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Updated: Jul 7, 2025
Complete and Partial Resuscitative Endovascular Balloon Occlusion of the Aorta for Hemorrhagic Shock
Published on: May 19, 2022
Long-term benefits of drug-coated balloons for coronary artery revascularization
Bernardo Cortese1,2, Sara Malakouti3, Waqas Mazhar3,4
1Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy - bcortese@gmail.com.
Insights
Drug-eluting stents (DES) show limitations in treating coronary artery disease compared to bypass surgery. Drug-coated balloons (DCB) offer potential advantages for long-term outcomes, with ongoing research exploring combined therapies.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomaterials in Medicine
Background:
- Drug-eluting stents (DES) are a primary treatment for coronary artery disease (CAD).
- Current DES have not demonstrated non-inferiority to coronary artery bypass grafting (CABG) regarding short-term clinical events.
- DES are linked to a higher risk of target vessel revascularization compared to CABG in long-term follow-up.
Purpose of the Study:
- To review the technical limitations of current drug-eluting stents (DES).
- To highlight the potential benefits of percutaneous coronary intervention (PCI) with drug-coated balloons (DCB) for long-term outcomes.
- To explore the potential non-inferiority of DCB-PCI compared to CABG.
Main Methods:
- Literature review and synthesis of existing studies on DES and DCB therapies in CAD.
- Analysis of clinical outcomes, including target vessel revascularization and cumulative clinical events.
- Discussion of ongoing research into blended therapies (DCB+DES).
Main Results:
- DES exhibit limitations in achieving long-term efficacy comparable to CABG.
- Drug-coated balloons (DCB) show promise in managing specific CAD challenges like in-stent restenosis and small vessel lesions.
- Further research is needed to evaluate DCB's long-term performance and non-inferiority to CABG.
Conclusions:
- Technical limitations of DES necessitate exploration of alternative or adjunctive therapies.
- DCB-PCI presents a viable option for improving long-term outcomes in CAD management.
- Blended DCB+DES therapy is under investigation for complex CAD cases, aiming to match CABG performance.
Abstract:
Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) represents the treatment of choice for the majority of patients with coronary artery disease. While currently available DES, in addition to physiological support, has failed to show the non-inferiority to coronary artery bypass grafting (CABG) in terms of cumulative incidence of clinical events over the short-term follow-up. Studies have also shown that DES is associated with an increased risk of target vessel revascularization compared to CABG after long-term follow-up. Drug-coated balloons (DCB) have been shown to provide clinically significant benefits in the management of in-stent restenosis and diffuse coronary artery disease, as well as small coronary artery lesions. The aim of this review was to describe the inherent technical limitations of DES and highlight the potential advantages of PCI with DCB for long-term outcomes and potentially demonstrate its non-inferiority to CABG. Currently, ongoing studies will provide more information and help to understand if a blended therapy of DCB+DES can match the performance of CABG in the need for revascularization in more complex patients.
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