From the Guidelines
Drug-coated balloon (DCB) therapy is a viable alternative to traditional stenting for coronary revascularization in specific clinical scenarios, particularly in small vessel disease, in-stent restenosis, and bifurcation lesions, as it reduces the need for prolonged dual antiplatelet therapy and potentially minimizes late complications like in-stent restenosis 1.
Key Considerations for DCB Therapy
- DCBs deliver anti-proliferative drugs to vessel walls without leaving a permanent implant, which can be beneficial in reducing late complications.
- The procedure involves proper vessel preparation with balloon pre-dilation, followed by DCB inflation for 30-60 seconds to ensure adequate drug transfer.
- Patients generally require shorter DAPT duration (1-3 months) compared to stenting, which can be advantageous in certain patient populations.
Clinical Outcomes and Comparisons
- Clinical outcomes show comparable rates of major adverse cardiac events to drug-eluting stents in selected populations, with potential advantages in preserving vessel anatomy and future treatment options 1.
- However, DCBs may not be optimal for heavily calcified lesions, chronic total occlusions, or lesions with significant recoil.
Future Research Directions
- Further studies are needed to determine the optimal use of DCB therapy in various clinical scenarios, including comparative-effectiveness studies to determine the optimal antiplatelet therapy for prevention of cardiovascular and limb-related events in patients with PAD 2.
- Research should focus on recent randomized controlled trials comparing DCBs to current-generation drug-eluting stents across various lesion types and patient populations.
Recommendations for Clinical Practice
- DCB therapy should be considered as a viable alternative to traditional stenting in specific clinical scenarios, particularly in small vessel disease, in-stent restenosis, and bifurcation lesions, due to its potential benefits in reducing late complications and preserving vessel anatomy 1.
- Clinicians should carefully evaluate patient-specific factors and lesion characteristics to determine the most appropriate treatment approach.
From the Research
Overview of Drug-Coated Balloons for Coronary Revascularization
- Drug-coated balloons (DCBs) have emerged as an alternative to drug-eluting stents (DES) for percutaneous coronary intervention (PCI) in patients with coronary artery disease 3.
- DCBs are balloons coated with antiproliferative agents and excipients, which aim to foster favorable vessel healing after lesion preparation 3.
Efficacy and Safety of DCBs
- Studies have shown that DCBs are effective in treating de novo coronary lesions, with comparable outcomes to DES 4, 5.
- A meta-analysis of 13 studies involving 2888 patients found no significant differences between DCBs and DES in terms of cardiovascular death, myocardial infarction, target lesion revascularization, and late lumen loss 5.
- DCBs have also been shown to be safe and effective for the treatment of small-vessel disease and high-bleeding-risk patients 6, 7.
Advantages of DCBs
- DCBs offer multiple advantages over DES, including preservation of vessel anatomy and function, and positive vessel remodeling 3.
- DCBs also eliminate the need for permanent foreign body implantation, which can reduce the risk of in-stent restenosis and stent thrombosis 3, 7.
Current Status and Future Perspectives
- DCBs have been approved for the treatment of in-stent restenosis in several countries, including the US 3, 7.
- Ongoing research is investigating the role of DCBs in other clinical situations, including acute coronary syndrome, large-vessel disease, bifurcation lesions, and long-diffuse distal lesions 4, 5, 7.
- Future studies are needed to further establish the benefits and limitations of DCBs in coronary revascularization 5, 6, 7.