Drug-eluting technologies in femoral artery lesions

ArticleinThe Journal of cardiovascular surgery 54(2):217-24 · April 2013with17 Reads
Source: PubMed
The treatment of femoropopliteal lesions has known an important evolution in the last years. An important limitation of current endovascular therapy remains the occurrence of restenosis. In order to minimize restenosis rates, drug eluting technologies are evolving. The use of drug-eluting stents (DES) in coronary arteries shows beneficial results, leading to investigation of DES in femoropopliteal arteries. In this article, we give an overview of current available data on treatment with drug eluting technologies in the superficial femoral artery (SFA). This paper su mmarizes also the current available data of the use of drug-coated balloons (DCB) in the femoropopliteal tract. Currently, no data are available on the use of DCB in long lesions. A drug eluting bioresorbable scaffold seems to be very promising in coronary arteries. The transfer to the peripheral area is nowadays ongoing. Which technique and device for which lesion and patient requires further investigation to build up a real evidence based SFA treatment strategy.
    • "The use of percutaneous, catheter-based vascular devices to treat coronary and peripheral artery disease, caused by arteriosclerosis, has become the standard of care. In order to overcome associated abrupt vessel re-narrowing or closure, antiproliferative drugs are often additionally administered during therapy by the application of well-known drug-eluting stents (DES) or drug-coated balloons (DCB) [1,2]. Major potential advantages of DCB in comparison to DES include the absence of a remaining foreign body in the artery, high initial drug delivery with little impact on long-term healing possibly limiting the risk of late stent thrombosis, and high deliverability, opening the opportunity of use in small vessels, bifurcations, long lesions, etc., hardly accessible by stents [3,4]. "
    [Show abstract] [Hide abstract] ABSTRACT: Polyvinylpyrrolidone (PVP) is a conventionally applied hydrophilic lubricious coating on catheter-based cardiovascular devices, used in order to ease movement through the vasculature. Its use as drug reservoir and transfer agent on drug-coated balloons (DCB) is therefore extremely promising with regard to the simplification of its approval as a medical device. Here, we developed a PVP-based coating for DCB, containing paclitaxel (PTX) as a model drug, and studied the impact of crosslinking via UV radiation on drug stability, wash off, and transfer during simulated use in an in vitro vessel model. We showed that crosslinking was essential for coating stability and needed to be performed prior to PTX incorporation due to decreased drug bioavailability as a result of photodecomposition and/or involvement in vinylic polymerization with PVP under UV radiation. Moreover, the crosslinking time needed to be carefully controlled. While short radiation times did not provide enough coating stability, associated with high wash off rates during DCB insertion, long radiation times lowered drug transfer efficiency upon balloon expansion. A ten minutes radiation of PVP, however, combined a minimized drug wash off rate of 34% with an efficient drug transfer of 49%, underlining the high potential of photochemically crosslinked PVP as a coating matrix for DCB.
    Full-text · Article · Dec 2013
  • [Show abstract] [Hide abstract] ABSTRACT: Background Despite initially encouraging technical success of femoropopliteal percutaneous transluminal angioplasty (PTA) restenosis still remains the major challenge. The main reason for restenosis is neointimal hyperplasia which can be suppressed with antiproliferative drugs. Drug-coated balloons (DCB) or drug-coated stents (DCS) are used for the inhibition of restenosis. Aim The present article gives an overview of the currently available DCB systems for femoropopliteal and infrapopliteal use and presents the completed, ongoing and planned trials and registries as well as the open questions for the use of DCBs in peripheral arterial occlusive disease. Material and methods A comprehensive search for infrainguinal use of DCBs from 2008 until July 2013 was performed in databases of medical journals, registered randomized controlled trials and published scientific session abstracts. Results The major advantages of DCBs are that no residual stent scaffold is left behind, immediate release of high drug concentrations with a single dose and efficacy in areas where DCSs are contraindicated. The clinical evidence of first generation paclitaxel drug-coated balloons (PTX-DCB) has been shown in several controlled randomized trials. Conclusions Depending on the type and location of the lesion, DCBs are suitable for treatment of in-stent restenoses, restenoses in the region of the popliteal artery or side branches of the profunda artery for which stent application is contraindicated.
    Article · Oct 2013
  • [Show abstract] [Hide abstract] ABSTRACT: Endovascular treatment has become first--line approach for revascularization of long and complex femoropopliteal lesions in many centers. This development urges the need for endovascular approaches with a sustainable success in terms of patency. In several recently published trials the VIABAHN endoprosthesis has shown promising patency rates comparable or even better than traditional surgical bypass procedures with prosthetic material.
    Article · Jun 2014
Show more

    Recommended publications

    Discover more