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Contemporary Use of Drug-Coated Balloons for Coronary Angioplasty: A Comprehensive Review
Nicola Verde1,2, Giuseppe Ciliberti1,3, Luca Pittorino1,4
1Division of Cardiology, Catheterization Laboratory, Montevergine Clinic, 83013 Mercogliano, Italy.
Insights
Drug-coated balloons (DCBs) offer an effective alternative to drug-eluting stents for treating coronary artery disease (CAD), particularly in complex cases like in-stent restenosis. This review explores DCB technology, applications, and future potential in interventional cardiology.
Area of Science:
- Interventional Cardiology
- Vascular Medicine
- Biomaterials Science
Background:
- Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is standard for coronary artery disease (CAD).
- In-stent restenosis (ISR) and limitations in specific anatomical locations necessitate alternative treatments.
- Drug-coated balloons (DCBs) have emerged as a promising therapeutic option.
Purpose of the Study:
- To provide a comprehensive review of current drug-coated balloon (DCB) platforms.
- To detail the clinical applications and supporting evidence for DCBs in various CAD settings.
- To discuss the future perspectives of DCB technology in interventional cardiology.
Main Methods:
- Review of existing literature on DCB technology and clinical trials.
- Analysis of DCB platforms, drug-eluting agents (Paclitaxel, Sirolimus), and delivery systems.
- Evaluation of DCB efficacy and safety data across different patient and lesion subsets.
Main Results:
- DCBs demonstrate high efficacy in treating in-stent restenosis by inhibiting intimal hyperplasia.
- Studies show promising results for DCBs in de novo lesions, small vessels, and complex coronary anatomies.
- DCBs are being investigated for acute coronary syndromes, high-bleeding risk patients, and diabetic individuals.
Conclusions:
- DCBs represent a significant advancement in interventional cardiology, offering a valuable treatment option beyond traditional DES.
- Their efficacy in ISR and expanding applications in diverse clinical scenarios highlight their therapeutic potential.
- Continued research and technological innovation are expected to further enhance the role of DCBs in managing coronary artery disease.
Abstract:
The interventional treatment of coronary artery disease (CAD) has undergone significant improvements thanks to technological innovations. Nowadays, percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation is the standard of care for the treatment of CAD. Nevertheless, the non-negligible incidence of in-stent restenosis (ISR) and suboptimal results in various anatomical settings has led to the development of drug-coated balloons (DCBs). DCBs are catheter-based balloons whose surface is coated with an anti-proliferative drug (mainly Paclitaxel or Sirolimus) loaded onto the balloon surface with different technologies and dose concentrations. In the beginning, these devices were used for the treatment of ISR showing an excellent efficacy profile in the inhibition of intimal hyperplasia. Subsequently, several studies evaluated their use in other angiographical and clinical contexts such as de novo lesions, small vessel disease, diffuse coronary disease, bifurcation lesions, acute coronary syndromes, high-bleeding risk and diabetic patients. This comprehensive review aims to describe the main DCB platforms on the market, their fields of application with the main supporting studies and their future perspectives.
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