Mehrotra Saurabh, Paramasivam Ganesh, Mishra Sundeep
PGIMER Chandigarh, Chandigarh, India.
AIIMS, Delhi, India.
Curr Cardiol Rep. 2017 Feb;19(2):10. doi: 10.1007/s11886-017-0823-4.
Percutaneous transluminal angioplasty is an established form of therapy for femoropopliteal artery disease. Currently, percutaneous transluminal angioplasty (PTA) is carried out using standard balloon with or without deployment of a stent but is associated with a high rate of restenosis and stent-related complications. Treatment options for restenosis, especially in-stent restenosis, are limited. Drug-coated balloons promise to reduce the rates of restenosis by effective delivery of antiproliferative agent (paclitaxel) directly to vessel wall without the need for a permanent implant. In this review, we look at the technology and rationale behind drug-coated balloons and examine the evidence available so far.
Recently, several studies tested the effectiveness of paclitaxel-coated balloon angioplasty compared to that of standard PTA in both de novo lesions and in-stent restenosis of femoropopliteal artery. Paclitaxel-coated balloon use resulted in reduced rates of restenosis and favourable clinical outcomes in both these lesion groups. However, in complex lesions, there is still lack of data to support the use of these balloons. Paclitaxel-coated balloon is a safe and effective therapeutic option in patients with both de novo lesions and in-stent restenosis involving femoropopliteal artery. In light of the new evidence, it is time to consider incorporation of this effective therapeutic option into clinical practice. However, further research is needed for the use of paclitaxel-coated balloons in complex femoropopliteal lesions like calcified lesions especially as adjuncts to cutting balloons and debulking strategies.
经皮腔内血管成形术是股腘动脉疾病的一种既定治疗方式。目前，经皮腔内血管成形术（PTA）是使用标准球囊进行，可带或不带支架植入，但与再狭窄率高及支架相关并发症有关。再狭窄的治疗选择，尤其是支架内再狭窄的治疗选择有限。药物涂层球囊有望通过将抗增殖剂（紫杉醇）直接有效递送至血管壁而无需永久性植入物来降低再狭窄率。在本综述中，我们探讨药物涂层球囊背后的技术和原理，并审视目前可得的证据。
最近，多项研究比较了紫杉醇涂层球囊血管成形术与标准PTA在股腘动脉初发病变和支架内再狭窄中的有效性。使用紫杉醇涂层球囊在这两类病变组中均导致再狭窄率降低及良好的临床结果。然而，在复杂病变中，仍缺乏支持使用这些球囊的数据。紫杉醇涂层球囊对于股腘动脉初发病变和支架内再狭窄患者是一种安全有效的治疗选择。鉴于新的证据，是时候考虑将这种有效的治疗选择纳入临床实践了。然而，对于在钙化病变等复杂股腘病变中使用紫杉醇涂层球囊，尤其是作为切割球囊和减容策略的辅助手段，还需要进一步研究。
