Newly approved devices for endovascular treatment of femoropopliteal disease: a review of clinical evidence

ABSTRACT

Introduction: Femoropopliteal lesions account for a significant proportion of endovascular interventions for peripheral artery disease. In this manuscript, we review the literature on the application of newly approved devices in the treatment of atherosclerotic lesions at this segment.

Areas covered: New drug-coating technologies provide sustained drug-eluting over time and better scaffolds are more resistant to the increased biomechanical stress at the femoropopliteal segment. Thus, the newer drug-eluting stents (i.e. Eluvia®), nitinol interwoven stents (i.e. Supera®), and drug-coated balloons (i.e. Stellarex®) are associated with improved pharmacokinetic profiles and promising primary patency rates. A major predictor of technical failure and restenosis is the calcification of the target vessel. Recently, intravascular lithotripsy of calcified lesions at the femoropopliteal segment with the Shockwave® balloon was introduced as a feasible treatment option for these complex lesions. Finally, we also describe the Tack Endovascular System®, the first-of-its-type, for the repair of post-angioplasty dissections.

Expert opinion: The use of innovative stent designs and novel drug-coating, the application of adjunctive intravascular lithotripsy, and the combined use of new devices treating complications might improve the overall outcomes of angioplasty, thereby promising favorable outcomes even for more complex lesions.

KEYWORDS:

• Peripheral artery disease
• femoropopliteal atherosclerosis
• eluvia nitinol stent
• supera nitinol stent
• low dose drug-coated balloon
• stellarex balloon
• intravascular lithotripsy
• shockwave balloon
• post-angioplasty dissection
• tack endovascular dissection repair system

Article highlights box

• The durability of endovascular interventions performed at the femoropopliteal artery is challenging.

• The innovative stent designs of Eluvia® and Supera® stents resist the increased stress and torsion forces at the femoropopliteal artery.

• Novel drug-eluting technologies providing sustained drug transfer to the arterial wall over time promise durable artery patency.

• Intravascular lithotripsy of calcified lesions at the femoropopliteal segment using the Shockwave® balloon as stand-alone treatment or in combination with PTA improves technical success of endovascular repair.

• Post-angioplasty dissection repair is now feasible with minimal metal implantation using the Tack Endovascular System®.

• The Tack Endovascular System® preserves vessel integrity and future treatment options.

Declaration of interest

E Armstrong is a Consultant/on the Advisory Board for: Abbott Vascular, Boston Scientific, Cardiovascular Systems, Intact Vascular, Medtronic, Philips. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.