TY - JOUR
T1 - Histological features of restenosis associated with paclitaxel drug-coated balloon
T2 - implications for therapy
AU - Krishnan, Prakash
AU - Purushothaman, K. Raman
AU - Purushothaman, Meerarani
AU - Tarricone, Arthur
AU - Chen, Simon
AU - Singla, Sandeep
AU - Purushottam, Bhaskar
AU - Kini, Annapoorna
AU - Sharma, Samin
AU - Moreno, Pedro R.
N1 - Funding Information:
We acknowledge the department of Pathology and Laboratory Medicine at Icahn School of Medicine (ISMMS) for the support in the histopathological material accessioning in this study. We acknowledge the professional consultation for the statistical review of this manuscript content by Dr. Baber Usman, M.D. Director of Biometrics, Cardiovascular Institute, and ISMMS. “All the authors have no conflict of interest to declare”.
Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2019/11/1
Y1 - 2019/11/1
N2 - Purpose: To investigate the cellular and extracellular changes induced by drug-coated balloons (DCB) in the treatment of superficial femoral artery (SFA) restenosis, and to compare histopathological features with those observed after plain old balloon angioplasty (POBA) from the same patients. Methods and Results: Plaque samples for five patients with SFA restenosis (first-time) after POBA were collected using atherectomy and DCB. These samples constitute the POBA restenosis group. The same five patients developed recurrent restenosis (RR) after DCB, at the same intervention site. These SFA-RR lesions were again treated using atherectomy and POBA. These samples constitute the DCB restenosis group. DCB restenosis group plaques showed significant reduction in neointima, smooth muscle cells, fibroblast densities, and Ki67 index; and increase in caspase 3, features of apoptosis and type III collagen deposition in comparison to the POBA restenosis group. Conclusion: Plaque tissue from the DCB restenosis group show reductions in neointimal thickness, cellularity, and cellular proliferation, along with increased apoptosis, and Type III collagen content. These results suggest a different mechanistic pathway for DCB restenosis, in which neointimal proliferation is reduced but reparative fibrosis is increased. The treatment for SFA-RR after DCB may therefore benefit from different forms of therapy including scaffolding, rather than recurrent anti-proliferative therapy.
AB - Purpose: To investigate the cellular and extracellular changes induced by drug-coated balloons (DCB) in the treatment of superficial femoral artery (SFA) restenosis, and to compare histopathological features with those observed after plain old balloon angioplasty (POBA) from the same patients. Methods and Results: Plaque samples for five patients with SFA restenosis (first-time) after POBA were collected using atherectomy and DCB. These samples constitute the POBA restenosis group. The same five patients developed recurrent restenosis (RR) after DCB, at the same intervention site. These SFA-RR lesions were again treated using atherectomy and POBA. These samples constitute the DCB restenosis group. DCB restenosis group plaques showed significant reduction in neointima, smooth muscle cells, fibroblast densities, and Ki67 index; and increase in caspase 3, features of apoptosis and type III collagen deposition in comparison to the POBA restenosis group. Conclusion: Plaque tissue from the DCB restenosis group show reductions in neointimal thickness, cellularity, and cellular proliferation, along with increased apoptosis, and Type III collagen content. These results suggest a different mechanistic pathway for DCB restenosis, in which neointimal proliferation is reduced but reparative fibrosis is increased. The treatment for SFA-RR after DCB may therefore benefit from different forms of therapy including scaffolding, rather than recurrent anti-proliferative therapy.
KW - Cell proliferation
KW - Drug-coated balloon
KW - Extracellular matrix
KW - Neointima
KW - Paclitaxel
KW - Peripheral artery disease
KW - Restenosis
UR - http://www.scopus.com/inward/record.url?scp=85070764558&partnerID=8YFLogxK
U2 - 10.1016/j.carpath.2019.06.003
DO - 10.1016/j.carpath.2019.06.003
M3 - Article
C2 - 31437716
AN - SCOPUS:85070764558
VL - 43
JO - Cardiovascular Pathology
JF - Cardiovascular Pathology
SN - 1054-8807
M1 - 107139
ER -