Abstract
Since the introduction of coronary stents, in-stent restenosis has been one of the main stumbling blocks for its application in coronary artery disease. The drug-eluting stents have effectively reduced and become the mainstay of the interventional therapy of coronary artery disease. However, concerns of delayed stent thrombosis, dependency on prolonged dual antiplatelet therapy, and recurrent restenosis led to a quest for new treatment modalities that could address restenosis rates without drug-eluting-stent-related drawbacks. The drug-coated balloon has emerged as an additional tool in the armamentarium of interventional cardiology. It is usually a semicompliant balloon coated with antiproliferative agents encapsulated in a polymer matrix, which is released into the wall after inflation and contact with the intima, leaving no implant behind. This review highlights the rationale for drug-coated balloon use, its effectiveness in different clinical and lesion settings, and the future perspective.
Highlights
Percutaneous plain old balloon angioplasty (POBA) revolutionized coronary revascularization
The study REVELATION (REVascularization With PaclitaxEL-Coated Balloon Angioplasty Versus Drug-Eluting Stenting in Acute Myocardial InfarcTION) compared drug-coated balloons (DCB) angioplasty with the Pantera Lux balloon (Biotronik AG, Bülach, Switzerland) with sirolimus or everolimus drug-eluting stents (DES), and showed no significant difference in late lumen loss (LLL) and major adverse cardiovascular events (MACE) at 9 month follow-up.[66]
Several randomized controlled trials (RCT) have demonstrated that DCB and DES result in superior patency and decreased target lesion failure, when compared to standard, non-DCB and bare-metal stents (BMS) for the treatment of femoropopliteal artery disease.[69,70,71,72]
Summary
Percutaneous plain old balloon angioplasty (POBA) revolutionized coronary revascularization. The acknowledgement of the limitations of POBA, including vessel dissection, elastic recoil, constrictive remodeling, and intimal hyperplasia, led to the development of coronary stents. Bare-metal stents (BMS) successfully addressed the acute complications of vessel dissection, as well as the problems of elastic recoil and constrictive remodeling, they did not impact on intimal hyperplasia and led to the creation of a new clinical problem – in-stent restenosis (ISR). The drug-eluting stents (DES) have dramatically improved the clinical outcomes of patients undergoing percutaneous coronary intervention (PCI) by reducing the risk of ISR and repeat revascularization. Late stent thrombosis and recurrent restenosis, with a risk of nearly 2% per year after implantation,
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