Coronary drug-coated balloons: Current evidence and emerging trends

Abstract

Percutaneous coronary intervention (PCI) for coronary and peripheral stenoses has advanced rapidly over the past three decades, driven by a series of innovative techniques since the introduction of the first balloon angioplasty. Significant progress in stent technology, beginning with bare-metal stents and followed by drug-eluting stents, has expanded the scope for successful revascularisation in complex lesions. However, challenges such as late stent thrombosis and in-stent restenosis (ISR) persist. Thus, further improvement in PCI techniques and devices is essential to achieve better patient outcomes. In recent years, drug-coated balloons (DCBs) have emerged as a promising alternative designed to overcome the limitations associated with drug-eluting stents, including the risks of late stent thrombosis, ISR, and the need for prolonged dual antiplatelet therapy. Several DCBs have been evaluated for both coronary and peripheral lesions, showing encouraging results in preclinical and clinical studies. DCBs have demonstrated efficacy in the treatment of ISR and have shown potential in other clinical scenarios, such as small-vessel disease and diffuse lesions. In this review, we present the underlying technology, mechanisms of action, key preclinical findings, emerging clinical indications, recent trial outcomes, and future perspectives of DCBs as they continue to define their role in PCI.

Keywords: Percutaneous coronary interventions; Restenosis; Paclitaxel; Small vessel disease; Clinical trials

Core Tip: Percutaneous coronary intervention has advanced rapidly over the past four decades. Despite significant progress in stent technology, there is still risk of late stent thrombosis and in-stent restenosis in long-term. Further improvement in percutaneous coronary intervention techniques/devices is imperative to achieve better outcomes. In recent years, drug-coated balloons have emerged as a viable alternative designed to overcome the limitations associated with drug-eluting stents. Drug-coated balloon leaves no residual metal inside coronary arteries and consequently suitable for an abridged antiplatelet regimen. They have demonstrated efficacy in the treatment of in-stent restenosis and can be useful in as small-vessel disease and diffuse lesions.