Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.010616
Jornal Vascular Brasileiro
Original Article

O uso do balão com paclitaxel no tratamento da reestenose intra-stent no segmento fêmoro-poplíteo

Use of paclitaxel-coated balloon to treat in-stent restenosis in femoropopliteal segments

Julio Cesar Peclat de Oliveira, Ana Paula Rolim Maia Peclat, Fernando Tebet Ramos Barreto, João Marcos Fonseca, Diogo Di Batista de Abreu e Souza, Stenio Karlos Alvim Fiorelli, Rossano Kepler Alvim Fiorelli, Marcos Arêas Marques

Downloads: 0
Views: 1165

Resumo

Contexto: A reestenose intra-stent por hiperplasia miointimal pós-angioplastia é uma intercorrência frequente e que limita a perviedade do procedimento a longo prazo. A terapia com balões revestidos de droga com ação antiproliferativa pode ser uma alternativa no tratamento dessa complicação. Objetivos: Demonstrar eficácia e as complicações (óbito, grandes amputações, etc.) do balão farmacológico no tratamento da reestenose intra-stent de segmento femoropoplíteo. Métodos: Estudo de coorte retrospectivo de 32 pacientes consecutivos tratados entre os anos de 2012 e 2016, submetidos a terapia de reestenose intra-stent de segmento femoropoplíteo com angioplastia com balão farmacológico revestido com paclitaxel. A taxa de sucesso foi mensurada pela ocorrência de sucesso do procedimento e reestenose inferior a 50% em avaliação por eco-Doppler colorido 30, 90 e 180 dias após o procedimento. Resultados: Quatro pacientes (12,5%) apresentaram reestenose superior a 50%, sendo um (3,1%) após 90 dias e três (9,4%) após 180 dias, conferindo uma taxa de sucesso de 87,5% ao procedimento. Após 180 dias, todos os pacientes referiam melhora ou cessação dos sinais e/ou sintomas apresentados antes do procedimento. Não houve óbitos, e complicações ocorreram apenas em dois casos, no pós-operatório imediato. Conclusões: Os resultados a curto prazo da terapia com balão farmacológico são promissores, com redução na taxa de reestenose e baixo índice de complicações. Ainda precisam ser apresentados estudos demonstrando os efeitos a longo prazo dessa terapia, assim como seu impacto econômico quando comparada a outros procedimentos.

Palavras-chave

doença arterial periférica; angioplastia; reestenose de enxerto vascular.

Abstract

Background: In-stent restenosis due to myointimal hyperplasia after angioplasty is common and limits long-term patency. Treatments using balloons coated with antiproliferative drugs may offer an alternative option for this pathology. Objectives: To demonstrate the efficacy and complications (death, major amputations, etc.) of drug-coated balloons for treatment of in-stent restenosis in femoropopliteal segments. Methods: This was a retrospective cohort study of 32 consecutive patients treated between 2012 and 2016 who underwent treatment to correct in-stent restenosis in the femoropopliteal segment using paclitaxel-coated balloons. The success rate was measured in terms of technical success and restenosis of less than 50% on Doppler ultrasonography at 30, 90, and 180 days after the procedure. Results: Four patients (12.5%) exhibited restenosis greater than 50%, one (3.1%) after 90 days and three (9.4%) after 180 days, equating to a success rate of 87.5% of procedures, and by 180 days all patients experienced improvement or cessation of the signs and/or symptoms they had presented prior to the procedure. There were no deaths and complications occurred in just 2 cases in the immediate postoperative period. Conclusions: Short-term results are promising, with reductions in the magnitude of restenosis and a low rate of complications. Further studies are needed that can demonstrate the long-term effects and the economic impacts in comparison to other procedures.

Keywords

peripheral artery disease; balloon angioplasty; vascular graft restenosis.

References

1. Reekers JA, Vries CJM. A decade of drug-eluting technology in peripheral arterial disease: blurred by dissembling evidence. Cardiovasc and Intv Radiol. 2016;39(12):1678-80. PMid:27671154. http://dx.doi.org/10.1007/s00270-016-1476-1.

2. Sobieszczyk P. In-stent restenosis after femoropopliteal interventions with drug-eluting stents. J Am Coll Cardiol Intv. 2016;9(8):835-7. PMid:27101909. http://dx.doi.org/10.1016/j.jcin.2016.02.015.

3. Tepe G. The Copacabana study: DEB vs. POBA in in-stent restenosis. Leipzig: LINC; 2015 [citado 2016 dez 22]. http://linc2015.cloudcontrolled.com/media/15t_1_1620_Tepe.pdf.

4. Rosenfield K, Jaff MR, White CJ, et al. Trial of a paclitaxel-coated balloon for femoropopliteal artery disease. N Engl J Med. 2015;373(2):145-53. PMid:26106946. http://dx.doi.org/10.1056/NEJMoa1406235.

5. Schmidt A, Piorkowski M, Görner H, et al. Drug-coated balloons for complex femoropopliteal lesions: 2-year results of a real-world registry. J Am Coll Cardiol Intv. 2016;9(7):715-24. PMid:27056311. http://dx.doi.org/10.1016/j.jcin.2015.12.267.

6. Laird JR, Schneider PA, Tepe G, et al. Durability of treatment effect using a drug-coated balloon for femoropopliteal lesions: 24-month results of IN.PACT SFA. J Am Coll Cardiol. 2015;66(21):2329-38. PMid:26476467. http://dx.doi.org/10.1016/j.jacc.2015.09.063.

7. Herten M, Torsello GB, Schönefeld E, Stahlhoff S. Critical appraisal of paclitaxel balloon angioplasty for femoral-popliteal arterial disease. Vasc Health Risk Manag. 2016;12:341-56. PMid:27621646. http://dx.doi.org/10.2147/VHRM.S81122.

8. Pietzsch JB, Geisler BP, Zeller T. Endovascular interventions for treatment of femoropopliteal peripheral artery disease: updated budget impact analysis for Germany based on latest clinical evidence. Value Health. 2015;18(7):A349. PMid:26531975. http://dx.doi.org/10.1016/j.jval.2015.09.632.

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5ce5919a0e8825d5088b4567 jvb Articles

J Vasc Bras

Share this page
Page Sections