Drug-Coated Balloon (DCB) Angioplasty in Large Coronary Vessels: A Future Game Changer?


Take Home Messages
  • DCB results are comparable to drug-eluting stents (DES) in most efficacy measures.
  • The philosophy of “leaving nothing behind” is tempting for specific lesions (e.g. diffuse disease, side branches, small arteries) and clinical circumstances (e.g. diabetes, multivessel disease, acute coronary syndromes, high bleeding risk individuals).
  • Future well-designed clinical trials with strict inclusion criteria are needed.

Since their introduction in 2004, drug-coated balloons (DCBs) have emerged as a novel technology for improving percutaneous  coronary intervention (PCI) outcomes by mitigating revascularisation, in-stent restenosis, and associated major adverse cardiac events (MACE) (1). DCBs function by locally delivering antiproliferative drugs to the vessel wall during balloon inflation via semi-compliant balloon. An excipient on the DCB aids in retaining the drug on the balloon during transit, enhancing the drug's adherence to the vessel wall, and improves the deposition of the drug in the tissue. Paclitaxel and sirolimus are commonly used drugs that prevent smooth muscle proliferation, minimize endothelial dysfunction and neoatherosclerosis. Their lipophilic nature facilitates quick absorption by cells and homogenous distribution, resulting in a sustained impact on smooth muscle cells.