Drug-coated balloons in cardiovascular disease: benefits, challenges, and clinical applications

ABSTRACT

Introduction: Newer-generation drug-eluting stents (DES) are the standard of care for the treatment of symptomatic coronary artery disease. However, their efficacy is limited by in-stent restenosis and stent thrombosis. Drug-coated balloons (DCB) are a treatment option for in-stent-restenosis and for certain clinical and anatomical situations in de novo diseases such as small coronary arteries, bifurcation lesions, and high bleeding risk situations.

Areas covered: This review summarizes the current clinical status of DCB angioplasty in coronary artery disease.

Expert opinion: DCB deliver an anti-proliferative drug into the vessel wall without implanting a stent and are a promising and technique in the treatment of coronary artery disease. Several studies and meta-analysis have demonstrated the safety and efficacy of DCB angioplasty for several indications such as in-stent restenosis, small-vessel disease, and high bleeding risk. Due to absent short- and long-term complications of stent implantation and a short dual antiplatelet therapy duration, DCB angioplasty has the potential to achieve a clear role in the interventional field in clinical settings with a comparable or even a superior efficacy in comparison with DES use.

KEYWORDS:

• Coronary artery disease
• small-vessel disease
• de novo stenosis
• bifurcation lesions
• drug-coated balloon
• drug-eluting balloon
• percutaneous coronary intervention

Article highlights

• Randomized clinical trials have demonstrated the safety and efficacy of DCB angioplasty for the treatment of in-stent restenosis.

• DCB angioplasty showed good efficacy and safety in de novo lesions, especially in small-vessel coronary artery disease, bifurcation lesions, and high bleeding risk.

• Current DCB are coated with paclitaxel and provide very satisfactory clinical and angiographic results. Further studies with sirolimus-coated balloons are currently performed.

This box summarizes the key points contained in the article.

Declaration of interest

T Nestelberger has received speaker honoraria and personal fees from Beckman-Coulter, Bayer, Orion Pharma, and Ortho Clinical Diagnostics, outside the submitted work. R Jeger has received speaker honoraria and research support from B. Braun and speaker honoraria from Cardionovum. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

A reviewer on this manuscript has disclosed that they are a co-author in DCB related research (coronary, peripheral), they are a researcher at the Charité Unversity Hospitals, and an employee at Medical Scientific Affairs B.Braun. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.