Freyhardt P, Zeller T, Kröncke T J, Schwarzwaelder U, Schreiter N F, Stiepani H, Sixt S, Rastan A, Werk M
Klinik für Strahlenheilkunde, Charité Universitätsmedizin, Berlin.
Rofo. 2011 May;183(5):448-55. doi: 10.1055/s-0029-1246028. Epub 2011 Jan 27.
Paclitaxel-coated balloon catheters inhibit restenosis after coronary and peripheral angioplasty (PCI,PTA). The aim of this study was to investigate paclitaxel plasma levels and laboratory parameters following PTA with paclitaxel-coated balloons (PCB) in peripheral arteries.
This single treatment arm, multicenter study included 14 patients with Rutherford stage 1 - 5 with occlusions of up to 5 cm or ≥ 70 % diameter stenosis of the superficial femoral or popliteal arteries (SFA, PA). PTA was performed using up to three PCB catheters. The paclitaxel plasma levels and safety laboratory parameters were determined by collecting blood samples pre-intervention, immediately post-intervention, at 0.5, 1, 2, 4, 8, 24 hours and 1 and 4 weeks post-intervention (p. i.). Vital signs were monitored to assess clinical safety.
PTA was performed successfully in all patients. Paclitaxel plasma levels were always below a level and duration known to cause systemic side effects. A mean peak paclitaxel plasma level (40 ng/ml) was reached immediately p. i. and decreased rapidly below detectable levels in more than half of the patients already 2 hours p. i. The paclitaxel plasma concentrations returned to values below detectable levels at 24 hours p. i. in all patients. Laboratory parameters and vital signs did not give any reason for safety concerns. No adverse events associated with balloon coating were observed.
The results of 14 patients with peripheral arterial occlusive disease show no systemic bioavailability of paclitaxel > 24 hours after PTA with one or more PCB catheters, indicating that the PCB catheter is safe with regard to possible systemic effects.
紫杉醇涂层球囊导管可抑制冠状动脉和外周血管成形术(PCI、PTA)后的再狭窄。本研究旨在调查外周动脉使用紫杉醇涂层球囊(PCB)进行经皮腔内血管成形术(PTA)后紫杉醇的血浆水平和实验室参数。
本单治疗组多中心研究纳入了14例卢瑟福分级为1 - 5级、股浅动脉或腘动脉闭塞长度达5 cm或直径狭窄≥70%的患者。使用最多三根PCB导管进行PTA。在干预前、干预后即刻、干预后0.5、1、2、4、8、24小时以及干预后1周和4周采集血样,测定紫杉醇血浆水平和安全性实验室参数。监测生命体征以评估临床安全性。
所有患者PTA均成功完成。紫杉醇血浆水平始终低于已知会引起全身副作用的水平和持续时间。干预后即刻平均紫杉醇血浆峰值水平达到40 ng/ml,超过半数患者在干预后2小时已迅速降至可检测水平以下。所有患者在干预后24小时紫杉醇血浆浓度均恢复至可检测水平以下。实验室参数和生命体征未显示出任何安全问题。未观察到与球囊涂层相关的不良事件。
14例外周动脉闭塞性疾病患者的结果显示,使用一根或多根PCB导管进行PTA后24小时以上紫杉醇无全身生物利用度,表明PCB导管在可能的全身影响方面是安全的。