Performance of drug-coated balloons in coronary and below-the-knee arteries: Anatomical, physiological and...

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Peripheral Artery Disease

Background:

• Below-the-knee atherosclerotic disease, or chronic limb-threatening ischemia (CLTI), poses significant challenges for endovascular treatment.
• CLTI leads to pain, tissue atrophy, high amputation rates (30%), and 25% 1-year mortality.

Purpose of the Study:

• To review the efficacy of drug-coated balloons (DCBs) in infrapopliteal arteries compared to plain balloon angioplasty.
• To explore anatomical, physiological, and pathological differences influencing DCB outcomes in infrapopliteal versus coronary arteries.

Main Methods:

• Review of randomized multicentre trials comparing endovascular interventions for infrapopliteal arterial disease.
• Analysis of existing literature on drug-eluting stents (DES) and DCBs in femoropopliteal, coronary, and infrapopliteal arteries.

Main Results:

• Drug-eluting stents (DES) improve patency and reduce revascularization compared to plain balloon angioplasty and bare-metal stents in focal infrapopliteal lesions.
• Multicentre trials found no advantage of DCBs over plain balloon angioplasty for infrapopliteal arteries, contrary to findings in coronary and femoropopliteal arteries.

Conclusions:

• The effectiveness of DCBs in infrapopliteal arteries is limited, potentially due to lesion complexity and arterial characteristics.
• Understanding anatomical and pathological differences is crucial for optimizing endovascular treatment strategies for CLTI.