Drug‐Coated Balloon in Acute Coronary Syndromes: Ready for the Prime Time?
The use of drug-coated balloons (DCBs) in the management of acute coronary syndromes (ACS) is a topic of growing interest. This technology has the potential to directly deliver therapy to vulnerable plaques, without the need for permanent metallic implants, and could potentially improve long-term medical treatment for patients with ACS. Despite limited evidence, DCB is being explored in various patient subgroups. This paper provides a comprehensive analysis of the existing evidence on the use of DCB in ACS management. Overall, it concludes that DCB is a highly attractive option in this context, offering a targeted anti-atherogenic treatment that can effectively address a wide range of vulnerable plaques and patients.
Long-Term benefits of drug-coated balloons for coronary artery revascularization
Several studies have also shown that DES is associated with a higher risk of target vessel revascularization compared to CABG after long-term follow-up. However, drug-coated balloons (DCB) have been shown to provide significant clinical benefits in the treatment of in-stent restenosis, diffuse coronary artery disease, and small coronary artery lesions. Therefore, this review aimed to highlight the limitations of DES and showcase the potential advantages of using PCI with DCB for long-term outcomes, potentially demonstrating its non-inferiority to CABG.
A 2024 scientific update on the clinical performance of drug-coated balloons
The development of drug-coated balloons (DCB) has been a significant advancement in the field of interventional cardiology. These devices have been proven to be effective in treating in-stent restenosis and there is growing evidence that they can also be used in other scenarios, such as de novo small and large vessel disease, complex bifurcations, and diffuse coronary disease. As the field continues to advance, there have been significant improvements in the design and efficacy of DCBs, making them a promising option for the future of angioplasty. This paper provided a comprehensive review of the current data and advancements in the use of DCB, including mid- and long-term follow-up reports on their effectiveness.
Long-term impact of intravascular ultrasound-guidance for percutaneous coronary intervention on unprotected left main. The IMPACTUS-LM, an observational, multicentric study
The use of IVUS-guided percutaneous Coronary Intervention (PCI) in patients with unprotected left main (ULM) disease has shown promising results in reducing the risk of major adverse events. This was concluded in the IMPACTUS LM-PCI study, which enrolled 627 patients with ULM disease and compared the outcomes of IVUS-guided PCI versus angioguided PCI. The study, conducted in 13 European high-volume centers from 2002 to 2015, highlighted the potential long-term benefits of using IVUS in ULM PCI procedures.
Sirolimus-coated balloon in all-comer population of coronary artery disease patients: the EASTBOURNE DIABETES prospective registry
The use of drug-coated balloons in diabetic patients undergoing percutaneous coronary intervention (PCI) has been a topic of debate due to suboptimal outcomes. A subgroup analysis of the EASTBOURNE registry showed that the use of a sirolimus-coated balloon (SCB) did not significantly increase the need for target lesion revascularization (TLR) in diabetic patients compared to non-diabetic patients. This suggests that the use of drug-coated balloons may be a viable option for diabetic patients undergoing PCI.
Drug-coated balloons on the “big stage”: is this technology ready for an all-comer population with de novo lesions?
Despite the benefits of using drug-coated balloons (DCB) for treating coronary artery disease, there are still concerns about leaving behind a residual coronary dissection, particularly in de novo lesions. However, it has been shown that a nonflow-limiting dissection after DCB treatment tends to heal during the first few months, with both the paclitaxel and sirolimus technologies, without leading to acute or subacute vessel closure. Additionally, there is evidence that proper lesion preparation is crucial for the success of DCB, with a fully expanded balloon of the correct size and accurate management of calcifications and residual stenosis being necessary for effective drug delivery. Therefore, while DCB can be a valuable alternative to traditional percutaneous coronary intervention, they should only be used as a final step and in conjunction with proper lesion preparation.