Efficacy and safety of paclitaxel drug-eluting balloons in femoropopliteal artery disease: a prospective observational study

Background: The femoropopliteal artery is most frequently involved artery in peripheral artery disease. To treat femoropopliteal artery disease (FPAD), various revascularization approaches have been available such as simple balloon angioplasty, debulking techniques, stent implantation, and recently the drug-eluting balloon (DEBs). Nowadays, the paclitaxel DEBs have been emerged to treat FPAD with promising outcomes. We therefore evaluate the efficacy and safety of paclitaxel DEBs in patients with lower limb FPAD.Methods: In total, 25 patients with FPAD were enrolled in the study. All patients underwent peripheral angioplasty using paclitaxel DEBs via antegrade femoral approach or contralateral femoral artery using crossover sheath. Demographics, risk factors, clinical characteristics, and pre- and post-procedure VascuQol-6 score were noted.Results: Out of 25 patients, the majority of patients (52%) were in the 6th decades of life. The incidence of FPAD was most common in patients with an O +ve blood group. The common risk factors of FPAD, include smoking (88%), diabetes (68%), dyslipidemia (68%), and hypertension (64%). Rest pain (64%) and ulcer (32%) were the most frequent clinical symptoms of FPAD. The percent stenosis was 100% in 17 patients, and 70-99% in 32 patients. A statistically significant difference was found in VascuQol-6 score between pre and post peripheral angioplasty (p<0.001).Conclusions: We have concluded that the paclitaxel DEBs are safe and efficacious in treating FPAD. Authors recommend that clinician should educate FPAD patients pertaining to modification of controllable risk factors such as cessation of smoking, unhealthy diet, sedentary lifestyle, high blood pressure, and high blood sugar.

Aneurysmal Degeneration After Paclitaxel-Eluting Balloon Angioplasty

Aneurysmal degeneration after peripheral angioplasty is a potentially serious complication. In this case, the patient underwent repeated angioplasty of a prior vein bypass graft utilizing a paclitaxel-coated balloon. He subsequently developed a progressive aneurysmal degeneration, threatening his bypass, which ultimately required an urgent exclusion with a covered stent. This case represents a rare complication of peripheral bypass graft related to percutaneous intervention as well as paclitaxel-coated devices and warns other practitioners of the increased scrutiny and caution one should exercise in the use of such interventions.

Correction to: The CLEAR (Considering Leading Experts’ Antithrombotic Regimes around peripheral angioplasty) survey: an international perspective on antiplatelet and anticoagulant practice for peripheral arterial endovascular intervention

An amendment to this paper has been published and can be accessed via the original article.

Surrogate Markers of Neutrophil Extracellular Trap Formation are Associated with Ischemic Outcomes and Platelet Activation after Peripheral Angioplasty and Stenting

Neutrophil extracellular traps (NETs) are supposed to play a central role in atherothrombosis. We measured circulating citrullinated histone H3 (H3Cit) and cell-free DNA (cfDNA), which serve as surrogate markers of NET formation, in 79 patients with peripheral artery disease (PAD) following infrainguinal angioplasty with stent implantation. Analysis of cfDNA and H3Cit was performed using Quant-iT™ PicoGreen® dsDNA Assay Kit or an ELISA, respectively. Within two years of follow-up, the primary endpoint defined as nonfatal myocardial infarction, stroke or transient ischemic attack, cardiovascular death, and >80% target vessel restenosis occurred in 34 patients (43%). Both H3Cit (HR per 1-SD: 2.72; 95% CI: 1.2–6.3; p = 0.019) and cfDNA (HR per 1-SD: 2.15; 95% CI: 1.1–4.2; p = 0.028) were associated with the primary endpoint in a univariate Cox regression analysis. Multivariate linear regression analyses showed associations between cfDNA and platelet surface expression of P-selectin (p = 0.006) and activated glycoprotein IIb/IIIa (p < 0.001) in response to arachidonic acid (AA) after adjustment for age, sex, clinical risk factors, and inflammatory markers. H3Cit was also associated with P-selectin expression in response to thrombin-receptor activating peptide (p = 0.048) and AA (p = 0.032). Circulating H3Cit and cfDNA predict ischemic outcomes after peripheral angioplasty with stent implantation, and are associated with on-treatment platelet activation in stable PAD.