Drug-eluting balloon: new tool in the box

Abstract

Percutaneous coronary intervention has revolutionized coronary revascularization therapy. It is increasingly becoming an attractive alternative to medical therapy and surgical revascularization in the treatment of coronary artery disease. Restenosis is a major challenge, and has been described as the Achilles heel of the procedure. It is a serious occurrence that can lead not only to recurrent angina and repeat revascularization, but also to acute coronary syndromes. Newer devices and strategies are being continuously sought to try and overcome these hurdles. Drug-eluting balloon technology is one such device that can potentially provide the solutions to these problems. This review focuses on the limitations associated with the use of drug-eluting stents in treating in-stent restenosis, and the concept and the available evidence for the use of drug-eluting balloons, particularly the paclitaxel-eluting balloons, in coronary and peripheral revascularization.

Drug-eluting stents and balloons in peripheral arterial disease: evidence so far

“…In a review of 5783 reports identified for the drug-eluting stents in the United States Food and Drug Administration database, Nebeker et al found 262 unique events with hypersensitivity symptoms, of which one (0.02%) was certainly and nine (0.15%) probably caused by the drug-eluting stents (24). We also do not know whether drug-eluting devices may cause long-term 'adverse positive remodelling', which may lead to arterial ectasia or aneurysm formation (25,26). The cost-effectiveness of drug-eluting balloons are also under intense scrutiny, as they are designed for single-inflation only, and some calcified, long, or locally dissected lesions may require multiple inflations requiring multiple drug-eluting balloons, thus amounting to the increased cost of the procedure (27).…”

Revascularization of Tibial and Foot Arteries: Below the Knee Angioplasty for Limb Salvage

“…The other possible solution to fight re-stenosis in the BTK district could be Drug eluting balloons. This new technology, Paclitaxel-coated balloons should be a potential role in the peripheral district (Manzi M, et al 2010;Sharma S, et al 2010;Waksman P, et al 2009) to avoid re-stenosis due to the antiproliferative effect. The use of DEB is not technically complex and there are, actually, a wide range of different devices.…”

Selected issues regarding coronary stents

“…Balony uwalniające lek antymitotyczny (drug eluting balloon, DEB) to potencjalna alternatywa dla stentów uwalniających lek antymitotyczny lub uzupełnienie dla BMS [18]. Obecnie dostępne na rynku DEB (uwalniające paklitaksel) to DIOR, Elutax, SeQuent™ i IN.PACT™ Falcon.…”