Coronary and peripheral interventions: an update.

Abstract

Download the Issue @ a Glance podcast Subscribe to the EHJ Podcast ![Graphic][1] When Andreas Gruntzig started his journey to become the founder of catheter-based cardiovascular interventions, he started—and this is often forgotten—in the peripheral circulation, at first in the iliac and later in the femoral arteries, with his home-made balloon. Only later did he dare to access the coronary circulation.1 The first Current Opinion article of this issue ‘ Drug-coated balloon treatment for lower extremity vascular disease intervention: an international positioning document ’ authored by Thomas Zeller from the HerzZentrum Bad Krozingen in Germany2 reminds us that not only coronary, but also peripheral interventions have made remarkable progress ever since. In particular, drug-coated balloons provide a novel method to deliver antiproliferative drugs such as paclitaxel locally into the arterial wall without the need for a chronically implanted delivery system. Following early positive pilot studies, two large pivotal trials confirmed the superiority of drug-coated balloons over plain old balloon angioplasty in the treatment of femoro-popliteal lesions. Even long lesions and in-stent restenosis showed promising mid-term technical and clinical results in small single-centre randomized studies. Unfortunately, these results have not been reproduced for below-the-knee applications. As a result, guidelines have not yet provided recommendations regarding the use of drug-coated balloons in peripheral interventions due to the lack of robust evidence. In the coronary circulation, potent antithrombotic therapies are commonly used to reduce the risk of recurrent ischaemic events and death, particularly in patients with acute coronary syndromes.3 Of note, such interventions inevitably lead to an increase in bleeding which in turn is associated with a prolonged length of stay, greater resource consumption, and eventually with a higher morbidity and mortality.4,5 Consequently, inclusion of bleeding as a safety endpoint in randomized controlled trials is essential in the … [1]: /embed/inline-graphic-1.gif