 0.73-2.1, P = .43), and target-vessel revascularization (OR 0.95, 95% CI 0.59-1.52, P = .84). CONCLUSIONS This meta-analysis suggests that the drug-coated balloon strategy is noninferior to the drug-eluting stent strategy, delivering a good outcome in nonfatal myocardial infarction, and can be recommended as an optimal treatment strategy in patients with de novo small coronary artery vessel disease. Larger randomized controlled studies with longer follow-up periods are needed to further confirm the benefits of the drug-coated balloon strategy.
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Affiliation(s)
- Min Li
- The First Clinical Medical College of Lanzhou University
| | - Chen Guo
- The First Clinical Medical College of Lanzhou University
| | - Yong-Hui Lv
- The First Clinical Medical College of Lanzhou University
| | - Ming-Bo Zhang
- The First Clinical Medical College of Lanzhou University
| | - Zhi-Lu Wang
- Department of Cardiology, The First Hospital of Lanzhou University, China
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Megaly M, Saad M, Brilakis ES. Role of Drug-coated Balloons in Small-vessel Coronary Artery Disease. US CARDIOLOGY REVIEW 2019. [DOI: 10.15420/usc.2019.4.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Percutaneous coronary intervention of small-vessel coronary artery disease (SVD) remains challenging due to difficulties with device delivery and high restenosis rate, even with the use of newer-generation drug-eluting stents. Drug-coated balloons represent an attractive emerging percutaneous coronary intervention option in patients with SVD. Potential advantages of drug-coated balloons in SVD include enhanced deliverability because of their small profile, avoidance of foreign-body implantation, and shorter duration of dual antiplatelet therapy.
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Affiliation(s)
- Michael Megaly
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN; Division of Cardiovascular Medicine, Hennepin Healthcare, Minneapolis, MN
| | - Marwan Saad
- Division of Cardiovascular Medicine, Department of Medicine, University of Arkansas, Little Rock, AR; Department of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt
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Serra A. Value of Drug-Coated Balloons in Small-Vessel Disease. JACC Cardiovasc Interv 2018; 11:2393-2395. [DOI: 10.1016/j.jcin.2018.10.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 10/09/2018] [Indexed: 11/15/2022]
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30
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Megaly M, Rofael M, Saad M, Rezq A, Kohl LP, Kalra A, Shishehbor M, Soukas P, Abbott JD, Brilakis ES. Outcomes with drug‐coated balloons in small‐vessel coronary artery disease. Catheter Cardiovasc Interv 2018; 93:E277-E286. [DOI: 10.1002/ccd.27996] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/17/2018] [Accepted: 11/04/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Michael Megaly
- Minneapolis Heart InstituteAbbott Northwestern Hospital and Minneapolis Heart Institute Foundation Minneapolis Minnesota
- Division of Cardiovascular MedicineHennepin HealthCare Minneapolis MN
| | - Michael Rofael
- Division of Cardiovascular MedicinePalmetto Health Columbia, University of South Carolina South Carolina
| | - Marwan Saad
- Division of Cardiovascular Medicine, Department of MedicineUniversity of Arkansas Little Rock Arkansas
| | - Ahmed Rezq
- Department of Cardiovascular MedicineAin Shams University Cairo Egypt
| | - Louis P. Kohl
- Division of Cardiovascular MedicineHennepin HealthCare Minneapolis MN
| | - Ankur Kalra
- Division of Cardiovascular Medicine, Department of MedicineCase Western Reserve University School of Medicine Cleveland Ohio
| | - Mehdi Shishehbor
- Division of Cardiovascular Medicine, Department of MedicineCase Western Reserve University School of Medicine Cleveland Ohio
| | - Peter Soukas
- Division of Cardiovascular Medicine, Department of MedicineWarren Alpert Medical School of Brown University Providence Rhode Island
| | - JD Abbott
- Division of Cardiovascular Medicine, Department of MedicineWarren Alpert Medical School of Brown University Providence Rhode Island
| | - Emmanouil S. Brilakis
- Minneapolis Heart InstituteAbbott Northwestern Hospital and Minneapolis Heart Institute Foundation Minneapolis Minnesota
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Venetsanos D, Lawesson SS, Panayi G, Tödt T, Berglund U, Swahn E, Alfredsson J. Long-term efficacy of drug coated balloons compared with new generation drug-eluting stents for the treatment of de novo coronary artery lesions. Catheter Cardiovasc Interv 2018; 92:E317-E326. [PMID: 29481718 DOI: 10.1002/ccd.27548] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 01/12/2018] [Accepted: 01/27/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Studies comparing drug coated balloons (DCB) with new generation drug-eluting stents (nDES) for the treatment of de novo coronary artery lesions are lacking. METHODS From 2009 to 2016, DCB or nDES used for treatment of de novo coronary lesions at our institution were included, in total 1,197 DEB and 6,458 nDES. We evaluated target lesions restenosis (TLR) and definite target lesion thrombosis (TLT). Propensity score modeling were utilized to study adjusted associations between treatment and outcomes. RESULTS Median follow-up was 901days. DCB patients were older, with higher cardiovascular risk profile. Bailout stenting after DCB was performed in 8% of lesions. The cumulative rate of TLR and TLT was 7.0 vs. 4.9% and 0.2 vs. 0.8% for DCB vs. nDES, respectively. Before adjustment, DCB was associated with a higher risk of TLR [hazard ratio (HR) 1.44; 95% confidence interval (CI) 1.07-1.94] and a non-significantly lower risk of TLT (HR 0.30; 95% CI 0.07-1.24), compared to nDES. In the propensity matched population consisted of 1,197 DCB and 1,197 nDES, treatment with DCB was associated with similar risk for TLR (adjusted HR 1.05; 95% CI 0.72-1.53) but significantly lower risk for TLT (adjusted HR 0.18; 95% CI 0.04-0.82) compared to nDES. CONCLUSIONS Treatment with DCB was associated with a similar risk of TLR and a lower risk of definite TLT compared with nDES. In selected cases, DCB appears as a good alternative to nDES for the treatment of de novo coronary lesions.
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Affiliation(s)
- Dimitrios Venetsanos
- Department of Cardiology, Linköping University, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Sofia Sederholm Lawesson
- Department of Cardiology, Linköping University, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Georgios Panayi
- Department of Cardiology, Linköping University, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Tim Tödt
- Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | - Ulf Berglund
- Department of Cardiology, Linköping University, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Eva Swahn
- Department of Cardiology, Linköping University, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Joakim Alfredsson
- Department of Cardiology, Linköping University, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Zhang D, Sun Y, Liu X, Liu F, Cheng Y, Ma X, Zhao Y, Zhou Y. Long-Term Follow-Up After Treatment of Drug-Eluting Stent Restenosis and De Novo Lesions Using SeQuent Please Paclitaxel-Coated Balloons. Angiology 2018; 70:414-422. [DOI: 10.1177/0003319718809423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Managing patients with in-stent restenosis (ISR) remains an important clinical challenge. In particular, large, randomized trials assessing the effect of drug-eluting balloons (DEB) in patients with de novo lesions are warranted. We investigated the effect of DEB on procedural complications, target lesion revascularization (TLR), and major adverse cardiac and cerebrovascular events in patients with drug-eluting stent ISR and de novo lesions. The clinical profiles of 238 consecutive patients treated for coronary ISR (n = 174) and de novo lesions (n = 64) using SeQuent Please paclitaxel-coated balloon were analyzed. Study end points were major adverse cardiac events (MACEs). At 1-year follow-up, TLR and MACEs occurred with acceptably low rates (5.0% and 6.3%, respectively). At 2.00 (0.74) years of follow-up, there was a significant difference in the rates of TLR between the ISR and the de novo lesions groups (14.4% [ISR] vs 3.1% [de novo], P = .028), and the occurrence of MACEs distinctly increased in the ISR group compared to the de novo lesions group (21.8% vs 6.2%, P = .009). The long-term outcomes of the ISR group were inferior to those of the de novo group (TLR, log-rank P = .019; MACEs, log-rank P = .010). Drug-eluting balloon for ISR and de novo lesions of small coronary vessels is effective and safe.
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Affiliation(s)
- Dai Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Chaoyang District, Beijing, China
| | - Yan Sun
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Chaoyang District, Beijing, China
| | - Xiaoli Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Chaoyang District, Beijing, China
| | - Fang Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Chaoyang District, Beijing, China
| | - Yujing Cheng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Chaoyang District, Beijing, China
| | - Xiaoteng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Chaoyang District, Beijing, China
| | - Yingxin Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Chaoyang District, Beijing, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Chaoyang District, Beijing, China
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Mohiaddin H, Wong TDFK, Burke-Gaffney A, Bogle RG. Drug-Coated Balloon-Only Percutaneous Coronary Intervention for the Treatment of De Novo Coronary Artery Disease: A Systematic Review. Cardiol Ther 2018; 7:127-149. [PMID: 30368735 PMCID: PMC6251821 DOI: 10.1007/s40119-018-0121-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Indexed: 02/06/2023] Open
Abstract
Percutaneous coronary intervention (PCI) with a drug coated balloon (DCB) is a novel treatment which seeks to acutely dilate a coronary stenosis and deliver an anti-proliferative drug to the vessel wall (reducing the risk of re-stenosis), without implanting a drug eluting stent (DES). In this study, we performed a systematic review of stentless DCB-only angioplasty in de novo coronary artery disease. We identified 41 studies examining the effects of DCB-only PCI in a variety of clinical scenarios including small vessels, bifurcations, calcified lesions, and primary PCI. DCB-only PCI appears to be associated with comparable clinical outcomes to DESs and superior angiographic outcomes to plain-old balloon angioplasty. Although current data are promising, there is still a need for further long-term randomized control trial data comparing a DCB-only approach specifically against a second- or third-generation DES. A 4-week period of dual antiplatelet therapy provides a real advantage for the DCB-only PCI approach, which is not possible with most DESs. Since rates of adverse clinical outcomes are very low for all PCI procedures attention should be turned to the development of robust endpoints with which to compare DCB-only PCI approaches to the standard treatment with a DES.
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Affiliation(s)
| | | | - Anne Burke-Gaffney
- Vascular Biology, National Heart & Lung Institute (NHLI), Faculty of Medicine, Imperial College London, London, UK
| | - Richard G Bogle
- Clinical Academic Group, St George's University Foundation Hospitals NHS Trust, London, UK
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Meneguz-Moreno RA, Ribamar Costa J, Abizaid A. Drug-Coated Balloons: Hope or Hot Air: Update on the Role of Coronary DCB. Curr Cardiol Rep 2018; 20:100. [PMID: 30171374 DOI: 10.1007/s11886-018-1025-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW The present manuscript reviews the mechanism of action of drug-coated balloons (DCBs), offering a brief summary of the main clinical evidence on these devices. RECENT FINDINGS DCBs are regular semi-compliant balloons coated with antiproliferative agents that are rapidly released on contact with the vessel intima, exerting an anti-restenotic effect. This technology may offer some benefits of drug-eluting stents, in particular for the treatment of restenotic lesions, small vessels, and in patients at high-bleeding risk, when the prolonged dual antiplatelet regimen should be avoided. Most recent data have pointed to a possible benefit of these devices in treating bare metal stents (BMS) or drug-eluting stents in-stent restenosis (DES ISR), effectively reducing the recurrence of restenosis and avoiding additional layers of metal in the same coronary segment. In other clinical scenarios such as bifurcations, small vessels, and de novo lesions, data is more scarce and the benefits are still unclear. There are potential benefits related to the use of DCB in selected populations. However, larger clinical trials with longer follow-up are still needed to confirm the enthusiastic initial results.
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Affiliation(s)
- Rafael A Meneguz-Moreno
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, Av. Dr. Dante Pazzanese, 500 - Vila Mariana, São Paulo, SP, 04012-180, Brazil.,Department of Medicine, Universidade Federal de Sergipe, Aracaju, Sergipe, Brazil
| | - J Ribamar Costa
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, Av. Dr. Dante Pazzanese, 500 - Vila Mariana, São Paulo, SP, 04012-180, Brazil
| | - Alexandre Abizaid
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, Av. Dr. Dante Pazzanese, 500 - Vila Mariana, São Paulo, SP, 04012-180, Brazil. .,Hospital Sírio Libanês, São Paulo, Brazil.
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Treatment of large de novo coronary lesions with paclitaxel-coated balloon only: results from a Chinese institute. Clin Res Cardiol 2018; 108:234-243. [PMID: 30074078 DOI: 10.1007/s00392-018-1346-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 07/30/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND To evaluate the efficacy of paclitaxel-coated balloons (SeQuent Please®) for large de novo coronary lesions with diameters greater than 2.8 mm. METHODS We performed a retrospective study of 527 consecutive patients with 595 de novo lesions (222 lesions) that comprised the large vessel disease (LVD) group, with a reference diameter (RD) ≥ 2.8 mm; the other 373 lesions comprised the small vessel disease (SVD) group, with a RD < 2.8 mm who received drug-coated balloon (DCB) angioplasty at the Beijing Hospital, Beijing, China. Sixty-eight patients with 91 lesions, including 45 LVD lesions, underwent coronary angiography at an average 10.7 months after DCB intervention. Clinical characteristics were recorded, and coronary angiograms were analysed with Quantitative Coronary Angiography (QCA) software. RESULTS The patients in the LVD group were much younger than those in the small vessel group (61.7 ± 11.3 vs. 63.8 ± 11.7, P = 0.003), and fewer LVD patients had diabetes (27.0 vs. 57.8%, P = 0.001), three-vessel disease (37.5 vs. 52.6%, P = 0.003) and complex lesions (37.8 vs. 48.8%, P = 0.009) than those in the SVD group. Lesion preparations for LVD were more complicated than for SVD, such as 40.1% of lesions required the additional use of a cutting or scoring balloon (P = 0.004), and 21.2% lesions required non-compliant (NC) balloons (P < 0.001). Coronary dissections occurred in 63(28.3%) lesions in the LVD group but bail-out drug-eluting stent (DES) implantation was required only in one lesion (0.5%), which were both comparable with those in the SVD group. The success rate of DCB intervention was quite high and also similar in the LVD group and SVD group (99.5 vs. 99.7%, P > 0.05). QCA analysis showed that the follow-up minimal lumen diameter (MLD) was significantly increased compared with the MLD immediately post angioplasty both in the SVD group (1.75 ± 0.48 vs. 1.58 ± 0.31 mm, P = 0.008) and the LVD group (2.26 ± 0.66 vs. 2.09 ± 0.40 mm, P = 0.067). At an average of 10.1 months of clinical follow-up, the major adverse cardiovascular event (MACE) rate was 0% in the LVD group and 1.4% in the SVD group, with target lesion revascularization (TLR) rates of 0% and 1.1%, respectively. No death was observed in either group. CONCLUSIONS DCB for de novo coronary lesions with diameters greater than 2.8 mm was as safe and effective as for small vessel lesions, suggesting that the DCB-only strategy is also feasible in large de novo lesions intervention.
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Sato A, Kijima M, Ichimura S, Yaegashi D, Anzai F, Shimizu T, Matsui Y, Kaneko H, Sakamoto K, Seino Y, Maruyama Y, Takeishi Y. Short-term outcome of percutaneous coronary intervention with directional coronary atherectomy followed by drug-coated balloon: a preliminary report. Cardiovasc Interv Ther 2018; 34:149-154. [PMID: 29987653 PMCID: PMC6439157 DOI: 10.1007/s12928-018-0537-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 07/03/2018] [Indexed: 11/26/2022]
Abstract
Directional coronary atherectomy (DCA) is a unique technique used in percutaneous coronary intervention (PCI) which involves the removal of plaque from the coronary artery. Treatment with a drug-coated balloon (DCB) appears to be effective, especially when a predilatation of the lesion is performed appropriately. We hypothesize that the combination therapy of DCA with DCB is an effective strategy in PCI. PCI with DCA followed by DCB was performed for 23 patients from December 2014 to April 2017. All DCA procedures were performed under the guidance of intravascular ultrasound (IVUS) findings and all procedures were successfully performed without incurring major complications such as a coronary perforation. Plaque area (PA) was reduced from 77.3 ± 10.4% at baseline to 50.9 ± 9.2% after DCA and luminal cross-sectional area (CSA) after PCI was enlarged from 3.6 ± 1.8 to 9.3 ± 3.3 mm2. Follow-up coronary angiography (CAG) performed at 6–10 months showed no cases having incurred restenosis. Plaque area at follow-up CAG was 52.0 ± 8.5% and luminal CSA was 9.5 ± 2.1 mm2. There were no cases undergoing target vessel revascularization (TVR) and target lesion revascularization (TLR) during the follow-up periods. PCI with DCA followed by DCB might be an effective strategy for de novo lesions.
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Affiliation(s)
- Akihiko Sato
- Department of Cardiology and Vascular Medicine, Hoshi General Hospital, 159-1 Mukaigawara, Koriyama, Fukushima, 963-8521, Japan.
| | - Mikihiro Kijima
- Department of Cardiology and Vascular Medicine, Hoshi General Hospital, 159-1 Mukaigawara, Koriyama, Fukushima, 963-8521, Japan
| | - Shohei Ichimura
- Department of Cardiology and Vascular Medicine, Hoshi General Hospital, 159-1 Mukaigawara, Koriyama, Fukushima, 963-8521, Japan
| | - Daiki Yaegashi
- Department of Cardiology and Vascular Medicine, Hoshi General Hospital, 159-1 Mukaigawara, Koriyama, Fukushima, 963-8521, Japan
| | - Fumiya Anzai
- Department of Cardiology and Vascular Medicine, Hoshi General Hospital, 159-1 Mukaigawara, Koriyama, Fukushima, 963-8521, Japan
| | - Takeshi Shimizu
- Department of Cardiology and Vascular Medicine, Hoshi General Hospital, 159-1 Mukaigawara, Koriyama, Fukushima, 963-8521, Japan
| | - Yuko Matsui
- Department of Cardiology and Vascular Medicine, Hoshi General Hospital, 159-1 Mukaigawara, Koriyama, Fukushima, 963-8521, Japan
| | - Hironori Kaneko
- Department of Cardiology and Vascular Medicine, Hoshi General Hospital, 159-1 Mukaigawara, Koriyama, Fukushima, 963-8521, Japan
| | - Keiji Sakamoto
- Department of Cardiology and Vascular Medicine, Hoshi General Hospital, 159-1 Mukaigawara, Koriyama, Fukushima, 963-8521, Japan
| | - Yoshitane Seino
- Department of Cardiology and Vascular Medicine, Hoshi General Hospital, 159-1 Mukaigawara, Koriyama, Fukushima, 963-8521, Japan
| | - Yukio Maruyama
- Department of Cardiology and Vascular Medicine, Hoshi General Hospital, 159-1 Mukaigawara, Koriyama, Fukushima, 963-8521, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
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Onishi T, Onishi Y, Kobayashi I, Umezawa S, Niwa A. Drug-coated balloon angioplasty for de novo small vessel disease including chronic total occlusion and bifurcation in real-world clinical practice. Cardiovasc Interv Ther 2018; 34:139-148. [PMID: 29915884 DOI: 10.1007/s12928-018-0534-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 06/11/2018] [Indexed: 11/28/2022]
Abstract
The aim of this study is to validate the efficacy of drug-coated balloons (DCBs) for real-world de novo small vessel diseases including chronic total occlusion and bifurcation. DCB angioplasty has been reported to be effective in the treatment of de novo small vessel disease. However, the number of reports that have focused on complex lesions is limited. This observational study comprised consecutive patients who underwent DCB angioplasty for de novo small vessel disease with a reference diameter of less than 2.5 mm by visual estimation. Outcome parameters included late lumen loss, restenosis rate, and major adverse cardiac events, such as cardiac death, non-fatal myocardial infarction, and target lesion revascularization (TLR). Fifty-two patients underwent DCB angioplasty for 59 lesions with a reference vessel diameter of 1.93 ± 0.63 mm. Thirty-eight of the lesions (69%) were classified as type B2/C, including chronic total occlusions (20%) and bifurcations (33%). At the 8-month follow-up, late lumen loss was - 0.01 ± 0.44 mm with a restenosis rate of 20%. No cardiac deaths or myocardial infarctions were reported and only 5 (9%) angiographically driven TLRs were reported. DCB angioplasty offered an acceptable 8-month lumen patency and a stable clinical outcome for real-world complex de novo coronary diseases.
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Affiliation(s)
- Takayuki Onishi
- Department of Cardiology, Hiratsuka Kyosai Hospital, 9-11 Oiwake, Hiratsuka, Kanagawa, 254-8502, Japan.
| | - Yuko Onishi
- Department of Cardiology, Hiratsuka Kyosai Hospital, 9-11 Oiwake, Hiratsuka, Kanagawa, 254-8502, Japan
| | - Isshi Kobayashi
- Department of Cardiology, Hiratsuka Kyosai Hospital, 9-11 Oiwake, Hiratsuka, Kanagawa, 254-8502, Japan
| | - Shigeo Umezawa
- Department of Cardiology, Hiratsuka Kyosai Hospital, 9-11 Oiwake, Hiratsuka, Kanagawa, 254-8502, Japan
| | - Akihiro Niwa
- Department of Cardiology, Hiratsuka Kyosai Hospital, 9-11 Oiwake, Hiratsuka, Kanagawa, 254-8502, Japan
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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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Mitomo S, Jabbour RJ, Mangieri A, Ancona M, Regazzoli D, Tanaka A, Giannini F, Carlino M, Montorfano M, Chieffo A, Latib A, Colombo A. Mid-term clinical outcomes after bailout drug-eluting stenting for suboptimal drug-coated balloon results: Insights from a Milan registry. Int J Cardiol 2018; 263:17-23. [PMID: 29685691 DOI: 10.1016/j.ijcard.2018.04.050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 03/27/2018] [Accepted: 04/10/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Drug-coated balloon (DCB) is an alternative to drug-eluting stent (DES) for the treatment of small vessel or in-stent restenosis (ISR) lesions, with bailout stenting reserved for poor results after DCB inflation (residual stenosis or dissection). Data regarding bailout stenting with DES are limited. The aim of this study was to evaluate clinical outcomes after bailout stenting with DES for suboptimal DCB results. METHODS From June 2009 to December 2015, patients who underwent bailout DES implantation for suboptimal results after DCB (residual stenosis > 30% or type C-F dissection) in 2 high-volume centers in Italy were analyzed. The primary endpoint was target lesion failure (TLF) defined as composite of cardiac mortality, target vessel myocardial infarction (MI) and target lesion revascularization (TLR). RESULTS A total of 103 patients (125 lesions) were analyzed. Mean age was 68.8 ± 9.5 years, 21.4% were diabetic, and 92.2% underwent PCI for stable angina. The left anterior descending artery was most commonly treated (35.2%), followed by right coronary artery (17.6%) and left circumflex artery (17.6%). Lesion complexity was high (type B2/C: 88.8%) and 24.8% were ISR lesions. During the follow-up period (median: 858 days [interquartile range: 467-1665]), the TLF rate was 4.3% at 1 year and 15.4% at 2 years, and mainly driven by TLR (3.3% at 1 year, 14.5% at 2 years, respectively). There were no target vessel MI or definite/probable stent thrombosis events. CONCLUSIONS Bailout stenting with DES for suboptimal DCB results is a feasible and safe strategy at mid-term follow-up.
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Affiliation(s)
- Satoru Mitomo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | | | - Antonio Mangieri
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Ancona
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Damiano Regazzoli
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Akihito Tanaka
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Giannini
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Mauro Carlino
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Matteo Montorfano
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Alaide Chieffo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Azeem Latib
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Colombo
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
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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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Bukka M, Rednam PJ, Sinha M. Drug-eluting balloon: design, technology and clinical aspects. ACTA ACUST UNITED AC 2018; 13:032001. [PMID: 29227279 DOI: 10.1088/1748-605x/aaa0aa] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A drug-eluting balloon is a non-stent technology in which the effective homogenous delivery of anti-proliferative drugs is processed by the vessel wall through an inflated balloon. This is done to restore luminal vascularity in order to treat atherosclerosis, in-stent restenosis and reduce the risk of late thrombosis without implanting a permanent foreign object. The balloon technology relies on the concept of targeted drug delivery, which helps in the rapid healing of the vessel wall and prevents the proliferation of smooth muscle cells. Several drug eluting devices in the form of coated balloons are currently in clinical use, namely DIOR®, PACCOCATH®, SeQuent®Please and IN.PACT™. The device varies in terms of the material used for making the balloon, the coating techniques, the choice of coated drug and the release pattern of the drug at the site. This review gives an insight into the evolution, rationale and comparison of the marketed drug-eluting balloons. Here, different coating techniques have been analysed for the application and critical analysis of available DEB technologies, and a technical comparison has been done.
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Affiliation(s)
- Meenasree Bukka
- Department of Medical Devices, National Institute of Pharmaceutical Education and Research, Ahmedabad (NIPER-A) Palaj, Opp. Air Force Station, Gandhinagar-382355, Gujarat, India
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Nef HM, Abdel-Wahab M, Achenbach S, Joner M, Levenson B, Mehilli J, Möllmann H, Thiele H, Zahn R, Zeus T, Elsässer A. Medikamentenfreisetzende Koronarstents/-scaffolds und medikamentenbeschichtete Ballonkatheter. DER KARDIOLOGE 2018. [DOI: 10.1007/s12181-017-0202-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ito R, Ueno K, Yoshida T, Takahashi H, Tatsumi T, Hashimoto Y, Kojima Y, Kitamura T, Morita N. Outcomes after drug-coated balloon treatment for patients with calcified coronary lesions. J Interv Cardiol 2017; 31:436-441. [PMID: 29266411 DOI: 10.1111/joic.12484] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/29/2017] [Accepted: 11/30/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To investigate the efficacy of drug-coated balloon (DCB) for calcified coronary lesions. BACKGROUND Calcified coronary lesions is associated with poor clinical outcomes after revascularization. Recently, DCB is emerging as an alternative strategy for de novo coronary lesions. However, reports describing the efficacy of DCB for calcified coronary lesions are limited. METHODS A total of 81 patients (96 lesions) who electively underwent DCB treatment for de novo coronary lesions were enrolled: 46 patients (55 lesions) in the calcified group and 35 patients (41 lesions) in the non-calcified group. Angiographic follow-up data and clinical outcomes after the procedure were evaluated. RESULTS The diameter of the DCB used was 2.5 ± 0.5 mm. No bail-out stenting was observed after DCB treatment. Rotational atherectomy was used in 82% of lesions in the calcified group. Follow-up angiography (median, 6.5 months after intervention) was performed for 59 patients (30 in the calcified group and 29 in the non-calcified group). Late lumen loss and rates of restenosis were comparable between the groups (0.03 mm in the calcified group vs -0.18 mm in the non-calcified group, P = 0.093 and 13.9% vs 3.03%, P = 0.095, respectively). The survival rates for target lesion revascularization free survival and major adverse cardiac events at 2 years were comparable between the groups (85.3% vs 93.4%, P = 0.64 and 81.4% vs 88.5%, P = 0.57, respectively). CONCLUSION Calcified coronary lesions might dilute the effect of DCB. However, clinical outcomes in the calcified group were similar to those in the non-calcified group.
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Affiliation(s)
- Ryuta Ito
- Department of Cardiology, Matsunami General Hospital, Kasamatsu, Japan
| | - Katsumi Ueno
- Department of Cardiology, Matsunami General Hospital, Kasamatsu, Japan
| | - Tamami Yoshida
- Department of Cardiology, Matsunami General Hospital, Kasamatsu, Japan
| | - Hiroshi Takahashi
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Tomohiko Tatsumi
- Department of Cardiology, Matsunami General Hospital, Kasamatsu, Japan
| | | | - Yoshinobu Kojima
- Department of Cardiology, Matsunami General Hospital, Kasamatsu, Japan
| | - Tomoya Kitamura
- Department of Cardiology, Matsunami General Hospital, Kasamatsu, Japan
| | - Norihiko Morita
- Department of Cardiology, Matsunami General Hospital, Kasamatsu, Japan
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Alfonso F, Scheller B. State of the art: balloon catheter technologies – drug-coated balloon. EUROINTERVENTION 2017; 13:680-695. [DOI: 10.4244/eij-d-17-00494] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kamioka N, Soga Y, Kuramitsu S, Iida O, Hirano K, Suzuki K, Kawasaki D, Yamaoka T, Suematsu N, Shintani Y, Miyashita Y, Takahashi H, Tsuchiya T, Shinozaki N, Okazaki S, Ando K. Clinical outcomes of balloon angioplasty alone versus nitinol stent implantation in patients with small femoropopliteal artery disease: Observations from the Retrospective Multicenter Analysis for Femoropopliteal Stenting (REAL-FP). Catheter Cardiovasc Interv 2017; 90:790-797. [PMID: 28722294 DOI: 10.1002/ccd.27192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 04/17/2017] [Accepted: 06/08/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVES We sought to assess whether balloon angioplasty (BA) alone for small femoropopliteal disease improved the outcome following endovascular therapy as compared with stent implantation. BACKGROUND The optimal strategy of endovascular therapy for small vessel arteries in femoropopliteal disease remains unclear. METHODS We performed a multicenter retrospective analysis of 337 consecutive patients (371 limbs) with femoropopliteal arteries 4.0 mm or less in diameter and 150 mm or less in length. RESULTS Cumulative 3-year incidence of primary patency was significantly higher in the BA group than in the stent group (53.8% vs. 34.2%, P = 0.002). While assisted-primary patency and freedom from any major adverse limb events were also significantly higher in the BA group than in the stent group (70.9% vs. 44.2%, P < 0.001 and 60.6% vs. 36.4%, P = 0.001, respectively), secondary patency did not significantly differ between the two groups (86.9% vs. 86.9%, P = 0.67). Predictors of restenosis were diabetes mellitus (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.14-2.31; P = 0.01), no administration of cilostazol (HR, 1.50; 95% CI, 1.07-2.13; P = 0.02), stent implantation (HR, 1.68; 95% CI, 1.15-2.41; P = 0.01), and lesion length >75.0 mm(HR, 2.09; 95% CI, 1.50-2.92; P < 0.001). CONCLUSIONS Lesions in small (<4.0 mm diameter) FP vessels demonstrated better primary patency at 3 years when successfully treated with balloon angioplasty alone as opposed to routine or bailout stenting. This difference was especially pronounced for lesions 75 to 150 mm in length.
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Affiliation(s)
- Norihiko Kamioka
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Shoichi Kuramitsu
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Osamu Iida
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | - Keisuke Hirano
- Department of Cardiology, Saiseikai Yokohama-City Eastern Hospital, Yokohama, Japan
| | - Kenji Suzuki
- Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan
| | - Daizo Kawasaki
- Cardiovascular Division, Hyogo College of Medicine, Nishinomiya, Japan
| | - Terutoshi Yamaoka
- Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Nobuhiro Suematsu
- Department of Cardiology, Fukuoka Red Cross Hospital, Fukuoka, Japan
| | | | - Yusuke Miyashita
- Department of Advanced PAD Therapeutics, Shinshu University, Matsumoto, Japan
| | - Hiroki Takahashi
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Taketsugu Tsuchiya
- Division of Trans-Catheter Cardiovascular Therapeutics, Kanazawa Medical University Hospital, Ishikawa, Japan
| | | | - Shinya Okazaki
- Department of Cardiology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
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Paclitaxel-Coated Balloons: Investigation of Drug Transfer in Healthy and Atherosclerotic Arteries - First Experimental Results in Rabbits at Low Inflation Pressure. Cardiovasc Drugs Ther 2017; 30:263-70. [PMID: 27033233 PMCID: PMC4919377 DOI: 10.1007/s10557-016-6658-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose Beyond antiproliferative properties, paclitaxel exhibits anti-inflammatory activity, which might be beneficial in the local treatment of nonocclusive coronary artery disease. Paclitaxel release and tissue concentrations after paclitaxel-coated balloon treatment using different pressures have not been investigated so far. The aim of the study was to investigate in an atherosclerotic rabbit model whether drug transfer from paclitaxel-coated balloons into the vessel wall is affected by the presence of atherosclerotic lesions and to which extent it depends on the inflation pressure used. Methods Paclitaxel-coated balloons (3.5 μg/mm2 paclitaxel) were inflated with pressures of 1, 2, or 6 atm (60s) in healthy (n = 39) and atherosclerotic (n = 22) arteries of New Zealand White Rabbits. Paclitaxel content in arterial walls (10 min after interventions) and paclitaxel remaining on balloons after treatment were analyzed using high-performance liquid chromatography. Results Median paclitaxel tissue concentrations were 829.3 μg/g (IQR 636.5–1487 μg/g) in healthy and 375.7 μg/g (IQR 169.8–771.6 μg/g) in atherosclerotic arteries (p = 0.0002). The paclitaxel tissue concentration was dependent on inflation pressure (1 atm vs. 2 atm vs. 6 atm) in atherosclerotic arteries (p = 0.0106) but not in healthy arteries (p ≥ 0.05). Conclusions Atherosclerotic lesions impede the transfer of paclitaxel into arterial walls. Higher inflation pressures resulted in an increased paclitaxel transfer in atherosclerotic but not in healthy arteries. However, it is assumed that the tissue concentrations achieved with an inflation pressure of 2 atm are potentially effective in this model.
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Funatsu A, Nakamura S, Inoue N, Nanto S, Nakamura M, Iwabuchi M, Ando K, Asano R, Habara S, Saito S, Kozuma K, Mitsudo K. A multicenter randomized comparison of paclitaxel-coated balloon with plain balloon angioplasty in patients with small vessel disease. Clin Res Cardiol 2017; 106:824-832. [PMID: 28589231 DOI: 10.1007/s00392-017-1126-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 06/01/2017] [Indexed: 11/24/2022]
Abstract
AIM We investigated the efficacy and safety of using paclitaxel-coated balloon (PCB) to treat small vessel disease. METHODS AND RESULTS In this multicenter, prospective, randomized controlled trial, one-hundred and thirty-five patients with native coronary lesions in small vessels were randomized into a PCB group and plain balloon angioplasty (POBA) group at a ratio of 2:1. There were no differences in target vessel failure (TVF) that was defined as cardiac death or target vessel-related myocardial infarction or target lesion revascularization (TLR), between the two groups (3.4 vs. 10.3%; P = 0.20), and TLR was slightly lower in the PCB group (2.3%) than that in the POBA group (10.3%) during 24 weeks follow-up. The late lumen loss (LLL) was significantly lower in the PCB group (0.01 ± 0.31 vs. 0.32 ± 0.34 mm; P < 0.01) and late lumen enlargement (LLE) was more frequently observed in the PCB group (48 vs. 15%; P < 0.01) by angiographic follow-up after 24 weeks. There were no cases of death, myocardial infarction, thrombosis and reocclusion in either group. CONCLUSIONS This study was not able to demonstrate superiority of PCB compared with POBA.
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Affiliation(s)
- Atsushi Funatsu
- Kyoto Katsura Hospital, Kyoto, Japan. .,, 17 Yamada hirao-cho, Nishikyo-ku, Kyoto, 615-8256, Japan.
| | | | | | - Shinsuke Nanto
- Osaka University Graduate school of Medicine, Osaka, Japan
| | | | | | - Kenji Ando
- Kokura Memorial Hospital, Kitakyushu, Japan
| | | | | | | | - Ken Kozuma
- Teikyo University Hospital, Tokyo, Japan
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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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Contemporary use of drug-coated balloons in coronary artery disease: Where are we now? Arch Cardiovasc Dis 2017; 110:259-272. [DOI: 10.1016/j.acvd.2017.01.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 01/03/2017] [Accepted: 01/04/2017] [Indexed: 11/24/2022]
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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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