Vessel Preparation Is Essential to Optimize Endovascular Therapy of Infrainguinal Lesions

Abstract

Symptomatic peripheral arterial disease management involves medical treatment and interventional procedures. Intermittent claudication and critical limb threatened ischemia (CLTI) should be individually considered with specific outcomes and procedures. When intervention is required, an endovascular approach is usually the first-line option. Plain balloon angioplasty was previously used to dilate clinically significant femoropopliteal lesions with variable results. However, over recent years, the use of self-expanding nitinol stents has enabled treatment of long lesions, yielding significantly improved clinical results. Drug-eluting technology has also exhibited a capacity to limit in-stent restenosis and to drive target revascularization. Nevertheless, calcifications and elastic recoil of the arterial wall remain risk factors for early restenosis and failure. Therefore, vessel preparation using specific devices is required to modify vessel compliance and debulk obstructive calcification. In this short review, we provide an overview of the options for gaining lumen before stenting or dilation using drug-coated balloons.

One single drug-coated balloon for all shapes/diameters? Neointimal proliferation inhibition in porcine peripheral arteries

“…gain, plaque modification, and enhancement of drug uptake especially in calcified lesions, which are prevalent in the SFA, prior to treatment with a DCB is now an integral part of restenosis prophylaxis [14,15]. However, in order to avoid further lumen expansion by conventional balloons with defined diameters which may again results in arterial wall injury prior selection of balloons with an appropriate diameter and length from a stock of a variety of devices with different dimensions as well as precise placement of balloons is required.…”

The Ability to Look Beyond: The Treatment of Peripheral Arterial Disease

“…The amount of embolized material may be limited by new-generation devices that offer aspiration in addition to atherectomy capabilities, but to minimize embolic events, distal filters should be considered, as well as vasodilators to prevent vasospasm [68]. Special Balloons: Different from POBA, the primary goal of these devices is to improve vessel compliance, lumen gain, and drug delivery [69]. Scoring balloons are semi-compliant balloons covered by helical scoring elements or longitudinal wires useful for a precise rupture of the plaque; cutting balloons have longitudinally oriented sharp metal blades on their surface to cut the atherosclerotic plaque.…”

State-of-the-Art Endovascular Therapies for the Femoropopliteal Segment: Are We There Yet?

“…106 Although prospective data to guide use remain limited to small single-center studies, forthcoming, prospective multicenter data of the Bard UltraScore device (NCT03693963) and the Angio-Sculpt balloon (MASCOT Study, NCT00619788) may offer further guidance. 105 Cutting balloons are similar to scoring balloons but have longitudinally oriented microsurgical blades that cut into lesions with inflation. They were initially developed for the treatment of restenotic lesions involving neointimal hyperplasia but are used in a variety of lesion types.…”

“…Specialty balloons differ from atherectomy devices, although they share the primary goal of improving vessel compliance, lumen gain, and drug delivery. 105 They are often used in areas where bailout stenting is consequential (popliteal artery and common femoral artery), in smaller caliber vessels that are prone to dissection when subjected to higher balloon inflation pressures, and to treat in-stent restenosis and under-expanded stents. 105 Although initially limited by bulkier devices that resulted in delivery challenges, newer iterations allow for the creation of lower profile devices that can be used in more complex lesion subsets.…”

“… 106 Although prospective data to guide use remain limited to small single-center studies, forthcoming, prospective multicenter data of the Bard UltraScore device ( NCT03693963 ) and the AngioSculpt balloon (MASCOT Study, NCT00619788 ) may offer further guidance. 105 …”