Cryoplasty for the prevention of arterial restenosis.
Restenosis after percutaneous transluminal angioplasty remains the limiting factor for the long-term benefit of endovascular therapies of peripheral arterial occlusive disease. Despite a variety of modifications and adjuncts to angioplasty such as bare metal stents, covered stents, and drug-eluting stents as well as a number of new technologies like laser angioplasty and cutting balloon angioplasty, restenosis rates have not been significantly affected and remain inferior to those for surgery for long lesions in the femoropopliteal segment. Cryoplasty, which combines balloon angioplasty with the application of cryothermal energy to the vessel wall, was suggested as a promising approach to prevent the formation of neointimal hyperplasia after angioplasty procedures. This review discusses the basic principles of cryoplasty, summarizes the current data on restenosis rates after cryoplasty treatment, and evaluates cryoplasty as a new treatment method to solve the problems associated with restenosis development. The results of the clinical studies suggest that cryoplasty is a feasible and safe technique in the treatment of femoropopliteal disease, however, they have failed to prove any superiority of cryoplasty over conventional angioplasty.
Wildgruber
Moritz G
MG
Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 13th Street, Building 149, Charlestown, MA 02129, USA. wildgruber.moritz@mgh.harvard.edu
Berger
Hermann J
HJ
D017130:Angioplasty / Q000379:methods; D000818:Animals; D017209:Apoptosis; D001157:Arterial Occlusive Diseases / Q000517:prevention & control* / Q000628:therapy; D017679:Cryotherapy / Q000379:methods*; D006083:Graft Occlusion, Vascular / Q000517:prevention & control*; D006801:Humans; D006965:Hyperplasia; D016491:Peripheral Vascular Diseases / Q000517:prevention & control* / Q000628:therapy; D055502:Secondary Prevention; D017539:Tunica Intima / Q000473:pathology; D014654:Vascular Patency / Q000502:physiology