Contemporary use of drug-coated balloons in coronary artery disease: Where are we now?

Abstract

The drug-coated balloon (DCB) has emerged as an additional tool in the arsenal of interventional cardiology devices; it delivers antiproliferative drugs to local arterial tissue by single prolonged coated balloon angioplasty inflation, and prevents restenosis, leaving no implant behind. This strategy theoretically decreases the risk of late inflammatory response to device components, without preventing positive remodelling. DCBs, when used carefully and with a good technique, may have a role in the treatment of lesion subsets, such as in-stent restenosis, small vessel disease or side branch bifurcations, in which the implantation of a drug-eluting stent is not desirable or is technically challenging. Using the latest evidence regarding the effectiveness of the currently available DCBs, this review will discuss the rationale for DCB use, and the effectiveness of DCBs in different clinical and lesion settings, and will give practical tips for their correct use in everyday clinical practice.

Real‐life experience of a stent‐less revascularization strategy using a combination of excimer laser and drug‐coated balloon for patients with acute coronary syndrome

“…The authors explained that a lack of structural support to the vessel was a crucial drawback of the DCB‐only strategy, and it may have outweighed its benefits such as an antiproliferative action and positive remodeling . Thus, so far, the DCB‐alone for the treatment of ACS is seen as a potential alternative strategy only for patients with contraindications to a DES . This limited benefit of DCB probably was the other contributing factor responsible for the disappointing result in our series.…”

“…21 Thus, so far, the DCB-alone for the treatment of ACS is seen as a potential alternative strategy only for patients with contraindications to a DES. 7 This limited benefit of DCB probably was the other contributing factor responsible for the disappointing result in our series. Consequently, it seemed that the two stent-less devices did not have a synergetic effect, and they even failed to compensate for their common shortcoming, a lack of structural support.…”

“…Its mechanism involves the local release of an antiproliferative agent into the vessel wall during balloon contact, inhibiting intimal hyperplasia. 6,7 The efficacy of the DCB has been proven by previous clinical trials. 8,9 Drug-eluting stent (DES) implantation represents the standard of care for patients with acute coronary syndrome (ACS), thanks to its potent antirestenotic effect.…”

“…The drug‐coated balloon (DCB) is a new treatment modality for coronary artery disease. Its mechanism involves the local release of an antiproliferative agent into the vessel wall during balloon contact, inhibiting intimal hyperplasia . The efficacy of the DCB has been proven by previous clinical trials …”

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“…This suggests that when using DCB, shorter dual antiplatelet therapy is justified without a higher risk of restenosis, corresponding to the findings in cardiology. 64,65 Furthermore, shorter dual antiplatelet therapy may lead to fewer bleeding complications. The outcomes of the studies in this meta-analysis were assessed as moderate and low quality according to the GRADE scoring system, mostly due to indirectness of evidence.…”