Assessing paclitaxel-coated vs sirolimus-coated balloon angioplasty for coronary artery diseases: A systematic review and meta-analysis

doi:10.4330/wjc.v17.i11.112018

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World Journal of Cardiology

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Meta-Analysis

World J Cardiol. Nov 26, 2025; 17(11): 112018
Published online Nov 26, 2025. doi: 10.4330/wjc.v17.i11.112018

Assessing paclitaxel-coated vs sirolimus-coated balloon angioplasty for coronary artery diseases: A systematic review and meta-analysis

Shree Rath, Allahdad Khan, Hamza Khan, Asad Ali Ahmed Cheema, Zahir Ud Din, Waseef Ullah, Raheel Ahmed

Shree Rath, Department of Medicine, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar 751019, Odisha, India

Allahdad Khan, Department of Medicine, Nishtar Medical University, Multan 60650, Punjab, Pakistan

Hamza Khan, Zahir Ud Din, Waseef Ullah, Department of Medicine, Lady Reading Hospital, Peshawar 25000, Pakistan

Asad Ali Ahmed Cheema, Department of Medicine, International School of Medicine, International University of Kyrgyzstan, Bishkek 720000, Kyrgyzstan

Raheel Ahmed, Department of Medicine, Imperial College London, London SW7 2AZ, United Kingdom

Author contributions: Rath S conceptualized the study, designed the research study, led the study, and was the lead author in performing the analysis, preparing figures, writing the manuscript and revising the final manuscript; Khan A conceptualized the study and was involved in data extraction and writing of the manuscript; Khan H, Cheema AAA, Din ZU, Ullah W, and Ahmed R were involved in data curation and writing of the manuscript; Ahmed R was responsible for the review of the manuscript; and all authors have read and approved the final manuscript.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Shree Rath, MD, Department of Medicine, All India Institute of Medical Sciences Bhubaneswar, Sijua, Patrapada, Bhubaneswar 751019, Odisha, India. shreerath4a@gmail.com

Received: July 16, 2025
Revised: July 28, 2025
Accepted: October 17, 2025
Published online: November 26, 2025
Processing time: 128 Days and 22.3 Hours

Abstract

BACKGROUND

Given the clinical challenges posed by drug-eluting stents, drug-coated balloons offer a promising alternative by delivering antiproliferative medications directly to the vessel wall.

AIM

To compare the efficacy of paclitaxel-coated balloon (PCB) angioplasty vs sirolimus-coated balloon (SCB) angioplasty in the treatment of coronary artery disease (CAD), focusing on both in-stent restenosis (ISR) and de-novo lesions (DNL).

METHODS

A comprehensive literature search on PubMed, EMBASE, and Cochrane Central from inception to 5^th February 2025. Only randomized controlled trials and observational studies comparing outcomes of PCB vs SCB angioplasty in patients with ISR or DNL were included.

RESULTS

A total of nine studies with 1981 patients (949 in PCB arm and 1032 in SCB arm) were included for further quantitative analysis. The results indicated that both PCB and SCB angioplasty are effective in treating CAD, with PCB showing a greater minimal lumen diameter for DNL [mean difference: -0.11 (95% confidence interval: -0.22 to -0.01, P = 0.03)]. However, the risk of target lesion revascularization and diameter stenosis was identical for both PCB and SCB during the 9-12-month follow-up period.

CONCLUSION

This meta-analysis highlights that PCB angioplasty may offer superior angiographic outcomes compared to SCB angioplasty, specifically in achieving greater minimal lumen diameter in patients with DNL. These findings suggest that while PCB has certain advantages in terms of tissue retention and immediate efficacy, both PCB and SCB are viable options for treating ISR or DNL in CAD patients. Further large-scale studies are required to conclusively determine the long-term benefits and potential risks associated with each type of drug-coated balloons angioplasty.

Keywords: Paclitaxel; Drug-eluting stents; Sirolimus; Coronary artery disease; Target lesion failure; Minimal lumen diameter

Core Tip: This meta-analysis presents the most up-to-date comparison of paclitaxel- vs sirolimus-coated balloon angioplasty for coronary artery disease, encompassing 1981 patients across diverse lesion types. Our findings reveal comparable clinical and angiographic outcomes for both devices but identify a potential advantage for paclitaxel-coated balloons in de novo lesions. These results underscore the need for personalized lesion-specific strategies and highlight the importance of further large-scale trials to refine the role of drug-coated balloons in percutaneous coronary intervention.