Balloon angioplasty for coronary artery disease: Best practices in the DCB era

As percutaneous coronary intervention with drug-coated balloon (DCB) increases, it will be critical to revisit criteria to define an optimal balloon angioplasty result. Given the importance of adequate vessel preparation prior to consideration of DCB utilization, many interventional cardiologists may be unfamiliar with what percentage of residual stenosis is considered acceptable following balloon angioplasty and which coronary dissections are safe to leave. Intravascular imaging may provide a powerful tool to aid in determining which lesions are safe to proceed with DCB use following vessel preparation and which lesions require bailout stenting. As DCB use expands into the treatment of de novo coronary lesions in the United States, employment of best practices and understanding whether a balloon angioplasty result is optimal will be critical for successful adoption of DCB technology.