Drug eluting balloons: should we use them more?

Take Home Messages
  • Drug-eluting balloons (DEB) are safe and efficient in treating in-stent restenosis and small de-novo coronary artery lesions leaving no metal inside the coronary artery.
  • DEB is a good option for high bleeding risk patients who need shortened duration of DAPT compared with drug-eluting stents.
  • Lesion preparation is pivotal to achieving the best results from DEB angioplasty.
  • DEB use is easy and similar to any other balloon in delivery and inflation (typically 30-60s).

Balloon angioplasty was first used to recanalise arteries in 1977 but its use was associated with significant complications like abrupt vessel closure, subintimal dissection and restenosis (1-4). To tackle these issues, bare metal stents (BMS) and drug-eluting stents (DES) were introduced in 1986 and 1999 (4). However, their use can cause delayed healing, local inflammation, and endothelial dysfunction resulting in-stent thrombosis as well as in-stent restenosis (ISR) (5,6). Furthermore, there are some limitations for stent use in small or tortuous vessels and diffuse calcific lesions due to difficulties in stent delivery. Also, stent struts can obstruct large side branches or bifurcation lesions (7). The drug-eluting balloon (DEB) or drug-coated balloon (DCB) was introduced in 2004 to overcome some of these limitations (8).