Treatment Of Peripheral Atherosclerosis Research Articles

Efficacy, safety and therapeutic mechanism of Shen-Qi Xiao-Tan formula in the treatment of peripheral atherosclerosis in patients with type 2 diabetes mellitus: a randomized, double-blind, placebo-controlled trial protocol

BackgroundPeripheral atherosclerosis is a common macrovascular complication of diabetes, but the treatment is limited. Chinese herbal medicine is the complementary and alternative therapy to delay the progression of atherosclerosis and reduce blood glucose and lipids. Shen-Qi Xiao-Tan (SQXT) formula is one of the prescriptions commonly used to treat diabetic peripheral atherosclerosis, but there is still a lack of high-quality evidence-based evidence.MethodsThis is a randomized, double-blind, placebo-controlled add-on trial that is expected to enroll 114 diabetic patients with peripheral atherosclerosis. After a 2-week run-in period, participants will been randomly assigned in a 1:1 ratio and receive 12 weeks of usual treatment and SQXT formula (treatment group) or usual treatment and placebo (control group). The primary outcome is the change in carotid intima-media thickness from baseline to endpoint. The secondary outcomes are the structure and function of peripheral arteries, blood glucose and lipids, traditional Chinese medicine syndrome score, and quality of life, and safety and endpoint events are evaluated. To explore the therapeutic mechanism through oxidative stress, inflammation, and advanced glycation end products, and lipidomics will be used to screen for biomarkers for diagnosis and efficacy evaluation.DiscussionThe objective of this trial is to evaluate the efficacy, safety and therapeutic mechanism of SQXT formula in the treatment of diabetic peripheral atherosclerosis. It will obtain high-quality evidence-based evidence and promote the treatment of diabetic macroangiopathy and the research and development of new drugs.Trial registrationThis trial is registered on Chinese Clinical Trials.gov with number ChiCTR2100047189 on 10 Jun 2021, and has been approved by the Ethical Review Committee of Hospital of Chengdu University of Traditional Chinese Medicine with number 2020KL-080.

Calcified plaque modification alters local drug delivery in the treatment of peripheral atherosclerosis

BackgroundCalcific atherosclerosis is a major challenge to intraluminal drug delivery in peripheral artery disease (PAD). ObjectivesWe evaluated the effects of orbital atherectomy on intraluminal paclitaxel delivery to human peripheral arteries with substantial calcified plaque. MethodsDiagnostic angiography and 3-D rotational imaging of five fresh human lower limbs revealed calcification in all main arteries. The proximal or distal segment of each artery was treated using an orbital atherectomy system (OAS) under simulated blood flow and fluoroscopy. Explanted arterial segments underwent either histomorphometric assessment of effect or tracking of 14C-labeled or fluorescent–labeled paclitaxel. Radiolabeled drug quantified bulk delivery and fluorescent label established penetration of drug over finer spatial domain in serial microscopic sections. Results were interpreted using a mathematical model of binding-diffusion mediated arterial drug distribution. ResultsLesion composition affected paclitaxel absorption and distribution in cadaveric human peripheral arteries. Pretreatment imaging calcium scores in control femoropopliteal arterial segments correlated with a log-linear decline in the bulk absorption rate-constant of 14C-labeled, declining 5.5-fold per calcified quadrant (p=0.05, n=7). Compared to controls, OAS-treated femoropopliteal segments exhibited 180μm thinner intima (p<0.001), 45% less plaque calcification, and 2 log orders higher paclitaxel bulk absorption rate-constants. Correspondingly, fluorescent paclitaxel penetrated deeper in OAS-treated femoropopliteal segments compared to controls, due to a 70% increase in diffusivity (p<0.001). ConclusionsThese data illustrate that calcified plaque limited intravascular drug delivery, and controlled OAS treatment of calcific plaques resulted in greater drug permeability and improved adjunct drug delivery to diseased arteries.

Peripheral arterial disease: Diagnosis and treatment

Peripheral arterial disease: Diagnosis and treatment Jay D. Coffman and Robert T. Eberhardt; Totowa, NJ; 2002; Humana Press; 356 pages; $129.50. This book is a recent addition to the “Contemporary Cardiology” series edited by a cardiologist, Christopher P. Cannon. Although the preface implies that the book's target readership is the “practicing physician and cardiologist”, there is sufficient authoritative information within to be of some value to a wider array of clinicians involved with patients suffering from peripheral vascular disease. The senior editor of this volume, one of the founders of the subspecialty of vascular medicine, enlisted 27 well-known contributors to author 19 chapters on a full array of topics with no glaring omissions. To the contrary, in addition to the usual fundamentals of pathogenesis, diagnosis, and treatment of peripheral atherosclerosis, useful chapters on the diabetic foot, arterial disease in women, atheroembolism, Buerger's disease, and large vessel vasculitis are included. There is a wistful chapter on angiogenesis and gene therapy, full of promise though as yet thin on published results. The chapter on perioperative cardiac evaluation and management for patients undergoing vascular surgery is excellent. Each chapter stands well by itself and usually includes adequate tables and figures as well as a plump bibliography. The organization of the book is somewhat jumbled, with the chapter on clinical evaluation of intermittent claudication placed in the midst of chapters on natural history, vascular laboratory, and diagnostic imaging rather than with the chapters on acute and chronic limb ischemia. There is some overlap, as is inevitable in a collection of essays such as this. Inconsistency is also inevitable and illustrative in areas of rapid change, as is evident in conflicting views of the relative place of endovascular and open surgical revascularization. The editors might have taken the opportunity to insist that the authors of the chapters in this area of controversy pursue the same scope and use the same terms, definitions and outcome measures based only upon high-quality recent data. Rather than providing a forum for helpful comparisons between therapeutic modalities, the endovascular therapy author's enthusiasm was allowed to bubble over into gratuitous sections on carotid, renal, and abdominal aortic aneurysm stenting. The depth of coverage of topics varies from chapter to chapter, ranging from elementary to more advanced. Since the goal of this book is to review a broad and deep topic in a manageable format, it must cover a lot of territory relatively lightly in its 386 pages. As an overview, this collection of essays is an excellent introduction to trainees in medicine, radiology, and surgery who have not yet differentiated into a subspecialty. It is also likely to be of value to generalists who deal regularly with patients subject to peripheral vascular disease or to specialists in fields allied to vascular surgery and vascular medicine. Most specialists who focus mainly on peripheral vascular disease may find this work too basic to be regularly useful as a reference for their daily work, particularly if they are engaged in moving this complicated field forward.