Jornal Vascular Brasileiro
https://www.jvascbras.org/journal/jvb/article/doi/10.1590/1677-5449.010616
Jornal Vascular Brasileiro
Original Article

O uso do balão com paclitaxel no tratamento da reestenose intra-stent no segmento fêmoro-poplíteo

Use of paclitaxel-coated balloon to treat in-stent restenosis in femoropopliteal segments

Julio Cesar Peclat de Oliveira, Ana Paula Rolim Maia Peclat, Fernando Tebet Ramos Barreto, João Marcos Fonseca, Diogo Di Batista de Abreu e Souza, Stenio Karlos Alvim Fiorelli, Rossano Kepler Alvim Fiorelli, Marcos Arêas Marques

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Resumo

Contexto: A reestenose intra-stent por hiperplasia miointimal pós-angioplastia é uma intercorrência frequente e que limita a perviedade do procedimento a longo prazo. A terapia com balões revestidos de droga com ação antiproliferativa pode ser uma alternativa no tratamento dessa complicação. Objetivos: Demonstrar eficácia e as complicações (óbito, grandes amputações, etc.) do balão farmacológico no tratamento da reestenose intra-stent de segmento femoropoplíteo. Métodos: Estudo de coorte retrospectivo de 32 pacientes consecutivos tratados entre os anos de 2012 e 2016, submetidos a terapia de reestenose intra-stent de segmento femoropoplíteo com angioplastia com balão farmacológico revestido com paclitaxel. A taxa de sucesso foi mensurada pela ocorrência de sucesso do procedimento e reestenose inferior a 50% em avaliação por eco-Doppler colorido 30, 90 e 180 dias após o procedimento. Resultados: Quatro pacientes (12,5%) apresentaram reestenose superior a 50%, sendo um (3,1%) após 90 dias e três (9,4%) após 180 dias, conferindo uma taxa de sucesso de 87,5% ao procedimento. Após 180 dias, todos os pacientes referiam melhora ou cessação dos sinais e/ou sintomas apresentados antes do procedimento. Não houve óbitos, e complicações ocorreram apenas em dois casos, no pós-operatório imediato. Conclusões: Os resultados a curto prazo da terapia com balão farmacológico são promissores, com redução na taxa de reestenose e baixo índice de complicações. Ainda precisam ser apresentados estudos demonstrando os efeitos a longo prazo dessa terapia, assim como seu impacto econômico quando comparada a outros procedimentos.

Palavras-chave

doença arterial periférica; angioplastia; reestenose de enxerto vascular.

Abstract

Background: In-stent restenosis due to myointimal hyperplasia after angioplasty is common and limits long-term patency. Treatments using balloons coated with antiproliferative drugs may offer an alternative option for this pathology. Objectives: To demonstrate the efficacy and complications (death, major amputations, etc.) of drug-coated balloons for treatment of in-stent restenosis in femoropopliteal segments. Methods: This was a retrospective cohort study of 32 consecutive patients treated between 2012 and 2016 who underwent treatment to correct in-stent restenosis in the femoropopliteal segment using paclitaxel-coated balloons. The success rate was measured in terms of technical success and restenosis of less than 50% on Doppler ultrasonography at 30, 90, and 180 days after the procedure. Results: Four patients (12.5%) exhibited restenosis greater than 50%, one (3.1%) after 90 days and three (9.4%) after 180 days, equating to a success rate of 87.5% of procedures, and by 180 days all patients experienced improvement or cessation of the signs and/or symptoms they had presented prior to the procedure. There were no deaths and complications occurred in just 2 cases in the immediate postoperative period. Conclusions: Short-term results are promising, with reductions in the magnitude of restenosis and a low rate of complications. Further studies are needed that can demonstrate the long-term effects and the economic impacts in comparison to other procedures.

Keywords

peripheral artery disease; balloon angioplasty; vascular graft restenosis.

References

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