Progress on developing an effective below-the-knee drug-coated balloon

Khoury, Rym El; Brodmann, Marianne; Schneider, Peter A.

doi:10.31083/j.rcm2203070

Cited by 5 publications

(1 citation statement)

References 94 publications

(142 reference statements)

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“…For this life-limiting disease, technology offers new choices every day. In the last two decades, miscellaneous options with their advantages and target lesions have been discovered to overcome difficulties [1][2][3]. Infrapopliteal procedures are challenging due to the smaller caliber of arterial structures.…”

Section: Introductionmentioning

confidence: 99%

Rotational atherectomy for below the knee lesions in critical limb threatening ischemia: Is it a wild goose chase?

Engin¹,

Şerefli²

2022

Turk J Vasc Surg

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Aim: Treatment of infrapopliteal peripheral arterial disease is still challenging. Rotational atherectomy (RA) is a novel option that aims removal of calcium from the lumen and improvement in outcomes. Material and Methods: Data of 27 patients (19 males, 8 females; mean age: 59.8±13.7 years; range, 25 to 79 years) with infrapopliteal occlusions treated by RA between January 2017 and December 2019 was retrospectively collected. The Global Limb Anatomic Staging System (GLASS) and the Rutherford classification (RC) were used for evaluation. The objective performance goals of Conte et al. (major adverse limb event [MALE] and major adverse cardiovascular event [MACE]) were used for assessing outcome performance. Visits were scheduled at 1, 6, 12, 18, and 24 months after treatment. In each visit, symptoms, RC, wound status, smoking status, lifestyle modifications, and medications were questioned, laboratory tests and Doppler ultrasonography were carried out, and the next visit was planned. Results: Device success was 88.89%, whereas procedural success was 100%. Unanticipated amputation rate was 11.1% in the 12-month follow-up. Over half of the patients (66.67%) showed RC improvement with a mean change of 3±1.17. Thirty-day safety endpoints were as follows: MALE, MACE, and amputation rates were 12.5%, 0%, and 8.33%, respectively. One-year efficacy endpoints were as follows: freedom from MALE+perioperative death was 71.42%, amputation-free survival was 76.19%, freedom from reintervention (amputation was 75%, limb salvage was 80%, and survival was 90.47%. Associations between RC (5-6) and calcification, chronic renal insufficiency and amputation, being a nonsmoker and failure to improve RC, and smoking and high infrapopliteal GLASS were found. Smoking cessation came with RC improvement in every case. Nonquitters experienced worsening more often compared to quitters (0% vs. 25%). Conclusion: Rotational atherectomy is feasible and effective in infrapopliteal chronic total occlusions. Closer follow-up is suggested for nonsmokers and patients with chronic renal insufficiency or advanced GLASS stages as they are prone to unfavorable clinical results. Quitting smoking should be underlined with its potential positive clinical effect even after the procedure.

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Section: Introductionmentioning

confidence: 99%

Rotational atherectomy for below the knee lesions in critical limb threatening ischemia: Is it a wild goose chase?

Engin¹,

Şerefli²

2022

Turk J Vasc Surg

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Nonsystematic review of drug-eluting resorbable scaffolds in infrapopliteal intervention: Unmet need and rationale for use

Khoury

Schneider

2023

JVS-Vascular Insights

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Drug-coated balloons in below-the-knee arteries

Stoll

Uslu

Blessing

et al. 2022

Vasa

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Summary: Background: The search for an optimal interventional treatment strategy in infrapopliteal peripheral artery disease remains in the focus of interest. Whether drug-coated balloons (DCB) might enhance interventional outcomes after crural interventions is a matter of debate, as studies yielded conflicting results on DCB safety and efficacy. Methods: We analyzed a retrospective cohort of 75 infrapopliteal DCB interventions performed at our institution in 68 patients with peripheral artery disease in Rutherford category 3 to 6. Results: Despite a high rate of long complex lesions and multi-vessel disease, freedom from clinically driven target lesions revascularization (TLR) after 365 days was 68%. After six months, healing or significant improvement of the ischemic ulcer was observed in 78% of cases. Accordingly, freedom from major amputation and death after 365 days was 82%. Freedom from major amputation and death was 76.2% of cases in patients with diabetes mellitus as opposed to 91.5% in patients without diabetes mellitus (p=0.049). Conclusions: With this real-world analysis we would like to contribute to the ongoing discussion on the benefit and safety of DCB treatment in below-the-knee interventions.

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Progress on developing an effective below-the-knee drug-coated balloon

Cited by 5 publications

References 94 publications

Rotational atherectomy for below the knee lesions in critical limb threatening ischemia: Is it a wild goose chase?

Rotational atherectomy for below the knee lesions in critical limb threatening ischemia: Is it a wild goose chase?

Nonsystematic review of drug-eluting resorbable scaffolds in infrapopliteal intervention: Unmet need and rationale for use

Drug-coated balloons in below-the-knee arteries

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