Drug-coated balloons

Summary

Drug coated balloons (DCB) represent a clinical treatment modality for non-stent based local drug delivery in coronary and peripheral artery disease. Their advantages over standard angioplasty and stent technologies include a homogeneous drug delivery to the vessel wall, an immediate drug release without the use of a polymer, the option of using balloon catheters alone or in combination with a stent, no foreign object left behind in the body, the potential of reducing antiplatelet therapy, and a lower restenosis rate in some indications. As with drug eluting stents (DES), one cannot assume a class effect for DCB. Data from randomised clinical trials identify the treatment of coronary in-stent restenosis (ISR; ESC recommendation 1A), of coronary de novo lesions in risk indications (e.g. small vessels and high bleeding risk), and of de novo and restenotic lesions in peripheral artery disease (new standard of care in the SFA) as viable options. Furthermore, treatment of de novo lesions in bifurcation lesions, long lesions, paediatric interventions, and cerebrovascular applications are potential beneficial indications. In the coronary application, a strategy of DCB-only (lesion preparation followed by DCB angioplasty alone or stenting in case of severe dissection) may become a better alternative in small vessel...