Safety Issues Associated with Paclitaxel-Eluting Balloons and Progress of Sirolimus-Eluting Balloons
Yu Xia Yin,
Zhi Yong Wang,
Lu Ning Wang,
Ming Kun Cao,
Tian Heng Lu,
Hai Jun Zhang
Issue:
Volume 6, Issue 5, September 2020
Pages:
54-59
Received:
1 February 2020
Accepted:
14 September 2020
Published:
19 September 2020
Abstract: Drug eluting balloons (DEBs) are semi-compliant angioplasty balloons covered with an antiproliferative drug which is rapidly released locally into the vessel wall during balloon contact. Their advantages include a broader area of drug contact, more homogenous drug-tissue transfer for stent-based local drug delivery, no implant leaving as well as shortened dual antiplatelet therapy. DEBs application was first recommended by the European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS) guidelines for the treatment of in-stent restenosis (ISR) after prior bare-metal stent (BMS) (Class IIA, Level B) in 2010. Since then, rapid progress has been made in the use of DEBs for treatment of in-stent restenosis, bifurcation, small vessel diseases, and other de novo occlusive coronary artery diseases even the symptomatic peripheral arterial disease. However, a meta-analysis of 28 randomized controlled trials (RCTs) with 4663 patients investigating paclitaxel-coated devices (DEBs & drug-eluting stent) in the femoral and/or popliteal arteries showed a highly significant association between risk of death and paclitaxel exposure in a dose-time-dependent manner. Safety issues associated with clinical application of paclitaxel DEBs in femoropopliteal artery was widely discussed. This study reviewed the issues, different molecular mechanisms of paclitaxel and sirolimus in antiproliferative effects, and progress of sirolimus-eluting balloons.
Abstract: Drug eluting balloons (DEBs) are semi-compliant angioplasty balloons covered with an antiproliferative drug which is rapidly released locally into the vessel wall during balloon contact. Their advantages include a broader area of drug contact, more homogenous drug-tissue transfer for stent-based local drug delivery, no implant leaving as well as sh...
Show More
Evolution of Surgery Offered to Aspergilloma over 2 Decades, Institutional Report
Hysam Abdelmohty,
Salah Eldin Khalaf,
Walid Hassan,
Ahmed Mostafa,
Mohamed-Adel Elanwar
Issue:
Volume 6, Issue 5, September 2020
Pages:
60-65
Received:
16 October 2020
Accepted:
26 October 2020
Published:
9 November 2020
Abstract: Background: Aspergilloma is the localized form of pulmonary colonization by Aspergillus species, which often hosted within a pre-existing cavitary lesion. The Aspergilloma (commonly known as mycetoma or fungus ball) consists of fungal hyphae, aggregates of inflammatory cells, fibrin threads, and destructed tissues debris. Aspergillus Fumigatu is the commonest species responsible for such lesions. In this study, over 20 years, data were collected for examination, on the outcomes of surgery for pulmonary Aspergilloma. Methods: Retrospective study of 54 patients, dating from January 1996 and December, 2015. Each patient’s preoperative, diagnostic, operative, postoperative and follow up data was collected for analysis. Results: Findings of 54 patients who underwent surgery for Aspergilloma, 47 had clinical diagnosis. While remaining 7 were confirmed post-resection. The median age was 46.3±7.8 (aged 17-64 years). Risk assessment identified that greater probability for the Left Lung to be infected and increase if gender was male (2.6:1). The main presentation was hemoptysis, seen in 70.4% of cases, while symptoms of cough and expectoration occurred in 83.3% of them. The most prevalent predisposing factor was tuberculosis (TB), present in 57.4% of cases. The indication for surgery was recurrent hemoptysis, asymptomatic simple Aspergilloma and complex Aspergilloma. All the patients underwent pulmonary resection, with 82.5% of cases having lobectomy. The main postoperative complication was prolonged air leak 29.6% (16/54). The in-hospital mortality rate was 7.5% (6/54) patients. Conclusion: Surgery offered to Aspergilloma patients (fungus ball) brought beneficial results with an acceptable morbidity. The mortality observed within these cases, was predominantly due to high risk patients, with complex Aspergillosis. Recommendations for a multidisciplinary approach, in future cases, are paramount for better selection criteria.
Abstract: Background: Aspergilloma is the localized form of pulmonary colonization by Aspergillus species, which often hosted within a pre-existing cavitary lesion. The Aspergilloma (commonly known as mycetoma or fungus ball) consists of fungal hyphae, aggregates of inflammatory cells, fibrin threads, and destructed tissues debris. Aspergillus Fumigatu is th...
Show More
