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The role for DCBs in the treatment of ISR
Nicolas Bague1, Bahaa Nasr, Philippe Chaillou
1Unit of Vascular Surgey, Thorax Institute, CHU Nantes, Nantes, France - yann.goueffic@chu-nantes.fr.
Insights
Drug-coating balloons (DCB) show promise for treating femoropopliteal in-stent restenosis (FP ISR). Studies indicate DCB offers better outcomes than standard angioplasty, making it a potential first-choice treatment.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomaterials Science
Background:
- Peripheral artery disease (PAD) management relies on endovascular therapy, but restenosis remains a challenge.
- Restenosis involves elastic recoil, constrictive remodeling, and intimal hyperplasia.
- Drug-coating balloons (DCB) are emerging as effective devices for preventing and treating restenosis.
Purpose of the Study:
- To review the efficacy of DCB in treating femoropopliteal in-stent restenosis (FP ISR).
- To compare DCB performance against other treatment modalities for FP ISR.
Main Methods:
- Review of existing studies on DCB use for femoropopliteal ISR.
- Analysis of freedom from target lesion revascularization (TLR) rates at one year.
- Comparison of DCB with atherectomy, cutting balloon, standard angioplasty, drug-eluting stents, brachytherapy, and covered stents.
Main Results:
- DCB studies for FP ISR primarily consist of uncontrolled or historical comparisons.
- One randomized controlled trial (FAIR trial) demonstrated superior freedom from TLR at 12 months for DCB (90.8%) versus standard angioplasty.
- DCB shows promising freedom from target lesion revascularization (87%-92.1%) and primary patency rates compared to other devices.
Conclusions:
- Drug-coating balloons (DCB) represent a potentially superior option for femoropopliteal in-stent restenosis (FP ISR) treatment.
- DCB's efficacy and ease of use position it as a potential first-choice device over more complex alternatives.
Introduction:
Currently, endovascular therapy is the standard of care for peripheral artery disease. The main issue of these techniques is restenosis which is a complex mechanism associating elastic recoil, constrictive remodelling and intimal hyperplasia. More and more evidence show that drug-coating balloon (DCB) is a promising device to prevent and to treat restenosis. Herein we have reviewed the role for DCB's in the treatment of in-stent restenosis (ISR).
Evidence Acquisition:
Currently, few studies are available regarding DCB use for femoropopliteal (FP) ISR treatment. In different studies evaluating DCB for treatment of FP ISR the freedom from target lesion revascularization rate at one year are range from 87% to 92.1%. In comparison to other devices used for treatment of FP ISR such as atherectomy, cutting balloon, standard angioplasty, DCB seems to show better results in terms of freedom from TLR and primary patency. Other devices such as drug-eluting stent, brachytherapy, covered stent show also good results for FP ISR.
Evidence Synthesis:
Majority of assessed data on FP ISR treated with DCB derived from uncontrolled study or historical comparisons. Only one randomized, controlled study compared DCB versus standard angioplasty. The FAIR trial showed better results in favour of DCB in terms of freedom from TLR at 12 months (90.8%).
Conclusions:
Drug coating balloon could be the first choice of devices for the treatment of FP ISR, because of its efficacy, its ease of use in comparison with more complex and less efficient devices.
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