Application of drug-coated balloon in coronary artery intervention: challenges and opportunities

In recent decades, the outcomes of coronary heart disease (CHD) have markedly improved, which can be partly attributed to the use of novel drugs (especially statins and antiplatelet drugs) and partly to the evolution of percutaneous coronary intervention (PCI). From percutaneous transluminal coronary angioplasty to bare-metal stent and then to drug-eluting stent, every step of PCI is attractive to interventional cardiologist, great progress has been made for patients with CHD. In the past few years, some successor devices for treating CHD have emerged. Undoubtedly, drug-coated balloon (DCB), which was recommended by 2014 ESC Guidelines on myocardial revascularization, is a "shining star" among them. DCB involves a semi-compliant angioplasty balloon coated with an anti-proliferative agent that can exert antirestenotic efficacy by permeating into the vessel wall during balloon contact. This review discusses the conception and merits, preclinical data, emerging clinical indications, and results from clinical trials of this novel interventional technology. Although DCB has shown authentic efficacy in the treatment of in-stent restenosis, its use in de novo coronary lesions is still in dispute. Hence, concerns and the future direction of DCB are also covered in this paper.