Korean Circ J.  2024 Sep;54(9):519-533. 10.4070/kcj.2024.0148.

Drug-Coated Balloon Treatment for De Novo Coronary Lesions: Current Status and Future Perspectives

• Her AY
• Shin ES

• KMID: 2559124
• DOI: http://doi.org/10.4070/kcj.2024.0148

Abstract

The outstanding development in contemporary medicine, highlighted by percutaneous coronary intervention (PCI), was achieved through the adoption of drug-eluting stents (DESs). Although DES is the established therapy for patients undergoing PCI for de novo coronary artery disease (CAD), their drawbacks include restenosis, stent thrombosis, and the requirement for dual antiplatelet therapy (DAPT) with an uncertain duration regarding its optimality. Drug-coated balloon (DCB) treatment leaves nothing behind on the vessel wall, providing the benefit of avoiding stent thrombosis and not necessitating obligatory extended DAPT. After optimizing coronary blood flow, DCB treatment delivers an antiproliferative drug directly coated on a balloon. Although more evidence is needed for the application of DCB treatment in de novo coronary lesions, recent studies suggest the safety and effectiveness of DCB treatment for diverse conditions including small and large vessel diseases, complex lesions like bifurcation lesions or diffuse or multivessel diseases, chronic total occlusion lesions, acute myocardial infarctions, patients at high risk of bleeding, and beyond. Consequently, we will review the current therapeutic choices for managing de novo CAD using DCB and assess the evidence supporting their concurrent application. Additionally, it aims to discuss future important perspectives.

Keyword

Percutaneous coronary intervention; Drug-eluting stent; De novo; Coronary artery disease; Drug-coated balloon

Figure

• 

  Figure 1 DCB treatment strategy for de novo CAD.CAD = coronary artery disease; DCB = drug-coated balloon; DES = drug-eluting stent; FFR = fractional flow reserve; PCI = percutaneous coronary intervention.

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  Figure 2 A representative case illustrating vascular remodeling based on the degree of dissection following drug-coated balloon treatment: (A) no dissection, (B) minimal dissection, (C) adequate dissection after balloon angioplasty (white arrows indicating dissection flaps).

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