Performance of drug-coated balloons in coronary and below-the-knee arteries: anatomical, physiological and pathological considerations

Ramses, R., Kennedy, S. , Good, R., Oldroyd, K. G. and Mcginty, S. (2024) Performance of drug-coated balloons in coronary and below-the-knee arteries: anatomical, physiological and pathological considerations. Vascular Pharmacology, 155, 107366. (doi: 10.1016/j.vph.2024.107366) (PMID:38479462)

Abstract

Below-the-knee (infrapopliteal) atherosclerotic disease, which presents as chronic limb-threatening ischemia (CLTI) in nearly 50% of patients, represents a treatment challenge when it comes to the endovascular intervention arm of management. Due to reduced tissue perfusion, patients usually experience pain at rest and atrophic changes correlated to the extent of the compromised perfusion. Unfortunately, the prognosis remains unsatisfactory with 30% of patients requiring major amputation and a mortality rate of 25% within 1 year. To date, randomized multicentre trials of endovascular intervention have shown that drug-eluting stents (DES) increase patency rate and lower target lesion revascularization rate compared to plain balloon angioplasty and bare-metal stents. The majority of these trials recruited patients with focal infrapopliteal lesions, while most patients requiring endovascular intervention have complex and diffuse atherosclerotic disease. Moreover, due to the nature of the infrapopliteal arteries, the use of long DES is limited. Following recent results of drug-coated balloons (DCBs) in the treatment of femoropopliteal and coronary arteries, it was hoped that similar effective results would be achieved in the infrapopliteal arteries. In reality, multicentre trials have failed to support the proposed hypothesis and no advantage was found in using DCBs in comparison to plain balloon angioplasty. This review aims to explore anatomical, physiological and pathological differences between lesions of the infrapopliteal and coronary arteries to explain the differences in outcome when using DCBs.

• Item Type: Articles
• Keywords: Drug-eluting balloons (DEBs), Paclitaxel-coated balloons (PCBs), Coronary artery disease (CAD), Below-the-knee (BTK) arterial disease, Lower extremity peripheral arterial disease (LEAD).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Mcginty, Dr Sean and Oldroyd, Dr Keith and Ramses, Rafic and Good, Dr Richard and Kennedy, Professor Simon

Creator Roles

Ramses, R.: Writing – original draft
Kennedy, S.: Writing – review and editing, Supervision
Good, R.: Writing – review and editing
Oldroyd, K. G.: Writing – review and editing
Mcginty, S.: Writing – review and editing

• Authors: Ramses, R., Kennedy, S., Good, R., Oldroyd, K. G., and Mcginty, S.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Science and Engineering > School of Engineering > Biomedical Engineering
• Journal Name: Vascular Pharmacology
• Publisher: Elsevier
• ISSN: 1537-1891
• ISSN (Online): 1879-3649
• Published Online: 11 March 2024
• Copyright Holders: Copyright © 2024 The Authors
• First Published: First published in Vascular Pharmacology 155:107366
• Publisher Policy: Reproduced under a Creative Commons License