Skip to main content
SpringerLink
Log in

Drug-Eluting Stents for Treatment of Peripheral Artery Disease

  • Review Article
  • Published:
American Journal of Cardiovascular Drugs Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Reference

  1. 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.

    Article  PubMed  Google Scholar 

  2. 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.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  3. Berger JS, Hiatt WR. Medical therapy in peripheral artery disease. Circulation. 2012;126:491–500.

    Article  PubMed  Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  5. Zeller T. Drug-coated balloons: hope or hype? 2012. https://evtoday.com/2012/08/drug-coated-balloons-hope-or-hype/. Accessed 23 Apr 2018.

  6. Schillinger M, Minar E. Restenosis after percutaneous angioplasty: the role of vascular inflammation. Vasc Health Risk Manag. 2005;1(1):73–8.

    Article  PubMed  PubMed Central  Google Scholar 

  7. 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.

    Article  PubMed  CAS  Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  9. 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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. 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.

    Article  PubMed  Google Scholar 

  13. 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.

    Article  PubMed  Google Scholar 

  14. 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.

    Article  PubMed  CAS  Google Scholar 

  15. 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.

    Article  PubMed  CAS  Google Scholar 

  16. 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.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  17. 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.

    Article  Google Scholar 

  18. 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.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  19. 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.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  20. Athanasios D. The Eluvia drug-eluting vascular stent system. Endovasc Today Eur. 2016;4(5):31–3.

    Google Scholar 

  21. “ELUVIA™.” ELUVIA™ Drug-Eluting Vascular Stent System— IMPERIAL clinical trial| Boston Scientific. N.p., n.d. Web. 01 May 2017.

  22. 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.

    Article  Google Scholar 

  23. 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.

    Article  PubMed  Google Scholar 

  24. 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.

    Article  PubMed  Google Scholar 

  25. 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.

    Article  PubMed  Google Scholar 

  26. 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.

    Article  PubMed  CAS  Google Scholar 

  27. 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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  29. 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.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  30. 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.

    Article  PubMed  Google Scholar 

  31. 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.

    Article  PubMed  Google Scholar 

  32. 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.

    Article  PubMed  Google Scholar 

  33. 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.

    Article  PubMed  CAS  Google Scholar 

Download references

Funding

No external funding was used in the preparation of this manuscript.

Author information

Authors and Affiliations

  1. University of Texas Southwestern Medical Center, Dallas, TX, USA

    Kazeen Abdullah, Bassel Bou Dargham, Micah Steinbrecher, Bo Sun, Houman Khalili, Emmanouil S. Brilakis & Subhash Banerjee

  2. Veterans Affairs North Texas Health Care System, 4500 S. Lancaster Road (111a), Dallas, TX, 75216, USA

    Micah Steinbrecher, Houman Khalili & Subhash Banerjee

  3. Beijing Friendship Hospital, Beijing, China

    Zhao Huiqiang

  4. Minneapolis Heart Institute, Minneapolis, MN, USA

    Emmanouil S. Brilakis

Authors
  1. Kazeen Abdullah
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bassel Bou Dargham
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Micah Steinbrecher
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bo Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zhao Huiqiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Houman Khalili
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Emmanouil S. Brilakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Subhash Banerjee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Subhash Banerjee.

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

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40256-018-0265-4

Search

Navigation