Evidence on Treating Coronary Artery Disease with Drug-Coated Balloons

Percutaneous transluminal coronary angioplasty with drug-coated balloons (DCBs) is the modality of coronary artery revascularization with local application of antiproliferative agents, paclitaxel or sirolimus. It has become an appealing alternative to drug-eluting stents (DESs) due to intervention simplification, absence of permanent metallic mesh implantation, preserved vasomotion, and shorter duration of dual antiplatelet therapy because of reduced risk of acute thrombosis. Numerous studies have assessed DCB safety and efficacy for various aspects of coronary artery disease (CAD) for in-stent restenosis (ISR) and de novo CAD, while interventional cardiologists worldwide report good results with DCB in everyday practice. However, data is not robust enough to recommend DCB according to the European Society of Cardiology guidelines, except for the ISR of bare-metal stents (BMSs). At the same time, the United States Food and Drug Administration approved the DCB usage for ISR of both BMS and DES in March 2024. Further studies are underway to increase the body of evidence, and new technologies, including DCB with combined paclitaxel and sirolimus, are developing.