Peripheral artery disease, commonly referred to as PAD, is a common circulatory problem in which narrowed arteries reduce blood flow to the limbs. It happens because of the build-up of plaque in the arteries which carry blood to the legs, thighs, buttocks or pelvis. The severity of PAD can range from asymptomatic to critical limb ischemia. Many people have symptoms of pain, cramping, fatigue or numbness in the legs or hips when walking or climbing stairs. In severe cases, PAD can lead to sores or wounds on legs and feet that do not heal.
Types of treatment for Drug Eluting Balloon
Medications
The first line of treatment consists of medications that help reduce blood pressure and cholesterol levels. Drug Eluting Balloon Antiplatelet drugs like aspirin and cilostazol are commonly prescribed to prevent blood clots from forming and blocking arteries. Statins are effective at lowering LDL or “bad” cholesterol.
Angioplasty and stent placement
For those with more severe PAD symptoms, minimally invasive procedures like angioplasty and stent placement can be performed. In angioplasty, a thin, flexible tube called a catheter is inserted into an artery and guided to the site of narrowing. A small balloon is inflated at the tip of the catheter to widen the artery. Stent placement involves implanting a mesh tube within the artery to keep it propped open.
Bypass surgery
For patients who do not get adequate relief from angioplasty or for whom the blockages are too extensive or complicated, bypass surgery may be recommended. The surgery involves grafting sections of veins or arteries from other parts of the body to route blood flow around the clogged arteries in the legs.
The advent of percutaneous transluminal angioplasty technology
While angioplasty and stent placement provide initial improvement, risk of reblockage is high due to scarring and recoiling of arteries over time. Around 30-50% of treated arteries reocclude within one year after plain balloon angioplasty alone. This is where percutaneous transluminal angioplastys come into play. A percutaneous transluminal angioplasty works just like a conventional angioplasty balloon but has an anti-proliferative drug coated on its abluminal surface.
Mechanism of action of percutaneous transluminal angioplastys
When inflated at the site of stenosis, the drug is transferred to the artery walls. This drug inhibits cell proliferation and migration thereby preventing scarring and renarrowing of arteries. The coating allows for delivery of high drug concentrations directly to the treated vessel segment without the need for stents. Once the procedure is completed, the drug is left behind and gets absorbed by surrounding tissues over 30 days. This localized drug delivery helps reduce issues like intimal hyperplasia which is a major cause of re-narrowing or restenosis with regular angioplasty.
Advantages of percutaneous transluminal angioplastys
One of the major Drug Eluting Balloon advantages of percutaneous transluminal angioplastys is that they can be used for treatment of atherosclerotic lesions as well as for in-stent restenosis, the recurrence of blockages inside previously placed stents. This makes them very versatile and useful in a variety of clinical scenarios. Percutaneous transluminal angioplastys have also been shown to produce better late lumen gain than uncoated balloons. Treatment with percutaneous transluminal angioplastys has demonstrated very low rates of target lesion revascularization within one year. A few more advantages include:
1) No permanent implant: Unlike stents, percutaneous transluminal angioplastys do not leave behind any permanent implant which reduces risk of implant fractures or thrombosis over long term.
2) Cost effective: Treatment with percutaneous transluminal angioplastys alone can potentially avoid the additional cost of implanting a stent.
3) Less inflammation: Stent deployment causes mechanical injury to vessel leading to inflammation and scar tissue build-up over time. This reaction is minimized with percutaneous transluminal angioplastys.
4) Better vessel compliance: Percutaneous transluminal angioplastys help restore natural elasticity and compliance of the treated blood vessel segment, unlike rigid metal stents.
In initially approved for treatment of PAD in below the knee arteries, percutaneous transluminal angioplastys are now being widely used for coronary artery disease and lesions in superficial femoral and popliteal arteries as well. Ongoing research studies are evaluating their role in treatment of in-stent restenosis, small vessel disease, bifurcation lesions and pediatric interventions. Combination therapies involving infusion catheters delivering drug intra-arterially along with percutaneous transluminal angioplastys hold promise of achieving even better results. Overall, percutaneous transluminal angioplasty angioplasty represents a major advancement for endovascular interventions with long term benefits. As technology around drug coatings and carrier solutions improves, this treatment approach is poised to revolutionize peripheral artery disease management in the coming years.