Novel Approaches to the Management of Advanced Per

Authors: Thomas Zeller Aljoscha Rastan Roland Macharzina Ulrich Beschorner Elias Noory

Publish Date: 2015/08/04

Volume: 17, Issue: 9, Pages: 69-

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Abstract

Introducing antirestenotic drugbased treatment modalities in femoropopliteal interventions is the potential revolutionizing reperfusion treatment of peripheral artery disease Durability of recanalization procedures using drugcoated balloons DCB and drugeluting stents DES yields in excellent midterm and longterm technical and clinical outcomes and may be cost saving on the long term as compared to traditional treatment modalities such as plain old balloon angioplasty POBA and bare metal nitinol stent implantation Drugeluting bioresorbable scaffolds are another drugbased promising treatment option but are still investigational In particular DCB provide a novel method to locally deliver paclitaxel into the arterial wall without the need of a chronically implanted delivery system or even if those devices will be indicated they can be delivered focally Following the first positive pilot studies two large pivotal trials have confirmed superiority of DCB over plain old balloon angioplasty POBA in the treatment of TASC II A and B femoropopliteal lesions Even for more complex femoropopliteal lesions such as long lesions and instent restenosis single center studies and small randomized studies have shown promising midterm technical and clinical results For DES followup data for the only commercially available device are now presented up to 5 years with excellent clinical outcome regarding freedom from target lesion revascularization and improvement of walking capacity This review article summarizes the current knowledge and perspectives of drugbased endovascular treatment modalities in femoropopliteal interventions and discusses still unresolved needs

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