Drug-coated balloon treatment in coronary artery disease: Recommendations from an Asia-Pacific Consensus Group

Abstract

Coronary artery disease (CAD) is currently the leading cause of death globally, and the prevalence of this disease is growing more rapidly in the Asia-Pacific region than in Western countries. Although the use of metal coronary stents has rapidly increased thanks to the advancement of safety and efficacy of newer generation drug eluting stent (DES), patients are still negatively affected by some the inherent limitations of this type of treatment, such as stent thrombosis or restenosis, including neoatherosclerosis, and the obligatory use of dual antiplatelet therapy (DAPT) with unknown optimal duration. Drug-coated balloon (DCB) treatment is based on a leave-nothing-behind concept and therefore it is not limited by stent thrombosis and long-term DAPT; it directly delivers an anti-proliferative drug which is coated on a balloon after improving coronary blood flow. At present, DCB treatment is recommended as the first-line treatment option in metal stent-related restenosis linked to DES and bare metal stent. For de novo coronary lesions, the application of DCB treatment is extended further, for conditions such as small vessel disease, bifurcation lesions, and chronic total occlusion lesions, and others. Recently, several reports have suggested that fractional flow reserve guided DCB application was safe for larger coronary artery lesions and showed good long-term outcomes. Therefore, the aim of these recommendations of the consensus group was to provide adequate guidelines for patients with CAD based on objective evidence, and to extend the application of DCB to a wider variety of coronary diseases and guide their most effective and correct use in actual clinical practice.

Cardiovascular outcomes following percutaneous coronary intervention with drug-eluting balloons in chronic kidney disease: a retrospective analysis

“…However, while the minimal recommended time following DEB angioplasty is 1-3 months, the mean DAPT duration for the CKD group was 10.0 ± 3.4 months, suggesting that the full potential benefits of shorter DAPT was not realized. The DAPT recommendation following ACS is 12 months [5,6]. Thus, we performed an additional analysis of the patients who underwent an Table 3 Outcomes following DEB of patients who underwent percutaneous coronary intervention with drug-eluting balloons Fig.…”

“…DEBs mechanically open obstructed vessels by inflating; this releases a homogeneous high dose of anti-proliferative drug (such as paclitaxel). The resultant reduction in neointimal proliferation prevents restenosis of the obstructed vessel [2,5].…”

Provisional drug-coated balloon treatment guided by physiology on de novo coronary lesion

“…The use of DCBs has been proven to be very effective for in-stent restenosis (ISR) and is recommended by European, German, and Asia-Pacific consensus groups [7][8][9]. Although DCB treatment is a reasonable option for ISR, recurrent target lesion failure (TLF) still occurs in some patients after treatment.…”

“…FFR-guided DCB treatment has several advantages compared to angiography-guided DCB application. A recent recommendation from an Asia-Pacific consensus group reported both angiographic and functional criteria for large de novo coronary lesions [9].…”

Systematic Scoring Balloon Lesion Preparation for Drug-Coated Balloon Angioplasty in Clinical Routine: Results of the PASSWORD Observational Study

“…They found that the optimal balloon size in the beginning of balloon angioplasty in the range of 0.9-1.3 revealed the most favorable combination of minimal dissection risk and highest vessel patency. The very recent recommendations from the Asia-Pacific consensus group [25] engulfed two new aspects of lesion preparation and DCB angioplasty. Firstly, the authors found enough evidence to recommend DCB angioplasty also for de novo lesions in larger vessels supported by diagnostic techniques such as fractional flow reserve or optical coherence tomography.…”