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Drug-coated balloons for treatment of coronary artery disease: updated recommendations from a consensus group
Franz X Kleber1, Harald Rittger, Klaus Bonaventura
1Charité, University Medicine, Berlin, Germany.
Insights
Drug-coated balloon catheters (DCB) offer local drug delivery for artery disease without permanent implants. Updated recommendations guide their use, potentially reducing restenosis and the need for long-term dual antiplatelet therapy (DAPT).
Area of Science:
- Cardiovascular Medicine
- Endovascular Therapy
- Interventional Cardiology
Background:
- Drug-coated balloon catheters (DCB) represent an evolving treatment for coronary and peripheral artery disease.
- Recent clinical evidence necessitates an update to existing recommendations for DCB utilization.
- The consensus group aims to provide current guidance based on robust data.
Purpose of the Study:
- To update clinical recommendations for the use of drug-coated balloon catheters (DCB).
- To synthesize evidence from randomized clinical trials and clinical data for DCB application.
- To guide the optimal application of DCB in endovascular therapy.
Main Methods:
- Development of consensus recommendations based on a review of randomized clinical trials.
- Analysis of recent clinical data published since the initial recommendations.
- Focus on lesion preparation and assessment for stent implantation in conjunction with DCB use.
Main Results:
- Recommendations emphasize lesion preparation, including conventional angioplasty, to optimize DCB drug delivery.
- DCB monotherapy may be considered in select cases with no flow-limiting dissection and acceptable primary results.
- Potential advantages include reduced restenosis, decreased need for dual antiplatelet therapy (DAPT), and avoidance of permanent implants.
Conclusions:
- Drug-coated balloons facilitate localized drug delivery in endovascular procedures.
- DCB therapy offers a unique approach by leaving no permanent implant, promoting vascular restoration.
- Updated guidance supports informed clinical decision-making for DCB use in artery disease.
Aims:
Drug-coated balloon catheters (DCB) are a new clinical treatment modality for coronary and peripheral artery disease. The goal of the consensus group is to develop recommendations for the clinical use of DCB based on randomized clinical trials and the best available clinical evidence. The present paper gives an update on the recommendations against the background of a variety of new data published since the first paper was presented.
Methods And Results:
The general concept of our recommendations for the coronary use of DCB includes the preparation of the lesion to facilitate drug delivery and to estimate the need for stent implantation, especially after relevant dissections. Lesion preparation includes conventional angioplasty. In more complex lesions, additional treatments and imaging or functional measurements are helpful. In case of no flow-limiting dissection and an acceptable but not stent-like primary result, DCB use without additional stent implantation may be considered. The proposed advantages of the DCB only concept over a direct stent approach include reduced restenosis rates in indications where DES show limited efficacy, the reduction of DAPT especially in patients with contraindications for prolonged DAPT, and the option of leaving no foreign object behind resulting in vascular restoration with potentially plaque regression instead of neo-atherosclerosis.
Conclusions:
DCB allow for local drug delivery in endovascular therapy leaving no permanent implant behind.
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