External Beam Radiation to Prevent Restenosis After Superficial Femoral Artery Balloon Angioplasty

Thérasse, Éric; Donath, David; Lespérance, Jacques; Tardif, Jean‐Claude; Guertin, Marie-Claude; Oliva, Vincent L.; Soulez, Gilles

doi:10.1161/circulationaha.104.502179

Cited by 21 publications

(12 citation statements)

References 31 publications

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“…At 1-year follow-up, there was a significant benefit for the group treated with 14 Gy in a single treatment session compared with the control and lower-dose groups. 62 The late catch-up phenomenon demonstrated for endovascular brachytherapy suggests that a longer follow-up will be necessary to determine the benefit for external-beam radiation to prevent restenosis. There are no intravascular brachytherapy delivery devices available in the United States to treat 5-to 6-mm-diameter SFA vessels.…”

Section: White and Gray Endovascular Therapies For Padmentioning

confidence: 99%

Endovascular Therapies for Peripheral Arterial Disease

2007

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Abstract-Peripheral arterial disease is one manifestation of systemic atherosclerosis. The prevalence of peripheral arterial disease increases with the age of the population. It is important to remember the significant association of coincident coronary artery disease, which is the major cause of mortality in these patients. (Figure 1). 1,2 It is important to remember the significant association of coincident coronary artery disease and cerebrovascular disease in these patients, because it represents the major cause of major morbidity and mortality in the PAD population. 3 Remarkable technological advances in the past decade, along with patient preference, have shifted revascularization strategies from traditional open surgical approaches toward lower-morbidity percutaneous endovascular treatments. Catheter-based revascularization of the lower extremities was first performed by Charles Dotter 4 and advanced by Andreas Gruentzig, who employed then newly developed inflatable balloon catheters that could dilate vascular stenoses. 5 The availability of stents, more than any other advance, has fueled the growth of catheterbased procedures by improving the safety, durability, and predictability of percutaneous revascularization.Endovascular therapy offers several distinct advantages over open surgical revascularization for selected lesions. 6,7 It is performed with local anesthesia, which enables the treatment of patients who are at high risk for general anesthesia. The morbidity and mortality from catheter-based therapy is extremely low, especially compared with open surgical revascularization. After successful percutaneous revascularization, patients are ambulatory on the day of treatment, and unlike after vascular surgery, they can often return to normal activity within 24 to 48 hours of an uncomplicated procedure. Endovascular therapies generally do not preclude or alter subsequent surgery and may be repeated if necessary.Multiple specialties, including interventional cardiology, have contributed to the advancement of the field of peripheral vascular intervention over the past several decades. 8 The recognition of an unmet need for a trained cadre of clinicians to care for patients with PAD prompted the development of a core curriculum document (COCATS-11) 9 and a multispecialty societal competency statement. 10 The American Heart Association and American College of Cardiology have published guidelines and recommendations for the diagnosis and treatment of PAD. 2 Improved patient and physician awareness of PAD and the availability of high-quality noninvasive diagnostic imaging have increased the number of patients seeking treatment for PAD. Diagnostic Evaluation Noninvasive AssessmentThe initial assessment should include a physical examination, with the patient's shoes and socks removed, to look for signs of acute or chronic peripheral ischemia and distal embolization and to determine the status of the peripheral pulses. The abdomen is examined for evidence of an aortic aneurysm, and blood pressure should be meas...

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Section: White and Gray Endovascular Therapies For Padmentioning

confidence: 99%

Endovascular Therapies for Peripheral Arterial Disease

2007

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“…Forty RCTs were accepted into the narrative review, published in 61 references. Study characteristics are shown in Table S1 (supporting information). Most of the trials recruited participants who had angioplasty of the superficial femoral and/or popliteal artery.…”

Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of additional technologies to enhance angioplasty for infrainguinal peripheral arterial occlusive disease

Simpson

Michaels

Thomas

et al. 2013

British Journal of Surgery

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Background: There are several additional techniques designed to enhance conventional percutaneous transluminal balloon angioplasty (PTA). This systematic review assessed current evidence on the clinical effectiveness of additional techniques for infrainguinal peripheral arterial occlusive disease (PAD).Methods: Relevant electronic databases, including MEDLINE, were searched in May 2011. The population comprised participants with symptomatic PAD undergoing endovascular treatment for disease distal to the inguinal ligament. Interventions were additional techniques compared with conventional PTA. Main outcome measures were restenosis and need for reintervention. Randomized clinical trials (RCTs) of clinical effectiveness were assessed for quality and data were extracted. Where appropriate, meta-analysis was undertaken to produce risk ratios (RRs).Results: Forty RCTs were selected. Meta-analysis showed a significant benefit in reducing restenosis rates at 6 months for self-expanding stents (RR 0·49) and drug-coated balloons (RR 0·40), and at 12 months for endovascular brachytherapy (RR 0·63). There was also evidence that use of a stent-graft significantly reduced restenosis compared with PTA, as did drug-eluting stents compared with baremetal stents. Meta-analysis showed that use of drug-coated balloons was associated with significantly lower reintervention rates than PTA alone at 6 months (RR 0·24) and 24 months (RR 0·27) of follow-up. There was also evidence of significantly lower reintervention rates for self-expanding stents at 6 months. Other techniques did not show significant treatment effects for restenosis or reintervention. Conclusion:The conclusions of this review should be tempered by small sample sizes, lack of clinical outcome measures and differing outcome definitions, making direct comparison across trials difficult. However, self-expanding stents, drug-eluting stents and drug-coated balloons appeared to be the most promising technologies worthy of future study.

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“…Moreover, other forms of radiation therapy -other than the beta-irradiation we studied -may show utility in the future. For instance, external beam radiation was reported as promising for femoral artery lesions [46]. Drug eluting stents (also an antiproliferative therapy) may limit the necessity for brachytherapy in the future for several reasons.…”

Section: Discussionmentioning

confidence: 99%

Nf-κb and AP-1 activation is associated with late lumen loss after porcine coronary angioplasty and antiproliferative beta-irradiation

Deiner

Shagdarsuren

Schwimmbeck

et al. 2007

Cardiovascular Research

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Objective: Despite the success of antiproliferative therapies, restenosis remains a common problem after percutaneous transluminal coronary angioplasty (PTCA). Longer-term clinical results of brachytherapy (intracoronary radiation), the lack of long-term clinical results after implantation of drug eluting stents, and the occurrence of late thrombosis after both procedures leave room for skepticism. Neointimal proliferation is not substantially inhibited at late time points after brachytherapy, and late lumen loss with a "catch-up" proliferation can occur. We hypothesized that the transcription factors nuclear factor-{kappa}B (NF-κB) and activator protein-1 (AP-1) are involved in these processes. We addressed the role of these mediators in a porcine model of coronary restenosis. Methods: Thirty-nine pigs underwent PTCA in two major coronary arteries. One of the two balloon-injured arteries was randomly assigned to receive immediate 20 Gy beta-irradiation (Brachy group) using a noncentered source train ( 90 Sr/Y Beta-Cath, Novoste). Animals were sacrificed after 1 day, 14 days, or 28 days. Proliferating cells were labeled prior to euthanasia. Results: At late time points, lumen area was significantly smaller and the inflammatory response was more pronounced in the Brachy group than in the PTCA group. These findings coincided with sustained activation of MMP-9 and transcription factors like NF-κB and AP-1. Initially, cell proliferation was reduced in the Brachy group; however, at late time points, differences between the two treatment groups were no longer significant. Conclusions: Brachytherapy initially inhibits cell proliferation; however, cellular and molecular inflammatory processes (e.g. activation of NF−κB) are enhanced within the arterial wall. This proinflammatory side effect may be responsible for the observed delayed proliferation and the resulting lumen loss.

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External Beam Radiation to Prevent Restenosis After Superficial Femoral Artery Balloon Angioplasty

Cited by 21 publications

References 31 publications

Endovascular Therapies for Peripheral Arterial Disease

Endovascular Therapies for Peripheral Arterial Disease

Systematic review and meta-analysis of additional technologies to enhance angioplasty for infrainguinal peripheral arterial occlusive disease

Nf-κb and AP-1 activation is associated with late lumen loss after porcine coronary angioplasty and antiproliferative beta-irradiation

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