Clinical application and expansion of paclitaxel-coated balloons in coronary atherosclerotic disease

Abstract

Drug-coated balloon angioplasty has become one of the important means of interventional treatment for atherosclerotic cardiovascular diseases, and its application in clinical practice is becoming more and more common. Although several expert consensuses and a small number of scattered guideline recommendations have been issued, there is a lack of comprehensive and systematic guideline guidance. However, relevant clinical research and practice are still making continuous progress. This article reviews the clinical research progress of the indications for the treatment of coronary artery stenosis with paclitaxel drug-coated balloons, focusing on introducing its application overview and techniques in in-stent restenosis, bifurcation lesions, new lesions in large and small blood vessels, acute and chronic coronary syndromes and other situations, the management of special complications, and the dual antiplatelet strategy after drug balloon angioplasty, revealing new perspectives on the use of drug-coated balloons in different coronary artery disease scenarios. This article also discusses the cellular and molecular mechanisms related to the anti-atherosclerotic and anti-restenosis effects of paclitaxel, with the hope of providing direct guidance for the daily clinical practice of cardiologists and interventionalists.

Keywords: Drug-coated balloon; Coronary artery disease; In-stent restenosis; Bifurcation lesion; Large blood vessel; Small blood vessel; Coronary artery dissection; Complication; Interventional treatment

Core Tip: Drug-coated balloon (DCB) angioplasty plays a pivotal role in the interventional management of atherosclerotic cardiovascular disease. This review focuses on the application of paclitaxel DCB in coronary artery stenosis, encompassing their use in in-stent restenosis, large or small vessel disease, bifurcation lesions, and other lesion types. Key topics include lesion preparation techniques, DCB delivery strategies, complication management, safety evaluations, and post-procedural dual antiplatelet therapy strategies. Additionally, the review explores cellular and molecular mechanisms underlying anti-atherosclerotic and anti-restenotic effects, including endothelial repair, inhibition of neointimal hyperplasia, and modulation of inflammatory pathways. Current challenges and future directions in optimizing DCB-based therapies are also discussed.