Features September 2015 Issue

Drug-coated Balloon Treats Narrowed Peripheral Arteries

Like a drug-eluting stent, a removable balloon releases a chemical to help keep arteries from narrowing again after circulation improves.

You may be familiar with drug-eluting stents (DES) that are used in the coronary arteries and other blood vessels. The framework of the tiny stents helps open narrowed arteries to improve blood flow. Over time, a medication is released from the surface of DES to help keep the artery from narrowing again.

But for people with peripheral artery disease (PAD), a similar treatment option is gaining in popularity. Instead of a drug-eluting stent, a drug-coated balloon is inserted into the narrowed artery with a catheter. In a procedure called angioplasty, the balloon is then inflated at the site of the blockage and blood flow is improved.

In this case, a drug such as paclitaxel is then transferred from the surface of the balloon to the inside walls of the artery. The drug helps keep the artery from narrowing again. After a designated period of time, the balloon is deflated and withdrawn from the artery. Your doctor will then monitor the artery in the following weeks and months to see if it remains open.

Samir Kapadia, MD, section head of Invasive/Interventional Cardiology at Cleveland Clinic, says drug-coated balloon angioplasty is an important new development in the treatment of PAD. “It’s already widely used in Europe,” he says.

In the U.S., the Food and Drug Administration last year approved the Medtronic IN.PACT Admiral Paclitaxel-coated PTA Balloon Catheter.

Safer than stents

While stents can be very effective in the arteries of the heart and elsewhere, there are limitations to their use in leg arteries, Dr. Kapadia explains.

“Typically, the arteries in the legs squeeze and twist as we walk,” he says. “This can lead to stent fracture. Stenting is not as effective in the legs in these situations. The drug-eluting balloon is better.”

Dr. Kapadia adds, however, that there are circumstances in which stenting is still a better option. In some cases, a stent is necessary if balloon angioplasty isn’t sufficient to widen the artery enough for adequate blood flow.

Not first-line treatment

As encouraging as the drug-coated balloon is in the treatment of PAD, it’s usually considered only after other approaches have failed to relieve symptoms and improve quality of life. PAD patients are first encouraged to make changes such as exercising daily, quitting smoking and taking medications aimed at treating symptoms.

“The first step is lifestyle change,” Dr. Kapadia says. “The balloon and other interventions are second-line treatments.”

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