Drug-Coated Balloon-Only Percutaneous Coronary Intervention for the Treatment of De Novo Coronary Artery Disease: A Systematic Review

Abstract

Percutaneous coronary intervention (PCI) with a drug coated balloon (DCB) is a novel treatment which seeks to acutely dilate a coronary stenosis and deliver an anti-proliferative drug to the vessel wall (reducing the risk of re-stenosis), without implanting a drug eluting stent (DES). In this study, we performed a systematic review of stentless DCB-only angioplasty in de novo coronary artery disease. We identified 41 studies examining the effects of DCB-only PCI in a variety of clinical scenarios including small vessels, bifurcations, calcified lesions, and primary PCI. DCB-only PCI appears to be associated with comparable clinical outcomes to DESs and superior angiographic outcomes to plain-old balloon angioplasty. Although current data are promising, there is still a need for further long-term randomized control trial data comparing a DCB-only approach specifically against a second- or third-generation DES. A 4-week period of dual antiplatelet therapy provides a real advantage for the DCB-only PCI approach, which is not possible with most DESs. Since rates of adverse clinical outcomes are very low for all PCI procedures attention should be turned to the development of robust endpoints with which to compare DCB-only PCI approaches to the standard treatment with a DES.Electronic supplementary materialThe online version of this article (10.1007/s40119-018-0121-2) contains supplementary material, which is available to authorized users.

Small vessel coronary artery disease: How small can we go with myocardial revascularization?

“…Drug-coated balloon therapy (otherwise known as drug-eluting balloon, DEB) has been proposed as an alternative to DES in SVD, obviating the need for implantation of a foreign body into a small artery [57]. The technique is based on rapid delivery of an antiproliferative drug to the arterial wall from a semi-compliant balloon covered with a lipophilic matrix [58]. Therapeutic agents, most commonly paclitaxel, are delivered during single balloon inflation, which should last between 30 and 60 seconds depending on the DCB type [58].…”

“…The technique is based on rapid delivery of an antiproliferative drug to the arterial wall from a semi-compliant balloon covered with a lipophilic matrix [58]. Therapeutic agents, most commonly paclitaxel, are delivered during single balloon inflation, which should last between 30 and 60 seconds depending on the DCB type [58]. A crucial step prior to deployment of DCB consists of adequate lesion preparation with a successful predilatation to avoid elastic recoil and flow-limiting dissections [59].…”

Drug-coated Balloons for Small Coronary Vessel Interventions: A Literature Review

“…However, most recent studies have identified an angiographic reference vessel <3 mm as the most appropriate cut-off. [19] Therefore, it can be stated that any coronary vessel amenable to percutaneous treatment with a 2.75 mm or smaller device should be considered ‘small’. [17] Some authors have suggested the term ‘very small vessel coronary artery disease’ for those coronary vessels that are amenable to percutaneous treatment with a 2 mm device.…”

Cardiovascular outcomes following percutaneous coronary intervention with drug-eluting balloons in chronic kidney disease: a retrospective analysis

“…DEBs mechanically open obstructed vessels by inflating; this releases a homogeneous high dose of anti-proliferative drug (such as paclitaxel). The resultant reduction in neointimal proliferation prevents restenosis of the obstructed vessel [2,5].…”