Back to the future: DCB use instead of DES for the treatment of complex, native coronary artery disease
Bernardo Cortese1,2, Erick Sanchez-Jimenez1
1San Carlo Clinic, Via Ospedale, 21, Milano, Italy.
Insights
Drug-coated balloons (DCBs) offer a promising alternative to stenting for complex coronary lesions, especially in patients ineligible for surgery. Further trials are needed to establish their role in native vessel disease and complex anatomies.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Percutaneous coronary intervention (PCI) is challenging for complex lesions in patients with comorbidities, especially when surgical revascularization is not an option.
- High complication rates with drug-eluting stents (DES) in complex cases necessitate alternative treatment strategies.
- Drug-coated balloons (DCBs) are emerging as a viable option for specific indications like small vessels and in-stent restenosis.
Purpose of the Study:
- To review current literature on the use of DCBs in complex coronary artery disease.
- To evaluate the efficacy and safety of DCBs in native vessel disease and complex anatomies.
- To highlight the need for well-designed clinical trials investigating DCB therapy in challenging patient populations.
Main Methods:
- Comprehensive literature review of recent studies on DCB utilization.
- Analysis of data concerning DCB performance in complex native lesions and challenging patient profiles.
- Exploration of DCBs as a potential adjunct or alternative to DES.
Main Results:
- Preliminary data suggest promising outcomes for DCBs in complex coronary lesions.
- Evidence for DCB use in native vessel disease and complex anatomies is still limited but growing.
- DCBs show potential as a complementary tool alongside or as a replacement for DES in select cases.
Conclusions:
- DCBs represent an important therapeutic advancement for specific complex coronary artery lesions.
- Further robust clinical trials are essential to define the optimal role of DCBs in complex PCI.
- DCBs may serve as a valuable tool to improve outcomes in high-risk patients undergoing revascularization.
Abstract:
The increasing complexity of coronary artery lesions in patients with significant co-morbidities and the need for revascularization, but with the ineligibility for surgical approach, has turned the percutaneous coronary intervention a challenging task, especially in a setting in which short- and long-term complications after drug-eluting stent implantation are high. Drug-coated balloons (DCBs) have become an important tool to replace stent placement in specific situations such as small coronary artery disease and in-stent restenosis. Although preliminary data of DCB use in complex lesions is promising, the available data are still limited. Therefore, in this article, we review the most recent and relevant literature about the use of DCB in native vessel disease and in complex anatomies/patients, and pretend to justify the necessity to develop well design trials about the use of this therapy in such settings, also thinking at DCBs as a complementary tool to drug-eluting stents.
More Related Videos
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:25Antianginal Drugs: Calcium Channel Blockers and Ranolazine
CCBs, a diverse class that includes dihydropyridines (nifedipine) and diphenylalkylamines (verapamil and diltiazem), exert their effect by blocking calcium channels in cardiac and smooth muscle cells. This...
01:20Antiarrhythmic Drugs: Class IV Agents as Calcium Channel Blockers
Verapamil, a calcium channel blocker, inhibits calcium movement across myocardial cell membranes and vascular smooth muscle. This results in the dilation of coronary and...
01:30Coronary Artery Disease I: Introduction
01:26Coronary Artery Disease IV: Preventive Measures