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Published on: May 14, 2013
Current Status of and Future Prospects for Drug-Eluting Stents and Scaffolds in Infrapopliteal Arteries
Elizabeth Lim1, Ramon L Varcoe2
1The Prince of Wales Hospital, Sydney, NSW 2031, Australia.
Insights
Drug-eluting stents improve infrapopliteal artery patency in chronic limb ischemia but have limitations. Resorbable scaffolds offer a promising alternative for complex lesions.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Biomaterials Science
Background:
- Chronic limb-threatening ischemia (CLTI) poses a significant risk of amputation.
- Infrapopliteal atherosclerotic disease presents treatment challenges due to small vessel size and plaque burden.
- Percutaneous transluminal angioplasty (PTA) is a minimally invasive first-line treatment but suffers from high restenosis rates.
Purpose of the Study:
- To review clinical data on coronary drug-eluting stents (DES) for infrapopliteal arterial disease.
- To evaluate the efficacy and limitations of DES in treating CLTI.
- To explore novel therapeutic options for complex infrapopliteal lesions.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) on DES in infrapopliteal disease.
- Analysis of published and presented clinical data.
- Comparison of outcomes between DES, angioplasty, and bare metal stents.
Main Results:
- Drug-eluting stents showed superior primary patency compared to angioplasty or bare metal stents alone.
- DES effectiveness is currently limited to short-segment infrapopliteal lesions.
- Widespread adoption of DES is hindered by their permanent nature.
Conclusions:
- Drug-eluting stents offer improved patency for select infrapopliteal lesions.
- Drug-eluting resorbable scaffolds represent a promising next-generation technology.
- Resorbable scaffolds may enable treatment of longer, complex lesions without a permanent implant, preserving vasomotion.
Abstract:
Background: Chronic limb-threatening ischaemia can be a debilitating disease and may result in limb amputation if untreated. Atherosclerotic disease of the infra-popliteal arteries is particularly challenging to treat due to the small caliber of the vessels and the heavy burden of atherosclerotic plaque. Percutaneous transluminal angioplasty is the conventional first-line approach and is advantageous due to its minimal invasiveness, repeatability, and cost-effectiveness but is limited by high rates of elastic recoil, dissection, and short- to mid-term re-stenosis. Methods: This review analyses the growing body of published and presented clinical data from multiple randomised controlled trials that have investigated the role of coronary drug-eluting stents in the treatment of infrapopliteal disease. Results: Coronary drug-eluting stents demonstrate superior primary patency compared with angioplasty and/or bare metal stenting alone but are limited to application in short-segment disease and have not been widely adopted due to the nature of the permanent implant. Conclusions: Newer devices like drug-eluting resorbable scaffolds are promising as they allow the restoration of vessel wall vasomotion without a residual foreign body and can be used to treat longer, complex lesions.
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