Download PDF
Dtsch Med Wochenschr 2016; 141(2): e24-e31
DOI: 10.1055/s-0041-110062
Fachwissen
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Praxis der Thrombozyten-Aggregationshemmung nach Katheterintervention der Becken- / Beinarterien in Deutschland

Clinical practice of dual antiplatelet therapy after percutaneous peripheral arterial interventions in Germany
M. Baumhäkel
1   CaritasKlinikum St. Theresia Saarbrücken, Klinik für Interventionelle Kardiologie / Angiologie, Saarbrücken
,
M. Kindermann
1   CaritasKlinikum St. Theresia Saarbrücken, Klinik für Interventionelle Kardiologie / Angiologie, Saarbrücken
› Author Affiliations
Further Information

Publication History

Publication Date:
22 January 2016 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Hintergrund und Fragestellung | Die Durchführung der Thrombozytenaggregationshemmung mit zwei verschiedenen Substanzen, die sogenannte duale Thrombozytenaggregationshemmung, nach peripherer arterieller Intervention ist aufgrund der mangelnden Studienlage weder in nationalen noch internationalen Leitlinien geregelt.

Methodik | Mittels eines standardisierten Evaluationsbogens wurden 212 Kliniken / Gefäßzentren in Deutschland bezüglich der Praxis der dualen Thrombozytenaggregationshemmung nach peripherer arterieller Intervention befragt. Die Evaluation erfolgte differenziert nach Lokalisation des intervenierten Gefäßsegmentes und Interventionsmethode.

Ergebnisse | Es wurden 89 Evaluationsbögen (42 %) beantwortet und zurückgesendet. Die Durchführung und Dauer der dualen Thrombozytenaggregationshemmung nach Intervention peripherer Arterien ist vor allem im Hinblick auf die unterschiedlichen Therapiemethoden (PTA: perkutane transluminale Angioplastie, DCB-PTA: Drug Coated Ballon, Stentintervention, DES: Drug Eluting Stent, Atherektomie) sehr heterogen. Die Dauer der dualen Thrombozytenaggregationshemmung betrug im Median für die alleinige PTA: iliacal / femoro-popliteal 0 Monate, crural 1 Monat, für die DCB-Intervention und Stentimplantation: iliacal 1 Monat, femoro-popliteal 1,5 Monate, crural 2 Monate; nach DE-Stentimplantation: iliacal 1,5 Monate, femoro-popliteal und crural 3 Monate, nach Atherektomie: femoro-popliteal und crural 1 Monat.

Folgerung | Die Datenlage bezüglich der dualen Thrombozytenaggregationshemmung nach Intervention der peripheren Arterien ist unzureichend.

Abstract

Background and aim: Guideline recommendations regarding antithrombotic treatment with two antiplatelet agents (dual antiplatelet treatment) after peripheral interventional procedures are vague due to missing data from clinical trials.

Methods: 212 vascular centres in germany were evaluated regarding dual antiplatelet treatment using a standardized questionnaire with differentiation of localisation of the treated artery and interventional methods being used.

Results: 89 (42 %) questionnaires returned completed. Application and duration of dual antiplatelet treatment after peripheral interventional procedures were quite different regarding interventional methods used (PTA: percutaneous transluminal angioplasty, DCB-PTA: drug coated ballon, Stenting, DES: drug eluting stent, Atherectomy). Mean duration of dual antiplatelet treatment were: PTA iliacal / femoro-popliteal 0 month, crural 1 month; DCB-Intervention and stenting: iliacal 1 month, femoro-popliteal 1,5 months, crural 2 months; DE-stenting iliacal 1,5 months, femoro-popliteal / crural 3 months and after femoro-popliteal / crural atherectomy 1 month.

Conclusion: Data about dual antiplatelet treatment after peripheral interventional procedures are sparse.

Schlüsselwörter

Intervention - duale Thrombozytenaggregationshemmung - periphere arterielle Verschlusskrankheit

Keywords

Intervention - dual antiplatelet treatment - peripheral artery disease

Supporting Information

 

  • Literatur

  • 1 Deutsche Gesellschaft für Angiologie Gesellschaft für Gefäßmedizin. Leitlinien zur Diagnostik und Therapie der peripheren arteriellen Verschlusskrankheit (PAVK) 2009. http://www.awmf.org/uploads/tx_ szleitlinien/065-003_S3_Diagnostik_und_ Therapie_der_peripheren_arteriellen_ Verschlusskrankheit_PAVK_abgelaufen_01.pdf Letzter Zugriff am 24.11.2015
    Google Scholar
  • 2 Dörffler-Melly J, Koopman M.M., Prins M.H., Büller H.R.. Antiplatelet and anticoagulant drugs for prevention of restenosis / reocclusion following peripheral endovascular treatment. Cochrane Database Syst Rev 2005; CD002071
    PubMedGoogle Scholar
  • 3 Tepe G, Bantleon R, Brechtel K et al. Management of peripheral arterial interventions with mono or dual antiplatelet therapy--the MIRROR study: a randomised and double-blinded clinical trial. Eur Radiol 2012; 22: 1998-2006
    CrossrefPubMedGoogle Scholar
  • 4 Strobl FF, Brechtel K, Schmehl J et al. Twelve-month results of a randomized trial comparing mono with dual antiplatelet therapy in endovascularly treated patients with peripheral artery disease. J Endovasc Ther 2013; 20: 699-706
    CrossrefPubMedGoogle Scholar
  • 5 Collaboration AT. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002; 324: 71-86
    CrossrefPubMedGoogle Scholar
  • 6 Gremmel T, Xhelili E, Steiner S et al. Response to antiplatelet therapy and platelet reactivity to thrombin receptor activating peptide-6 in cardiovascular interventions: Differences between peripheral and coronary angioplasty. Atherosclerosis 2014; 232: 119-124
    CrossrefPubMedGoogle Scholar
  • 7 Deutsche Gesellschaft für Gefäßchirurgie Medikamentöse Therapie nach gefäßchirurgischen Operationen und endovaskulären Interventionen 2008.
    Google Scholar
  • 8 Alonso-Coello P, Bellmunt S, McGorrian C et al. Antithrombotic therapy in peripheral artery disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141: e669S-e690S
    CrossrefPubMedGoogle Scholar
  • 9 Tsetis D, Uberoi R. Quality improvement guidelines for endovascular treatment of iliac artery occlusive disease. Cardiovasc Intervent Radiol 2008; 31: 238-245
    CrossrefPubMedGoogle Scholar
  • 10 Tendera M, Aboyans V, Bartelink ML et al. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J 2011; 32: 2851-2906
    CrossrefPubMedGoogle Scholar
  • 11 Laird JR, Katzen BT, Scheinert D et al. Nitinol stent implantation versus balloon angioplasty for lesions in the superficial femoral artery and proximal popliteal artery: twelve-month results from the RESILIENT randomized trial. Circ Cardiovasc Interv 2010; 3: 267-276
    CrossrefPubMedGoogle Scholar
  • 12 Davaine JM, Azéma L, Guyomarch B et al. One-year clinical outcome after primary stenting for Trans-Atlantic Inter-Society Consensus (TASC) C and D femoropopliteal lesions (the STELLA „STEnting Long de L‘Artére fémorale superficielle“ cohort). Eur J Vasc Endovasc Surg 2012; 44: 432-441
    CrossrefPubMedGoogle Scholar
  • 13 Misselt AJ, Zielinski MD, Medina OI et al. Clinical outcomes after endovascular treatment of superficial femoral disease in patients with disabling claudication and critical limb ischemia: midterm analysis. Angiology 2012; 63: 259-265
    CrossrefPubMedGoogle Scholar
  • 14 Bosiers M, Torsello G, Gissler HM et al. Nitinol stent implantation in long superficial femoral artery lesions: 12-month results of the DURABILITY I study. J Endovasc Ther 2009; 16: 261-269
    CrossrefPubMedGoogle Scholar
  • 15 Bosiers M, Deloose K, Callaert J et al. Results of the Protégé EverFlex 200-mm-long nitinol stent (ev3) in TASC C and D femoropopliteal lesions. J Vasc Surg 2011; 54: 1042-1050
    CrossrefPubMedGoogle Scholar
  • 16 Zeller T, Tiefenbacher C, Steinkamp HJ et al. Nitinol stent implantation in TASC A and B superficial femoral artery lesions: the Femoral Artery Conformexx Trial (FACT). J Endovasc Ther 2008; 15: 390-398
    CrossrefPubMedGoogle Scholar
  • 17 Ferreira M, Lanziotti L, Monteiro M et al. Superficial femoral artery recanalization with self-expanding nitinol stents: long-term follow-up results. Eur J Vasc Endovasc Surg 2007; 34: 702-708
    CrossrefPubMedGoogle Scholar
  • 18 Krankenberg H, Schlüter M, Steinkamp HJ et al. Nitinol stent implantation versus percutaneous transluminal angioplasty in superficial femoral artery lesions up to 10 cm in length: the femoral artery stenting trial (FAST). Circulation 2007; 116: 285-292
    CrossrefPubMedGoogle Scholar
  • 19 Matsumura JS, Yamanouchi D, Goldstein JA et al. The United States StuDy for EvalUating EndovasculaR TreAtments of Lesions in the Superficial Femoral Artery and Proximal Popliteal By usIng the Protégé EverfLex NitInol STent SYstem II (DURABILITY II). J Vasc Surg 2013; 58: 73-83
    CrossrefPubMedGoogle Scholar
  • 20 van Overhagen H, Spiliopoulos S, Tsetis D. Below-the-knee interventions. Cardiovasc Intervent Radiol 2013; 36: 302-311
    CrossrefPubMedGoogle Scholar
  • 21 Brodmann M, Froehlich H, Dorr A et al. Percutaneous transluminal angioplasty versus primary stenting in infrapopliteal arteries in critical limb ischemia. Vasa 2011; 40: 482-490
    CrossrefPubMedGoogle Scholar
  • 22 Rand T, Basile A, Cejna M et al. PTA versus carbofilm-coated stents in infrapopliteal arteries: pilot study. Cardiovasc Intervent Radiol 2006; 29: 29-38
    CrossrefPubMedGoogle Scholar
  • 23 Rand T, Lammer J, Rabbia C et al. Percutaneous transluminal angioplasty versus turbostatic carbon-coated stents in infrapopliteal arteries: InPeria II trial. Radiology 2011; 261: 634-642
    CrossrefPubMedGoogle Scholar
  • 24 Randon C, Jacobs B, De Ryck F, Vermassen F. Angioplasty or primary stenting for infrapopliteal lesions: results of a prospective randomized trial. Cardiovasc Intervent Radiol 2010; 33: 260-269
    CrossrefPubMedGoogle Scholar
  • 25 Bosiers M, Peeters P, D’Archambeau O et al. AMS INSIGHT--absorbable metal stent implantation for treatment of below-the-knee critical limb ischemia: 6-month analysis. Cardiovasc Intervent Radiol 2009; 32: 424-435
    CrossrefPubMedGoogle Scholar
  • 26 Micari A, Cioppa A, Vadalà G et al. Clinical evaluation of a paclitaxel-eluting balloon for treatment of femoropopliteal arterial disease: 12-month results from a multicenter Italian registry. JACC Cardiovasc Interv 2012; 5: 331-338
    CrossrefPubMedGoogle Scholar
  • 27 Tepe G, Zeller T, Albrecht T et al. Local delivery of paclitaxel to inhibit restenosis during angioplasty of the leg. N Engl J Med 2008; 358: 689-699
    CrossrefPubMedGoogle Scholar
  • 28 Liistro F, Porto I, Angioli P et al. Drug-eluting balloon in peripheral intervention for below the knee angioplasty evaluation (DEBATE-BTK): a randomized trial in diabetic patients with critical limb ischemia. Circulation 2013; 128: 615-621
    CrossrefPubMedGoogle Scholar
  • 29 Liistro F, Grotti S, Porto I et al. Drug-eluting balloon in peripheral intervention for the superficial femoral artery: the DEBATE-SFA randomized trial (drug eluting balloon in peripheral intervention for the superficial femoral artery). JACC Cardiovasc Interv 2013; 6: 1295-1302
    CrossrefPubMedGoogle Scholar
  • 30 Werk M, Albrecht T, Meyer DR et al. Paclitaxel-coated balloons reduce restenosis after femoro-popliteal angioplasty: evidence from the randomized PACIFIER trial. Circ Cardiovasc Interv 2012; 5: 831-840
    CrossrefPubMedGoogle Scholar
  • 31 Scheinert D, Duda S, Zeller T et al. The LEVANT I (Lutonix paclitaxel-coated balloon for the prevention of femoropopliteal restenosis) trial for femoropopliteal revascularization: first-in-human randomized trial of low-dose drug-coated balloon versus uncoated balloon angioplasty. JACC Cardiovasc Interv 2014; 7: 10-19
    CrossrefPubMedGoogle Scholar
  • 32 Dake MD, Scheinert D, Tepe G et al. Nitinol stents with polymer-free paclitaxel coating for lesions in the superficial femoral and popliteal arteries above the knee: twelve-month safety and effectiveness results from the Zilver PTX single-arm clinical study. J Endovasc Ther 2011; 18: 613-623
    CrossrefPubMedGoogle Scholar
  • 33 Scheinert D, Katsanos K, Zeller T et al. A prospective randomized multicenter comparison of balloon angioplasty and infrapopliteal stenting with the sirolimus-eluting stent in patients with ischemic peripheral arterial disease: 1-year results from the ACHILLES trial. J Am Coll Cardiol 2012; 60: 2290-2295
    CrossrefPubMedGoogle Scholar
  • 34 Rastan A, Tepe G, Krankenberg H et al. Sirolimus-eluting stents vs. bare-metal stents for treatment of focal lesions in infrapopliteal arteries: a double-blind, multi-centre, randomized clinical trial. Eur Heart J 2011; 32: 2274-2281
    CrossrefPubMedGoogle Scholar
  • 35 Rastan A, Brechtel K, Krankenberg H et al. Sirolimus-eluting stents for treatment of infrapopliteal arteries reduce clinical event rate compared to bare-metal stents: long-term results from a randomized trial. J Am Coll Cardiol 2012; 60: 587-591
    CrossrefPubMedGoogle Scholar
  • 36 Falkowski A, Poncyljusz W, Wilk G, Szczerbo-Trojanowska M. The evaluation of primary stenting of sirolimus-eluting versus bare-metal stents in the treatment of atherosclerotic lesions of crural arteries. Eur Radiol 2009; 19: 966-974
    CrossrefPubMedGoogle Scholar
  • 37 Bosiers M, Scheinert D, Peeters P et al. Randomized comparison of everolimus-eluting versus bare-metal stents in patients with critical limb ischemia and infrapopliteal arterial occlusive disease. J Vasc Surg 2012; 55: 390-398
    CrossrefPubMedGoogle Scholar
  • 38 Sixt S, Rastan A, Beschorner U et al. Acute and long-term outcome of Silverhawk assisted atherectomy for femoro-popliteal lesions according the TASC II classification: a single-center experience. Vasa 2010; 39: 229-236
    CrossrefPubMedGoogle Scholar
  • 39 Regine R, Catalano O, De Siero M et al. Endovascular treatment of femoropopliteal stenoses / occlusions with a SilverHawk directional atherectomy device: immediate results and 12-month follow-up. Radiol Med 2010; 115: 1208-1218
    CrossrefPubMedGoogle Scholar
  • 40 McKinsey JF, Goldstein L, Khan HU et al. Novel treatment of patients with lower extremity ischemia: use of percutaneous atherectomy in 579 lesions. Ann Surg 2008; 248: 519-528
    PubMedGoogle Scholar
  • 41 Zeller T, Rastan A, Sixt S et al. Long-term results after directional atherectomy of femoro-popliteal lesions. J Am Coll Cardiol 2006; 48: 1573-1578
    PubMedGoogle Scholar
  • 42 Zeller T, Sixt S, Schwarzwälder U et al. Two-year results after directional atherectomy of infrapopliteal arteries with the SilverHawk device. J Endovasc Ther 2007; 14: 232-240
    CrossrefPubMedGoogle Scholar