J Cardiovasc Interv.  2024 Oct;3(4):190-198. 10.54912/jci.2024.0019.

Drug-Coated Balloon-Based Percutaneous Coronary Intervention in De Novo Coronary Artery Disease and Tips for Procedural Success

• Kim S
• Kang DO
• Her AY
• Song WH
• Shin ES

• KMID: 2561218
• DOI: http://doi.org/10.54912/jci.2024.0019

Abstract

Drug-coated balloon (DCB)-based percutaneous coronary intervention (PCI) is an emerging therapeutic approach that has the potential to be a viable alternative to drug-eluting stent (DES)-based PCI in treating de novo coronary artery disease (CAD). DCB-based PCI refers to performing lesion pre-dilation with the intent to use DCB as the default strategy and selecting the final device, either DCB or stents, based on the lesion preparation results. DCBbased PCI requires modified procedural steps compared to conventional DES implantation due to the potential absence of mechanical scaffolds. Achieving successful DCB-based PCI hinges on meticulous lesion preparation, facilitated by various technical strategies. Unlike DES, DCB-based PCI requires meeting stricter criteria, such as a diameter stenosis of 30% or less and the absence of flow-limiting dissections. Aggressive pre-dilation with a balloon-toartery ratio of up to 1:1 is recommended, often using specialty balloons, particularly scoring balloons. Post-preparation assessment is crucial, requiring optimal angiographic results, ideally guided by functional assessment like fractional flow reserve. If lesion preparation is satisfactory, DCB treatment can proceed; otherwise, provisional switching to vascular scaffolding with a DES or other scaffolds is advised to prevent bailout conditions. Managing coronary dissections is crucial, with repeat angiography used to identify complications. Lowpressure ballooning often resolves flow-limiting dissections. Future studies are needed to standardize DCB-based PCI procedures across diverse CAD patient populations, supported by robust clinical evidence. This review will explore the concept and technical aspects of DCB-based PCI compared to conventional DES PCI, focusing on optimal lesion preparation strategies and providing expert guidance for the safe and effective use of DCBs in treating de novo CAD.

Keyword

Angioplasty, balloon, coronary; Coronary artery disease; Drug-eluting stents; Percutaneous coronary intervention