scholarly journals Drug-coated Balloons for Small Coronary Vessel Interventions: A Literature Review

2019 ◽  
Vol 14 (3) ◽  
pp. 131-136 ◽  
Author(s):  
Thomas Nestelberger ◽  
Raban Jeger
Keyword(s):  
De Novo ◽  
Small Vessel Disease ◽  
Bare Metal Stents ◽  
Standard Of Care ◽  
Target Lesion ◽  
Small Vessel ◽  
Current Evidence ◽  
Metal Stents ◽  
Vessel Disease ◽  
Stent Restenosis

Newer-generation drug-eluting stents (DES) are the standard of care for the treatment of symptomatic coronary artery disease. However, some lack of efficacy has been reported in small coronary arteries based on higher rates of target lesion restenosis, thrombosis and MI resulting in repeated interventions. Drug-coated balloons (DCBs) are an established treatment option for in-stent restenosis in both bare metal stents and DES and they can deliver an anti-proliferative drug into the vessel wall without implanting a stent. DCBs are a promising technique for selected de novo coronary lesions, especially in small vessel disease. In this article, the current evidence for the treatment of small vessel disease with DCBs will be reviewed.

scholarly journals Drug-coated Balloons for Small Coronary Disease—A Literature Review

2021 ◽  
Vol 23 (11) ◽  
Author(s):  
Ketina Arslani ◽  
Raban Jeger
Keyword(s):  
De Novo ◽  
Small Vessel Disease ◽  
Bare Metal Stents ◽  
Metal Stents ◽  
Interventional Treatment ◽  
Efficacy And Safety ◽  
Stent Restenosis ◽  
Drug Eluting ◽  
Artery Disease ◽  
New Generation

Abstract Purpose of Review In the interventional treatment of coronary artery disease, new-generation drug-eluting stents (DES) currently are the standard treatment. In addition, drug-coated balloons (DCB) are a well-established option for the treatment of in-stent restenosis in both bare-metal stents (BMS) and DES, where DCBs deliver an antiproliferative drug without the necessity of re-implanting a stent. Since the field of use for DCB has increasingly been extended to other indications such as de novo lesions in small vessel disease (SVD), a review of literature may be useful. Recent Findings Recent randomized trial data show good efficacy and safety for DCB in de novo lesions, especially in small coronary arteries, and confirm long-term clinical efficacy and safety up to three years. Summary DCB are an attractive and safe option in the treatment of de novo lesions in SVD.

scholarly journals Drug-Coated Balloon-Only Angioplasty Outcomes in Diabetic and Nondiabetic Patients with De Novo Small Coronary Vessels Disease

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Botey Katamu Benjamin ◽  
Wenjie Lu ◽  
Zhanying Han ◽  
Liang Pan ◽  
Xi Wang ◽  
...  
Keyword(s):  
De Novo ◽  
Small Vessel Disease ◽  
Independent Predictor ◽  
Coronary Vessels ◽  
Target Lesion ◽  
Target Lesion Revascularization ◽  
Vessel Disease ◽  
One Year ◽  
Target Lesion Failure ◽  
Drug Coated Balloon

Background. The revascularization of small vessels using drug-eluting stents remains challenging. The use of the drug-coated balloon is an attractive therapeutic strategy in de novo lesions in small coronary vessels, particularly in the diabetic group. This study aimed to assess the outcomes of DCB-only angioplasty in small vessel disease. Methods. A total of 1198 patients with small vessel disease treated with DCB-only strategy were followed. Patients were divided into the diabetic and nondiabetic groups. Clinical and angiographical follow-up were organized at 12 months. The primary endpoints were target lesion failure and secondary major adverse cardiac events. Results. There was a significantly higher rate of target lesion failure among diabetic patients compared to nondiabetic [17 (3.9%) vs. 11 (1.4%), P = 0.006 ], taken separately, the rate of target lesion revascularization significantly differed between groups with a higher rate observed in the diabetic group [9 (2%) vs. 4 (0.5%), P = 0.014 ]. Diabetes mellitus remained an independent predictor for TLF (HR: 2.712, CI: 1.254–5.864, P = 0.011 ) and target lesion revascularization (HR: 3.698, CI: 1.112–12.298, P = 0.033 ) after adjustment. However, no significant differences were observed between groups regarding the target vessel myocardial infarction (0.6% vs. 0.1%, P = 0.110 ) and MACE [19 (4.4%) vs. 21 (2.7%), P = 0.120 ]. Conclusion. Drug-coated balloon-only treatment achieved lower incidence rates of TLF and MACE. Diabetes is an independent predictor for target lesion failure and target lesion revascularization at one year following DCB treatment in small coronary vessels. We observed no significant differences between groups regarding MACE in one year.

Predictors of Favorable Angiographic Outcomes After Drug-Coated Balloon Use for de novo Small Vessel Coronary Disease (DCB-ONLY)

Angiology ◽  
2021 ◽  
pp. 000331972110155
Author(s):  
Woong Chol Kang ◽  
Sang Min Park ◽  
Albert Youngwoo Jang ◽  
Pyung Chun Oh ◽  
Eun-Seok Shin ◽  
...  
Keyword(s):  
De Novo ◽  
Small Vessel Disease ◽  
Vessel Diameter ◽  
Target Lesion ◽  
Small Vessel ◽  
Luminal Diameter ◽  
Minimal Luminal Diameter ◽  
Late Luminal Loss ◽  
Drug Coated Balloon

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.

Abstract 5954: Does Sirolimus-Eluting Stent Implantation Lead to an Increased Risk of Stent Fracture?

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Hisashi Umeda ◽  
Tomoko Gochi ◽  
Mitsuhiro Iwase ◽  
Hideo Izawa ◽  
Mitsuhiro Yokota ◽  
...  
Keyword(s):  
Bare Metal Stents ◽  
Target Lesion ◽  
Complete Separation ◽  
Metal Stents ◽  
Stent Fracture ◽  
Consecutive Series ◽  
Cardiac Events ◽  
Stent Restenosis ◽  
Increased Risk ◽  
Stent Length

Stent fracture (SF) of sirolimus-eluting stents (SES) has emerged recently in literature and shown to be associated with an increased risk of restenosis. We sought to assess whether the use of SES increases the frequency of SF compared with bare-metal stents (BMS). A consecutive series of 499 lesions of 434 patients undergoing SES implantation (total stent length: 10 to 40 mm) followed by coronary angiography at 6 to 9 months were compared with 137 consecutive patients (147 lesions) treated with BMS (total stent length: 10 to 40 mm) which consists of stent platform of SES. SF was defined as single or multiple stent strut fracture as well as complete separation of stent segments. There were no significant differences in total stent length and the angulation of the lesion between the 2 groups. At follow up, SF occurred in 21 lesions (4.2%) in the SES group and 2 lesions (1.4%) in the BMS group (P=0.129). In-stent restenosis rates were 34.8% (SES; 33.3%, BMS; 50.0%) in lesions with SF and 7.7% (SES; 3.8%, BMS; 20.7%) in lesions without SF (P<0.001). As a result, cumulative rate of major adverse cardiac events at 1 year (death, myocardial infarction, or target lesion revascularization) was higher in patients with SF than in patients without SF (27.3% vs. 12.0%, P=0.035, SES; 25.0% vs. 8.2%, P=0.035, BMS; 50.0% vs. 23.7%, P=0.425). Figure summarizes multivariable predictors of SF. In this model, SES use was not associated with a significantly increased risk of SF at 6 to 9 months. The implantation of stents in tortuous lesion and/or longer lesions covered with longer stents rather than the use of SES may increase the likelihood of SF in this population subset.

scholarly journals 6-MONTHS OUTCOMES OF THE PLACLITAXEL ELUTING BALLOON FOR THE TREATMENT OF IN-STENT RESTENOSIS AND SMALL VESSEL DISEASE: INSIGHTS FROM THE SPANISH MULTICENTER REGISTRY

2010 ◽  
Vol 55 (10) ◽  
pp. A200.E1877
Author(s):  
beatriz vaquerizo ◽  
Antonio Serra ◽  
Faustino Miranda ◽  
Vanesa Martinez ◽  
Jose Antonio Gómez-Hospital ◽  
...  
Keyword(s):  
Small Vessel Disease ◽  
Small Vessel ◽  
Vessel Disease ◽  
Stent Restenosis ◽  
Multicenter Registry ◽  
In Stent Restenosis

scholarly journals Association of obstructive sleep apnea and cerebral small vessel disease: a systematic review and meta-analysis

SLEEP ◽  
2019 ◽  
Vol 43 (4) ◽  
Author(s):  
Yuhong Huang ◽  
Chunsong Yang ◽  
Ruozhen Yuan ◽  
Ming Liu ◽  
Zilong Hao
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Small Vessel Disease ◽  
Meta Analysis ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Current Evidence ◽  
Cochrane Library ◽  
Vessel Disease ◽  
Obstructive Sleep

Abstract Study Objectives The objective of the present study was to investigate the association between obstructive sleep apnea (OSA) and the presence of various neuroimaging marker of cerebral small vessel disease (CSVD). Methods We systematically searched PubMed, Embase, Web of Science, Scopus, and Cochrane library (from inception to May 2019) for studies evaluating the association between OSA and CSVD, which included white matter hyperintensities (WMH), silent brain infarction (SBI), cerebral microbleeds (CMBs), and perivascular spaces (PVS). Pooled odds ratios (ORs) with 95% confidence interval (CIs) were estimated using random-effects meta-analysis. Results After screening 7290 publications, 20 studies were finally included involving 6036 subjects. The sample size ranged from 27 to 1763 (median 158, interquartile range: 67–393). The meta-analysis showed that moderate to severe OSA was positively associated with WMH (13 studies, n = 4412, OR = 2.23, 95% CI = 1.53 to 3.25, I2 = 80.3%) and SBI (12 studies, n = 3353, OR 1.54, 95% CI = 1.06 to 2.23, I2 = 52%). There was no association with CMBs (three studies, n = 342, OR = 2.17, 95% CI = 0.61 to 7.73, I2 = 60.2%) or PVS (two studies, n = 267, OR = 1.56, 95% CI = 0.28 to 8.57, I2 = 69.5%). There was no relationship between mild OSA and CSVD. Conclusion Current evidence suggests that moderate to severe sleep apnea is positively related to WMH and SBI, but not CMBs or PVS, which suggests that OSA may contribute to the pathogenesis of CSVD. Further large cohort studies should be prioritized to confirm the findings.

A novel ultrasound controlled paclitaxel releasing balloon catheter versus plain balloon catheter in the treatment of small coronary vessel stenosis: study protocol of a randomized controlled clinical trial (Vasoguard I Trial)

2020 ◽  
Author(s):  
Yueyi Pan ◽  
Feng Zhang ◽  
Jingpu Wang ◽  
Ji'e Yang ◽  
Li Shen ◽  
...  
Keyword(s):  
Small Vessel Disease ◽  
Balloon Catheter ◽  
Target Lesion ◽  
Small Vessel ◽  
Controlled Clinical Trial ◽  
Efficacy And Safety ◽  
Randomized Controlled Clinical Trial ◽  
Vessel Disease ◽  
Randomized Controlled ◽  
Drug Coated Balloon

Abstract Background The optimal intervention strategy remains controversial in small vessel disease which is a very common kind of coronary artery lesions. For now, balloon-only percutaneous coronary intervention is the major percutaneous revascularization method in these patients, but the restenosis rate is still at a high level. Drug coated balloon is designed to deliver paclitaxel to target vessel to inhibit the proliferation of vascular endothelial cells, it aims at restraining the stenosis process after intervention so as to reduce the rate of restenosis. Ultrasound controlled paclitaxel releasing balloon catheter (Vasoguard TM ) is a newly designed drug coated balloon, expected to promote the drug release process via external ultrasound intervention so as to improve drug bioavailability. The current trial was designed to assess the efficacy and safety of Vasoguard in the treatment of small vessel coronary disease.Methods A prospective, multicenter, randomized, controlled clinical trial has been designed to compare the safety and efficacy of Vasoguard with plain balloon angioplasty in the treatment of small vessel coronary disease. 230 patients will be included in this trial, the primary endpoint is late lumen loss of target lesion at 9 months post operation measured by quantitative coronary angiography. Secondary endpoints include angiographic findings such as device success rate, operation success rate, in-segment restenosis, clinical outcomes such as target lesion revascularization, target vessel revascularization, device oriented composite endpoint and thrombotic events.Discussion This trial will evaluate the efficacy and safety of Vasoguard in the treatment of small vessel coronary disease by comparing to plain balloon angioplasty. It will clarify the practicability of the newly designed balloon and may lend more credence to the role of drug coated balloon in the treatment of small vessel disease.

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