The Diagnostic Value of Circulating Biomarkers and Role of Drug-Coated Balloons for In-Stent Restenosis in Patients with Peripheral Arterial Disease

Abstract

Peripheral arterial disease (PAD) is an increasingly pathological condition that commonly affects the femoropopliteal arteries. The current fashionable treatment is percutaneous transluminal angioplasty (PTA), often with stenting. However, the in-stent restenosis (ISR) rate after the stenting of the femoropopliteal (FP) district remains high. Many techniques have been proposed for the treatment of femoropopliteal ISR, such as intravascular brachytherapy, laser atherectomy, second stenting and drug-coated balloons angioplasty (DCB). DCB showed a significantly lower rate of restenosis and target lesions revascularization (TLR) compared to conventional PTA. However, further studies and multi-center RCTs with dedicated long-term follow-up are needed to verify the true efficiency of this approach. Nowadays, the correlation between PAD and inflammation biomarkers is well known. Multiple studies have shown that proinflammatory markers (such as C-reactive proteins) and the high plasma levels of microRNA could predict the outcomes after stent placement. In particular, circulating microRNA-320a, microRNA-3937, microRNA-642a-3p and microRNA-572 appear to hold promise in diagnosing ISR in patients with PAD, but also as predictors of stent patency. This narrative review intends to summarize the current knowledge on the value of circulating biomarkers as predictors of ISR and to foster the scientific debate on the advantages of using DCB in the treatment of ISR in the FP district.

Drug-Coated Balloon versus Plain Balloon Angioplasty in the Treatment of Infrainguinal Vein Bypass Stenosis: A Systematic Review and Meta-Analysis

“…In addition, circulating biomarkers as predictors of postinterventional restenosis for VGS could help optimize the use of DCBs. For instance, proinflammatory markers and high plasma levels of micro-RNA have been reported to potentially influence the outcomes after peripheral stenting [36].…”

Tissue Engineering and Targeted Drug Delivery in Cardiovascular Disease: The Role of Polymer Nanocarrier for Statin Therapy

“…ISR occurs in 25% of patients undergoing PCIs, caused by neointimal hyperplasia. Therefore, bare metal stents have been gradually replaced by drug-eluting stents such as everolimus and sirolimus, which have shown reduced risk of ISR [ 69 , 70 , 71 ]. Statins were examined considering their effect on the endothelium, such as (i) the inhibition of intimal hyperplasia or cell proliferation, (ii) the inhibition of the mTOR pathway, through the activation of AMP-K, and (iii) the inhibition of the inflammatory cascade carried out by macrophages.…”

The Roles of microRNAs in the Cardiovascular System

“…However, the greater risk of late thrombosis associated with drug-eluting stents is a concern that must be addressed. The promotion of late thrombosis in these stents is attributed to the regenerative ability of endothelial cells resulting from vascular wall injury and the prolonged arterial healing process [ 145 , 146 , 147 , 148 , 149 ].…”