Drug-coated balloons in interventional cardiology

Abstract

Over the last few years, drug-coated balloon (DCB) therapy has emerged as a promising therapeutic intervention for the management of obstructive cardiovascular disease. The dictum of this novel technology is that effective prevention of restenosis can be achieved by the short-term transfer of antiproliferative drug to local arterial tissue by means of a single prolonged balloon angioplasty dilatation. Its main attraction is that no foreign body is implanted eliminating thus the risk of late inflammatory response to device components without preventing positive remodeling. Here, we discuss the evidence regarding the effectiveness of DCB in different lesion types and clinical settings as well as the types of DCB commercially available or under development.

Keywords::

• bailout stenting
• bifurcation lesion
• coronary artery disease
• de novo coronary lesion
• diffuse coronary disease
• drug carrier
• drug-coated balloon
• excipient
• in-stent restenosis
• paclitaxel
• percutaneous coronary intervention
• semicompliant balloons
• small vessel disease

Financial & competing interests disclosures

A Latib serves on a Medtronic advisory board. 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.

No writing assistance was utilized in the production of this manuscript.

Key issues

• The emergence of drug-coated balloon (DCB) therapy as a novel therapeutic option in the management of obstructive coronary artery disease holds promise as an alternative to conventional percutaneous coronary intervention mainly for lesion subsets in which stent implantation is not the optimal option.

• The dictum of DCB technology is that effective prevention of restenosis may be achieved by the short-term transfer of antiproliferative drug to local arterial tissue by means of a single prolonged balloon angioplasty dilatation.

• Studies examining the role of DCB in the treatment of in-stent restenosis have demonstrated superiority of this technology over plain old balloon angioplasty and first-generation drug-eluting stents in terms of late lumen loss and restenosis. DCB may have a role in diffuse de novo coronary disease as well as in the treatment of small vessels.

• Not all DCBs are created equal due to differences in coating, release kinetics and tissue retention following drug delivery.

• Lesion preparation, rapid device delivery, minimal contact with the balloon itself and prolonged balloon inflation at nominal pressure are all important when utilizing DCB.

• Better performing balloon catheters combined with newer antiproliferative drugs, as well as improvements in excipient technology that enhance drug transfer and retention in the vessel wall may improve the outcomes currently observed with this technology.