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<p>Background: Drug-coated balloons (DCBs) are increasingly being used to treat superficial femoral artery (SFA) lesions during endovascular therapy (EVT). However, the evaluation of paclitaxel distribution following DCB treatment remains challenging. This study aimed to develop a novel criterion to systematically semi-quantitatively grade the degree of paclitaxel distribution using nonobstructive general angioscopy and analyze the clinical factors affecting this criterion. Method and results: This study included 18 patients (20 limbs) who underwent EVT for SFA lesions using DCBs. Angioscopic observation of the vessel surface was performed before and after DCB treatment. The amount of paclitaxel distribution was systematically graded using the novel surface observation by nonobstructive general angioscopy of wall drug-distribution (SNOW) grade. Clinical factors were statistically analyzed to determine their relationship with the SNOW grade. Paclitaxel particles were observed on vessel walls after DCB treatment in all patients. A significant relationship was found between the DCB diameter and reference vessel and lumen diameter, measured by intravascular ultrasound; specifically, a same DCB-to-vessel ratio was associated with greater drug distribution. Conclusions: The SNOW grading system was successfully developed for systematic evaluation of paclitaxel distribution. Our findings suggest that appropriate DCB sizing is essential for adequate drug application, highlighting that an undersized DCB may provide insufficient coverage. Therefore, a careful DCB selection that balances optimal drug delivery with the imperative to avoid vessel injury is crucial.</p>

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Paclitaxel distribution assessment after drug-coated balloon treatment in the superficial femoral artery: SNOW grade

  • 期刊论文

  • 发表日期：

    2025年10月11日

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  • Takeo Horikoshi,
  • Takamitsu Nakamura,
  • Toshiki Takei,
  • Miu Eguchi,
  • Ryota Yamada,
  • Toru Yoshizaki,
  • Manabu Uematsu,
  • Tsuyoshi Kobayashi,
  • Akira Sato

摘要

Background: Drug-coated balloons (DCBs) are increasingly being used to treat superficial femoral artery (SFA) lesions during endovascular therapy (EVT). However, the evaluation of paclitaxel distribution following DCB treatment remains challenging. This study aimed to develop a novel criterion to systematically semi-quantitatively grade the degree of paclitaxel distribution using nonobstructive general angioscopy and analyze the clinical factors affecting this criterion. Method and results: This study included 18 patients (20 limbs) who underwent EVT for SFA lesions using DCBs. Angioscopic observation of the vessel surface was performed before and after DCB treatment. The amount of paclitaxel distribution was systematically graded using the novel surface observation by nonobstructive general angioscopy of wall drug-distribution (SNOW) grade. Clinical factors were statistically analyzed to determine their relationship with the SNOW grade. Paclitaxel particles were observed on vessel walls after DCB treatment in all patients. A significant relationship was found between the DCB diameter and reference vessel and lumen diameter, measured by intravascular ultrasound; specifically, a same DCB-to-vessel ratio was associated with greater drug distribution. Conclusions: The SNOW grading system was successfully developed for systematic evaluation of paclitaxel distribution. Our findings suggest that appropriate DCB sizing is essential for adequate drug application, highlighting that an undersized DCB may provide insufficient coverage. Therefore, a careful DCB selection that balances optimal drug delivery with the imperative to avoid vessel injury is crucial.