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Medikamentenfreisetzende Stents

  • S. Müller-Hülsbeck

Zusammenfassung

Medikamentenfreisetzende Stents («drug-eluting stents», DES) werden seit einigen Jahren in der Therapie der pAVK zur Behandlung femoropoplitealer Läsionen zur Reduzierung der Restenoserate eingesetzt. Neben dem polymerfreien Paclitaxel beschichteten Zilver®-PTX®-Stent ist derzeit auch der mit einem Polymer beschichtete Eluvia™-Stent verfügbar. Die Verwendung eines biokompatiblen Polymers soll den Vorteil haben, eine Medikamentenfreisetzung über eine längeren Zeitraum ermöglichen. 1- und 2-Jahres-Ergebnisse des Eluvia™-Stents sind dahingehend vielversprechend. Das Potenzial für beide medikamentenfreisetzenden Stentsysteme ist nach bisherigem Kenntnisstand darin zu sehen, dass sie insbesondere dann Einsatz finden sollten, wenn medikamentenbeschichtete Ballonkatheter im Kurzzeitverlauf scheitern bzw. nach Vorbereitung einer femoropoplitealen Läsionen mittels PTA eine Stentimplantation aufgrund eines elastischen Recoils oder flussrelevanter Dissektionen unumgänglich ist.

Literatur

  1. Axel DI, Kunert W, Goggelmann C, Oberhoff M, Herdeg C, Kuttner A, et al. (1997) Paclitaxel inhibits arterial smooth muscle cell proliferation and migration in vitro and in vivo using local drug delivery. Circulation 96(2):636–45CrossRefPubMedGoogle Scholar
  2. Bosiers M, Scheinert D, Peeters P, Torsello G, Zeller T, Deloose K, Schmidt A, Tessarek J, Vinck E, Schwartz LB (2012) Randomized comparison of everolimus-eluting versus bare-metal stents in patients with critical limb ischemia and infrapopliteal arterial occlusive disease. J Vasc Surg 55(2):390–8CrossRefPubMedGoogle Scholar
  3. Dake MD, Ansel GM, Jaff MR, Ohki T, Saxon RR, Smouse HB, Machan LS, Snyder SA, O’Leary EE, Ragheb AO, Zeller T; Zilver PTX Investigators (2016) Durable Clinical Effectiveness With Paclitaxel-Eluting Stents in the Femoropopliteal Artery: 5-Year Results of the Zilver PTX Randomized Trial. Circulation 133(15):1472–83CrossRefPubMedPubMedCentralGoogle Scholar
  4. Dake MD, Ansel GM, Jaff MR, Ohki T, Saxon RR, Smouse HB, Snyder SA, O’Leary EE, Tepe G, Scheinert D, Zeller T; Zilver PTX Investigators (2013) 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 61(24):2417–27CrossRefPubMedGoogle Scholar
  5. Duda SH, Bosiers M, Lammer J, Scheinert D, Zeller T, Tielbeek A, Anderson J, Wiesinger B, Tepe G, Lansky A, Mudde C, Tielemans H, Bérégi JP (2005) Sirolimus-eluting versus bare nitinol stent for obstructive superficial femoral artery disease: the SIROCCO II trial. J Vasc Interv Radiol 16(3):331–8CrossRefPubMedGoogle Scholar
  6. Elens M, Verbist J, Keirse K, Van Den Eynde W, Peeters P (2014) Which is currently the best strategy for treatment of SFA in-stent restenosis? J Cardiovasc Surg (Torino) 55(4):477–81Google Scholar
  7. Health Quality Ontario (2015) Paclitaxel Drug-Eluting Stents in Peripheral Arterial Disease: A Health Technology Assessment. Ont Health Technol Assess Ser 15(20):1–62Google Scholar
  8. Iida O, Nanto S, Uematsu M, Ikeoka K, Okamoto S, Dohi T, Fujita M, Nagata S (2009) Long-term results of endovascular therapy with nitinol stent implantation for TASC II A/B femoro-popliteal artery lesions: 4 years’ experience. Circ J 73(11):2143–7CrossRefPubMedGoogle Scholar
  9. Iida O, Takahara M, Soga Y, Nakano M, Yamauchi Y, Zen K, Kawasaki D, Nanto S, Yokoi H, Uematsu M; ZEPHYR Investigators (2015) 1-Year Results of the ZEPHYR Registry (Zilver PTX for the Femoral Artery and Proximal Popliteal Artery): Predictors of Restenosis. JACC Cardiovasc Interv 8(8):1105–12Google Scholar
  10. Karnabatidis D1, Spiliopoulos S, Diamantopoulos A, Katsanos K, Kagadis GC, Kakkos S, Siablis D (2011) Primary everolimus-eluting stenting versus balloon angioplasty with bailout bare metal stenting of long infrapopliteal lesions for treatment of critical limb ischemia. J Endovasc Ther 18(1):1–12CrossRefPubMedGoogle Scholar
  11. Katsanos K, Spiliopoulos S, Diamantopoulos A, Siablis D, Karnabatidis D, Scheinert D (2016) Wound Healing Outcomes and Health-Related Quality-of-Life Changes in the ACHILLES Trial: 1-Year Results From a Prospective Randomized Controlled Trial of Infrapopliteal Balloon Angioplasty Versus Sirolimus-Eluting Stenting in Patients With Ischemic Peripheral Arterial Disease. JACC Cardiovasc Interv 9(3):259–67PubMedGoogle Scholar
  12. Kimura T, Yokoi H, Nakagawa Y, Tamura T, Kaburagi S, Sawada Y, Sato Y, Yokoi H, Hamasaki N, Nosaka H, et al. (1996) Three-year follow-up after implantation of metallic coronary-artery stents. N Engl J Med 334(9):561–6CrossRefPubMedGoogle Scholar
  13. Lammer J, Bosiers M, Zeller T, Schillinger M, Boone E, Zaugg MJ, Verta P, Peng L, Gao X, Schwartz LB (2011) First clinical trial of nitinol self-expanding everolimus-eluting stent implantation for peripheral arterial occlusive disease. J Vasc Surg 54(2):394–401CrossRefPubMedGoogle Scholar
  14. Lavigne MC, Eppihimer MJ, Cheng R, Barry JJ (2010) Anti-proliferative compounds for the prevention of restenosis: Anti-restenotic mechanisms of paclitaxel action. Curr Pharm Des 16(36):3989–4001Google Scholar
  15. Müller-Hülsbeck S (2016a) CIRSEGoogle Scholar
  16. Müller-Hülsbeck S (2016b) VIVAGoogle Scholar
  17. Müller-Hülsbeck S, Keirse K, Zeller T, Schroë H, Diaz-Cartelle J (2016c) Twelve-Month Results From the MAJESTIC Trial of the Eluvia Paclitaxel-Eluting Stent for Treatment of Obstructive Femoropopliteal Disease. J Endovasc Ther 23(5):701–7CrossRefPubMedPubMedCentralGoogle Scholar
  18. Müller-Hülsbeck S (2016d) Eluvia™ peripheral stent system for the treatment of peripheral lesions above the knee. Expert Opin Drug Deliv 5:1–6Google Scholar
  19. Ohki T et al. (2014) Two-year analysis of the Japanese cohort from the Zilver PTX randomized controlled trial supports the validity of multinational clinical trials. J Endovasc Ther 21(5):644–53CrossRefPubMedGoogle Scholar
  20. Rastan A, Tepe G, Krankenberg H, Zahorsky R, Beschorner U, Noory E, Sixt S, Schwarz T, Brechtel K, Böhme C, Neumann FJ, Zeller T (2011) Sirolimus-eluting stents vs. bare-metal stents for treatment of focal lesions in infrapopliteal arteries: a double-blind, multi-centre, randomized clinical trial. Eur Heart J 32(18):2274–8CrossRefPubMedGoogle Scholar
  21. Scheinert D, Katsanos K, Zeller T, Koppensteiner R, Commeau P, Bosiers M, Krankenberg H, Baumgartner I, Siablis D, Lammer J, Van Ransbeeck M, Qureshi AC, Stoll HP; ACHILLES Investigators (2012) A prospective randomized multicenter comparison of balloon angioplasty and infrapopliteal stenting with the sirolimus-eluting stent in patients with ischemic peripheral arterial disease: 1-year results from the ACHILLES trial. J Am Coll Cardiol 60(22):2290–5Google Scholar
  22. Wiskirchen J, Schöber W, Schart N, et al. (2004) The effects of paclitaxel on the three phases of restenosis: smooth muscle cell proliferation, migration, and matrix formation: an in vitro study. Invest Radiol 39:565–571CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Deutschland 2018

Authors and Affiliations

  1. 1.Institut für Diagnostische und Interventionelle ­Radiologie und NeuroradiologieDiakonissenkrankenhaus FlensburgFlensburgDeutschland

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