Drug-eluting stents and balloons in peripheral arterial disease: evidence so far

Abstract

Restenosis by myointimal hyperplasia after peripheral arterial angioplasty or stenting is a major problem limiting its long-term efficiency and patency, and may lead to recurrent symptoms. Drug-eluting devices which inhibit the proliferation of neo-intimal growth of vascular smooth muscle cells may prevent restenosis. The aim of this article is to examine the evidence in published literature on the use of drug-eluting devices in the treatment of peripheral arterial diseases. A systematic literature review was undertaken of all published literature on this subject using Medline and cross-referenced. All published relevant articles on the use of drug-eluting stents and balloons in peripheral arterial disease were used. Cochrane Central Register of Controlled Trials and electronic databases were also searched for on-going studies. Published results from randomised studies such as the SIROCCO I and II Trials and the THUNDER study, together with single cohort studies, are now available. There are on-going studies comparing drug-eluting and non-drug-eluting devices. Evidence from the published literature suggests that drug-eluting stents and balloons are safe and effective in preventing restenosis after peripheral angioplasty. However, drug-eluting devices are more expensive and many are limited to single-use only. It is anticipated that results from all the on-going studies may allow a meta-analysis to show whether these preliminary data can translate into a clinically applicable cost-effective strategy in combating restenosis after peripheral angioplasty or stenting.

Injectable skeletal muscle matrix hydrogel promotes neovascularization and muscle cell infiltration in a hindlimb ischemia model

“…Critical limb ischemia (CLI) is the most advanced form of PAD, often leading to amputation of the limb and potential mortality (Chan and Cheng, 2011;Dattilo and Casserly, 2011). The only current clinical treatment for PAD and CLI is endovascular or surgical revascularization (Dattilo and Casserly, 2011).…”

Targeted Treatments for Restenosis and Vein Graft Disease

“…Angioplasty, inflating a balloon within a narrowed artery to crush the plaque and open up the lumen, is a widely used and relatively cheap treatment for lower limb ischaemia, angina pectoris, and myocardial infarction [7,12]. It can be complicated by acute closure, spasm and elastic recoil ("rebound"), embolism, or thrombosis [4].…”

“…The increase in luminal area after angioplasty is due to plaque reduction, plaque translocation to distal and proximal areas, and expansion of the total vessel area, while luminal loss is most likely due to late recoil [12,34]. Arteries treated by angioplasty catheters have been reported to restenose about 30% of the time, but may this rise to 60-75% in the lower limbs of diabetic patients [5,7,12,35].…”

“…These surgical treatments include arterial bypass grafting (coronary and peripheral bypass grafting), endarterectomy, and angioplasty (with or without stent placement). Although these procedures have improved both patient mortality and quality of life, their success is limited by immediate occlusive complications in up to 18% of patients, and by the longer-term complications of vein graft disease (vein graft thickening) or restenosis (arterial reblockage at the same site), often resulting in partial or complete closure of surgically treated vessels by 10 years after the procedure [2,[4][5][6][7][8].…”

“…Targeted (or local) treatment not only reduces the amount of drug required (compared with systemic administration), it also eliminates the need for repeated dosing and minimises side effects. One form of local treatment is the drug-eluting stent, which has reduced the restenosis rate to less than 10% [3,7,22,23]. However, it is not possible to use stents to treat all atherosclerotic plaques, and there are concerns regarding stent cost and safety.…”