Abstract
Endovascular intervention is a mainstay treatment of peripheral artery disease (PAD) in addition to aggressive risk factor modification and exercise programs in patients with favorable anatomy or in those who are considered too high risk for surgical intervention. Treatment with percutaneous transluminal angioplasty (PTA) and bare metal stents (BMS) has been limited by high rates of in-stent restenosis (ISR) requiring repeat revascularization. Drug-eluting stents (DES), developed and designed to reduce ISR, offer a promising solution to the current challenges in endovascular management of PAD. Several randomized clinical trials have shown improved short- and mid-term outcomes with DES as compared with both PTA and BMS. Herein we provide an up-to-date review of the current literature on DES use in PAD.
Similar content being viewed by others
Reference
Allison MA, Ho E, Denenberg JO, et al. Ethnic-specific prevalence of peripheral arterial disease in the United States. Am J Prev Med. 2007;32:328–33.
Joosten MM, Pai JK, Bertoia ML, et al. Associations between conventional cardiovascular risk factors and risk of peripheral artery disease in men. JAMA. 2012;308:1660–7.
Berger JS, Hiatt WR. Medical therapy in peripheral artery disease. Circulation. 2012;126:491–500.
Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: executive summary. Vasc Med. 2017;22(3):NP1–43.
Zeller T. Drug-coated balloons: hope or hype? 2012. https://evtoday.com/2012/08/drug-coated-balloons-hope-or-hype/. Accessed 23 Apr 2018.
Schillinger M, Minar E. Restenosis after percutaneous angioplasty: the role of vascular inflammation. Vasc Health Risk Manag. 2005;1(1):73–8.
Suzuki T, Kopia G, Hayashi S, Bailey LR, Llanos G, Wilensky R, et al. Stent-based delivery of sirolimus reduces neointimal formation in a porcine coronary model. Circulation. 2001;104(10):1188–93.
Sarode K, Spelber DA, Bhatt DL, Mohammad A, Prasad A, Brilakis ES, et al. Drug delivering technology for endovascular management of infrainguinal peripheral artery disease. JACC Cardiovasc Interv. 2014;7(8):827–39.
Duda SH, Bosiers M, Lammer J, Scheinert D, Zeller T, Oliva V, et al. Drug-eluting and bare nitinol stents for the treatment of atherosclerotic lesions in the superficial femoral artery: long-term results from the SIROCCO trial. J Endovasc Ther. 2006;13(6):701–10.
Lammer J, Bosiers M, Zeller T, et al. First clinical trial of nitinol self-expanding everolimus-eluting stent implantation for peripheral arterial occlusive disease. J Vasc Surg. 2011;54:394–401.
Feiring AJ, Krahn M, Nelson L, Wesolowski A, Eastwood D, Szabo A. Preventing leg amputations in critical limb ischemia with below-the-knee drug-eluting stents: the PaRADISE (PReventing Amputations using Drug eluting StEnts) trial. J Am Coll Cardiol. 2010;55(15):1580–9.
Bradbury AW, Adam DJ, Bell J, et al. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet. 2005;366(9501):1925–34.
Bosiers M, Scheinert D, Peeters P, et al. Randomized comparison of everolimus-eluting versus bare-metal stents in patients with critical limb ischemia and infrapopliteal arterial occlusive disease. J Vasc Surg. 2012;55:390–8.
Dake MD, Ansel GM, Jaff MR, Ohki T, Saxon RR, Smouse HB, et al. Paclitaxel-eluting stents show superiority to balloon angioplasty and bare metal stents in femoropopliteal disease: twelve-month Zilver PTX randomized study results. Circ Cardiovasc Interv. 2011;4:495–504.
Dake MD, Ansel GM, Jaff MR, Ohki T, Saxon RR, Smouse HB, et al. Sustained safety and effectiveness of paclitaxel-eluting stents for femoropopliteal lesions: 2-year follow-up from the Zilver PTX randomized and single-arm clinical studies. J Am Coll Cardiol. 2013;61(24):2417–27.
Dake MD, Ansel GM, Jaff MR, Ohki T, Saxon RR, Smouse HB, et al. Durable clinical effectiveness with paclitaxel-eluting stents in the femoropopliteal artery: 5-year results of the Zilver PTX randomized trial. Circulation. 2016;133(15):1472–83.
Hiroyoshi Y, Takao O, Kimihiko K, Masato N, et al. Zilver PTX post-market surveillance study of paclitaxel-eluting stents for treating femoropopliteal artery disease in Japan. JACC Cardiovasc Interv. 2016;9(3):271–7.
Goueffic Y, Kaladji A, Guyomarch B, Montagne C, Fairier D, Gestin S, et al. Bare metal stent versus paclitaxel eluting stent for intermediate length femoropopliteal arterial lesions (BATTLE trial): study protocol for a randomized controlled trial. Trials. 2014;15:423.
Spreen MI, Martens JM, Hansen BE, Knippenberg B, Verhey E, van Dijk LC, et al. Percutaneous transluminal angioplasty and drug-eluting stents for infrapopliteal lesions in critical limb ischemia (PADI) trial. Circ Cardiovasc Interv. 2016;9(2):e002376.
Athanasios D. The Eluvia drug-eluting vascular stent system. Endovasc Today Eur. 2016;4(5):31–3.
“ELUVIA™.” ELUVIA™ Drug-Eluting Vascular Stent System— IMPERIAL clinical trial| Boston Scientific. N.p., n.d. Web. 01 May 2017.
Bosiers M, Peeters P, D’Archambeau O, Hendriks J, Pilger E, Duber C, et al. AMS INSIGHT–absorbable metal stent implantation for treatment of below-the-knee critical limb ischemia: 6-month analysis. Cardiovasc Interv Radiol. 2009;32(3):424–35.
Werner M, Micari A, Cioppa A, Vadala G, Schmidt A, Sievert H, et al. Evaluation of the biodegradable peripheral Igaki-Tamai stent in the treatment of de novo lesions in the superficial femoral artery: the GAIA study. JACC Cardiovasc Interv. 2014;7(3):305–12.
Lammer J, Bosiers M, Deloose K, Schmidt A, Zeller T, Wolf F, et al. Bioresorbable everolimus-eluting vascular scaffold for patients with peripheral artery disease (ESPRIT I): 2-year clinical and imaging results. JACC Cardiovasc Interv. 2016;9(11):1178–87.
Varcoe RL, Schouten O, Thomas SD, et al. Experience with the absorb everolimus-eluting bioresorbable vascular scaffold in arteries below the knee: 12-month clinical and imaging outcomes. JACC Cardiovasc Interv. 2016;9(16):1721–8.
Kereiakes DJ, Ellis SG, Metzger C, Caputo RP, Rizik DG, Teirstein PS et al. 3-year clinical outcomes with everolimus-eluting bioresorbable coronary scaffolds: the ABSORB III trial. J Am Coll Cardiol. 2017;70(23):2852–62.
Wykrzykowska JJ, Kraak RP, Hofma SH, van der Schaaf RJ, Arkenbout EK, IJsselmuiden AJ, et al. Bioresorbable scaffolds versus metallic stents in routine PCI. New Engl J Med. 2017;376(24):2319–28.
Rosenfield K, Jaff MR, White CJ, Rocha-Singh K, Mena-Hurtado C, et al. Trial of a paclitaxel-coated balloon for femoropopliteal artery disease. N Engl J Med. 2015;373:145–53.
Tepe G, Laird J, Schneider P, Brodmann M, Krishnan P, et al. Drug-coated balloon versus standard percutaneous transluminal angioplasty for the treatment of superficial femoral and popliteal peripheral artery disease: 12-month results from the IN.PACT SFA randomized trial. Circulation. 2015;131(5):495–502.
Micari A, Nerla R, Vadalà G, et al. 2-year results of paclitaxel-coated balloons for long femoropopliteal artery disease: evidence from the SFA-Long Study. JACC Cardiovasc Interv. 2017;10(7):728–34.
Siablis D, Kitrou PM, Spiliopoulos S, Katsanos K, Karnabatidis D. Paclitaxel-coated balloon angioplasty versus drug-eluting stenting for the treatment of infrapopliteal long-segment arterial occlusive disease: the IDEAS randomized controlled trial. JACC Cardiovasc Interv. 2014;7(9):1048–56.
Feiring AJ, Krahn M, Nelson L, et al. Preventing leg amputations in critical limb ischemia with below-the-knee drug-eluting stents: the PaRADISE (PReventing Amputations using Drug eluting StEnts) trial. J Am Coll Cardiol. 2010;55(15):1580–9.
Rastan A, Brechtel K, Krankenberg H, et al. Sirolimus-eluting stents for treatment of infrapopliteal arteries reduce clinical event rate compared to bare-metal stents: long-term results from a randomized trial. J Am Coll Cardiol. 2012;60(7):587–91.
Funding
No external funding was used in the preparation of this manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Dr. Brilakis has received a speaker honorarium from Abbott Vascular, Asahi, Cardinal Health, Elsevier, GE Healthcare, and St. Jude Medical and research support from InfraRedx and Boston Scientific. His spouse is an employee of Medtronic. Dr. Banerjee has received a speaker honorarium from Medtronic and Gore and research grants from Boston Scientific and Merck. Kazeen Abdullah, Bassel Bou Dargham, MD, Micah Steinbrecher, Bo Sun, MD, Zhao Huiqiang, MD and, Houman Khalili have no conflict of interest that is relevant to this manuscript.
Rights and permissions
About this article
Cite this article
Abdullah, K., Bou Dargham, B., Steinbrecher, M. et al. Drug-Eluting Stents for Treatment of Peripheral Artery Disease. Am J Cardiovasc Drugs 18, 175–180 (2018). https://doi.org/10.1007/s40256-018-0265-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40256-018-0265-4