Drug-Coated Balloons: Hope or Hot Air: Update on the Role of Coronary DCB

Abstract

DCBs are regular semi-compliant balloons coated with antiproliferative agents that are rapidly released on contact with the vessel intima, exerting an anti-restenotic effect. This technology may offer some benefits of drug-eluting stents, in particular for the treatment of restenotic lesions, small vessels, and in patients at high-bleeding risk, when the prolonged dual antiplatelet regimen should be avoided. Most recent data have pointed to a possible benefit of these devices in treating bare metal stents (BMS) or drug-eluting stents in-stent restenosis (DES ISR), effectively reducing the recurrence of restenosis and avoiding additional layers of metal in the same coronary segment. In other clinical scenarios such as bifurcations, small vessels, and de novo lesions, data is more scarce and the benefits are still unclear. There are potential benefits related to the use of DCB in selected populations. However, larger clinical trials with longer follow-up are still needed to confirm the enthusiastic initial results.

Editor's Choice – Drug Coated Balloon Angioplasty vs. Standard Percutaneous Transluminal Angioplasty in Below the Knee Peripheral Arterial Disease: A Systematic Review and Meta-Analysis

“…This was based on the use of DCBs in cardiac small vessel disease. 4 A meta-analysis of randomised trials published in 2016 showed no differences between standard PTA and DCB angioplasty in clinical outcomes at 12 months. 5 In the last two years, new case series and comparative studies and one large randomised controlled trial have been performed with the use of new types of DCBs with promising results.…”

Systematic evaluation of particle loss during handling in the percutaneous transluminal angioplasty for eight different drug-coated balloons

“…For currently used DCBs, paclitaxel represents the most often used drug that is provided with manufacturer-specific coatings in different concentrations and with different excipients on the balloon surface. DCB is a promising emerging technology 5 following the "leaving nothing behind" principle 6 and providing favorable initial results in areas where a drug-eluting stent (DES) is not suitable. Nevertheless, restenosis remains a major issue in endovascular treatment 7 .…”

Late Stent Thrombosis After Drug-Coated Balloon Coronary Angioplasty for In-Stent Restenosis

“…Although the value of DCB angioplasty in the treat- ment of new lesions needs to be studied further, the effectiveness of DCB angioplasty in the treatment of ISR has been confirmed in several studies. 3,4) Compared to newgeneration DESs, DCB angioplasty has multiple advantages in the treatment of ISR. 6) The surface area of the balloon is much larger than the adherence area of the stent metal beam, which can deliver more antiproliferative drugs to the vessel wall and release antiproliferative drugs more evenly, avoiding "blind areas."…”

“…Drug-coated balloon (DCB) angioplasty is an emerging technology that has been tested for ISR treatment. 4) As the DCB delivers the antiproliferative drugs to the area of ISR, avoiding the introduction of an additional stent layer, treatment with DCB for ISR should have faster and safer vessel healing and a shorter dual antiplatelet therapy (DAPT) regimen. 4) We report the case of a female patient who underwent DCB angioplasty because of recurrent ISR and late stent thrombosis that occurred after 70 days, despite uninterrupted DAPT.…”