Drug-coated balloon in superficial femoral artery in-stent restenosis

Abstract

The femoropopliteal artery is one of the commonest sites of involvement in peripheral artery disease (PAD) leading to intermittent claudication and/or critical limb ischemia. Endovascular therapy for superficial femoral artery (SFA) disease has been recognized as a safe and efficient therapy and is recommended by current guidelines as the first-line approach. Although the widespread use of new-generation, self-expanding, nitinol stents in SFA stenosis has reduced the shortcomings associated with plain old balloon angioplasty (POBA), lumen renarrowing at the stented (in-stent restenosis – ISR) level still represents a relevant clinical problem, because of higher risk of recurrent ISR, occlusion and surgical revascularization compared to de-novo lesions. In this setting, different treatment options are available and drug-coated balloons (DCBs) have shown good results in terms of safety and effectiveness. In this review we examine the results of different trials exploring the outcome of using DCBs for the treatment of SFA ISR. The available data demonstrate that SFA ISR can be safely treated with percutaneous transluminal angioplasty with a DCB, with a reduction in recurrent restenosis and target lesion revascularization (TLR) at least at 1 year after POBA. The consistent and positive results of different registries and randomized trials support the use of DCB to reduce SFA ISR recurrence.

The safety and efficacy of different endovascular treatments for in-stent restenosis of the femoropopliteal artery: A network meta-analysis

“…Therefore, ELA and DCB should be superior to other percutaneous strategies and may provide more opportunities for subsequent treatment. 31,32 The debulking procedures in combination with other treatment modalities can provide better primary patency after revascularization. 33,34 ELA can remove calcified plaque and intimal hyperplasia in the stent, decrease recoil before balloon inflation, enlarge the effective lumen and provide better vascular preparation for DCB.…”

Long-term outcomes and determinants of stenosis recurrence after renal artery angioplasty in hypertensive patients with renovascular disease

“…All endovascular procedures are affected by recurrent stenosis, and this main drawback of PTA of RAS has an average reported incidence rate of between 6.5% and 40% [18]. However, univocally different risk factors for RS in extra-coronary territory are postulated [28][29][30].…”

Calcification patterns in femoral and carotid atheromatous plaques: A comparative morphometric study

“…Some studies have investigated the role of size and location of calcification regarding the restenosis rate after surgical treatment. Compared with the low percentage of restenosis after coronary drug-eluted stent replacement (10-15%) (12), restenosis after lower limb artery stenting reaches 40-50% (13,14), while the variable rate of this complication is between 1 and 36% after intervention at the carotid level (15).…”