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Drug-Coated Balloons: Hope or Hot Air: Update on the Role of Coronary DCB

  • Interventional Cardiology (SR Bailey, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The present manuscript reviews the mechanism of action of drug-coated balloons (DCBs), offering a brief summary of the main clinical evidence on these devices.

Recent Findings

DCBs are regular semi-compliant balloons coated with antiproliferative agents that are rapidly released on contact with the vessel intima, exerting an anti-restenotic effect. This technology may offer some benefits of drug-eluting stents, in particular for the treatment of restenotic lesions, small vessels, and in patients at high-bleeding risk, when the prolonged dual antiplatelet regimen should be avoided. Most recent data have pointed to a possible benefit of these devices in treating bare metal stents (BMS) or drug-eluting stents in-stent restenosis (DES ISR), effectively reducing the recurrence of restenosis and avoiding additional layers of metal in the same coronary segment. In other clinical scenarios such as bifurcations, small vessels, and de novo lesions, data is more scarce and the benefits are still unclear.

Summary

There are potential benefits related to the use of DCB in selected populations. However, larger clinical trials with longer follow-up are still needed to confirm the enthusiastic initial results.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Axel DI, Kunert W, Goggelmann C, Oberhoff M, Herdeg C, Kuttner A, et al. Paclitaxel inhibits arterial smooth muscle cell proliferation and migration in vitro and in vivo using local drug delivery. Circulation. 1997;96(2):636–45.

    Article  CAS  PubMed  Google Scholar 

  2. Bondesson P, Lagerqvist B, James SK, Olivecrona GK, Venetsanos D, Harnek J. Comparison of two drug-eluting balloons: a report from the SCAAR registry. EuroIntervention. 2012;8(4):444–9.

    Article  PubMed  Google Scholar 

  3. Joner M, Byrne RA, Lapointe JM, Radke PW, Bayer G, Steigerwald K, et al. Comparative assessment of drug-eluting balloons in an advanced porcine model of coronary restenosis. Thromb Haemost. 2011;105(5):864–72.

    Article  CAS  PubMed  Google Scholar 

  4. Radke PW, Joner M, Joost A, Byrne RA, Hartwig S, Bayer G, et al. Vascular effects of paclitaxel following drug-eluting balloon angioplasty in a porcine coronary model: the importance of excipients. Euro Interv. 2011;7(6):730–7.

    Google Scholar 

  5. Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, et al. 2014 ESC/EACTS guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2014;35(37):2541–619.

    Article  PubMed  Google Scholar 

  6. Scheller B, Hehrlein C, Bocksch W, Rutsch W, Haghi D, Dietz U, et al. Treatment of coronary in-stent restenosis with a paclitaxel-coated balloon catheter. N Engl J Med. 2006;355(20):2113–24.

    Article  CAS  PubMed  Google Scholar 

  7. Scheller B, Hehrlein C, Bocksch W, Rutsch W, Haghi D, Dietz U, et al. Two year follow-up after treatment of coronary in-stent restenosis with a paclitaxel-coated balloon catheter. Clin Res Cardiol. 2008;97(10):773–81.

    Article  PubMed  Google Scholar 

  8. Scheller B, Clever YP, Kelsch B, Hehrlein C, Bocksch W, Rutsch W, et al. Long-term follow-up after treatment of coronary in-stent restenosis with a paclitaxel-coated balloon catheter. JACC Cardiovasc Interv. 2012;5(3):323–30.

    Article  PubMed  Google Scholar 

  9. Unverdorben M, Vallbracht C, Cremers B, Heuer H, Hengstenberg C, Maikowski C, et al. Paclitaxel-coated balloon catheter versus paclitaxel-coated stent for the treatment of coronary in-stent restenosis. Circulation. 2009;119(23):2986–94.

    Article  CAS  PubMed  Google Scholar 

  10. • Unverdorben M, Vallbracht C, Cremers B, Heuer H, Hengstenberg C, Maikowski C, et al. Paclitaxel-coated balloon catheter versus paclitaxel-coated stent for the treatment of coronary in-stent restenosis: the three-year results of the PEPCAD II ISR study. EuroIntervention. 2015;11(8):926–34. This article demonstrates stability of lesions treated with paclitaxel-DCB throughout 3 years, in comparison to paclitaxel-DES, regarding treatment of BMS ISR.

    Article  PubMed  Google Scholar 

  11. Adriaenssens T, Dens J, Ughi G, Bennett J, Dubois C, Sinnaeve P, et al. Optical coherence tomography study of healing characteristics of paclitaxel-eluting balloons vs. everolimus-eluting stents for in-stent restenosis: the SEDUCE (Safety and Efficacy of a Drug elUting balloon in Coronary artery rEstenosis) randomised clinical trial. Euro Interv. 2014;10(4):439–48.

    Google Scholar 

  12. Alfonso F, Perez-Vizcayno MJ, Cardenas A, Garcia Del Blanco B, Seidelberger B, Iniguez A, et al. A randomized comparison of drug-eluting balloon versus everolimus-eluting stent in patients with bare-metal stent-in-stent restenosis: the RIBS V clinical trial (restenosis intra-stent of bare metal stents: paclitaxel-eluting balloon vs. everolimus-eluting stent). J Am Coll Cardiol. 2014;63(14):1378–86.

    Article  CAS  PubMed  Google Scholar 

  13. • Pleva L, Kukla P, Kusnierova P, Zapletalova J, Hlinomaz O. Comparison of the efficacy of paclitaxel-eluting balloon catheters and everolimus-eluting stents in the treatment of coronary in-stent restenosis: the treatment of in-stent restenosis study. Circ Cardiovasc Interv. 2016;9(4):e003316. This article reports significantly less 12-month LLL paclitaxel-DCB treatment throughout 3 years, in comparison to second-generation DES, regarding BMS ISR.

    Article  CAS  PubMed  Google Scholar 

  14. Byrne RA, Neumann FJ, Mehilli J, Pinieck S, Wolff B, Tiroch K, et al. Paclitaxel-eluting balloons, paclitaxel-eluting stents, and balloon angioplasty in patients with restenosis after implantation of a drug-eluting stent (ISAR-DESIRE 3): a randomised, open-label trial. Lancet. 2013;381(9865):461–7.

    Article  CAS  PubMed  Google Scholar 

  15. Cai JZ, Zhu YX, Wang XY, Bourantas CV, Iqbal J, Zhu H, et al. Comparison of new-generation drug-eluting stents versus drug-coated balloon for in-stent restenosis: a meta-analysis of randomised controlled trials. BMJ Open. 2018;8(2):e017231.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Puymirat E, Barbato E. Percutaneous revascularization strategies in small-vessel disease. Ann Cardiol Angeiol (Paris). 2014;63(1):28–31.

    Article  CAS  Google Scholar 

  17. Caputo R, Leon M, Serruys P, Neumann FJ, Yeung A, Windecker S, et al. Performance of the resolute zotarolimus-eluting stent in small vessels. Catheter Cardiovasc Interv. 2014;84(1):17–23.

    Article  PubMed  Google Scholar 

  18. Unverdorben M, Kleber FX, Heuer H, Figulla HR, Vallbracht C, Leschke M, et al. Treatment of small coronary arteries with a paclitaxel-coated balloon catheter in the PEPCAD I study: are lesions clinically stable from 12 to 36 months? Euro Interv. 2013;9(5):620–8.

    Google Scholar 

  19. Cortese B, Micheli A, Picchi A, Coppolaro A, Bandinelli L, Severi S, et al. Paclitaxel-coated balloon versus drug-eluting stent during PCI of small coronary vessels, a prospective randomised clinical trial. The PICCOLETO study. Heart. 2010;96(16):1291–6.

    Article  PubMed  Google Scholar 

  20. Latib A, Colombo A, Castriota F, Micari A, Cremonesi A, De Felice F, et al. A randomized multicenter study comparing a paclitaxel drug-eluting balloon with a paclitaxel-eluting stent in small coronary vessels: the BELLO (Balloon Elution and Late Loss Optimization) study. J Am Coll Cardiol. 2012;60(24):2473–80.

    Article  CAS  PubMed  Google Scholar 

  21. • Latib A, Ruparelia N, Menozzi A, Castriota F, Micari A, Cremonesi A, et al. 3-year follow-up of the Balloon Elution and Late Loss Optimization study (BELLO). JACC Cardiovasc Interv, 2015. 8(8):1132–4. This article reports lower MACE rates at 3 years with paclitaxel-DCB use in comparison with paclitaxel DES use, treating BMS ISR in small coronary vessels.

    PubMed  Google Scholar 

  22. Lassen JF, Holm NR, Banning A, Burzotta F, Lefevre T, Chieffo A, et al. Percutaneous coronary intervention for coronary bifurcation disease: 11th consensus document from the European Bifurcation Club. Euro Interv. 2016;12(1):38–46.

    Google Scholar 

  23. Lee JM, Park KW, Koo BK, Kim HS. Stenting of coronary bifurcation lesions: a literature and technical review. Curr Cardiol Rep. 2015;17(6):45.

    Article  PubMed  Google Scholar 

  24. Berland J, Lefevre T, Brenot P, Fajadet J, Motreff P, Guerin P, et al. DANUBIO - a new drug-eluting balloon for the treatment of side branches in bifurcation lesions: six-month angiographic follow-up results of the DEBSIDE trial. Euro Interv. 2015;11(8):868–76.

    Google Scholar 

  25. Jim MH, Lee MK, Fung RC, Chan AK, Chan KT, Yiu KH. Six month angiographic result of supplementary paclitaxel-eluting balloon deployment to treat side branch ostium narrowing (SARPEDON). Int J Cardiol. 2015;187:594–7.

    Article  PubMed  Google Scholar 

  26. Worthley S, Hendriks R, Worthley M, Whelan A, Walters DL, Whitbourn R, et al. Paclitaxel-eluting balloon and everolimus-eluting stent for provisional stenting of coronary bifurcations: 12-month results of the multicenter BIOLUX-I study. Cardiovasc Revasc Med. 2015;16(7):413–7.

    Article  PubMed  Google Scholar 

  27. Kleber FX, Mathey DG, Rittger H, Scheller B. How to use the drug-eluting balloon: recommendations by the German consensus group. EuroIntervention. 2011;7(Suppl K):K125–8.

    Article  PubMed  Google Scholar 

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Funding

J. Ribamar Costa Jr. reports a research grant paid to the hospital to conduct trials related to some of the devices.

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Authors and Affiliations

  1. Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, Av. Dr. Dante Pazzanese, 500 - Vila Mariana, São Paulo, SP, 04012-180, Brazil

    Rafael A. Meneguz-Moreno, J. Ribamar Costa Jr & Alexandre Abizaid

  2. Department of Medicine, Universidade Federal de Sergipe, Aracaju, Sergipe, Brazil

    Rafael A. Meneguz-Moreno

  3. Hospital Sírio Libanês, São Paulo, Brazil

    Alexandre Abizaid

Authors
  1. Rafael A. Meneguz-Moreno
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  2. J. Ribamar Costa Jr
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  3. Alexandre Abizaid
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Correspondence to Alexandre Abizaid.

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Conflict of Interest

Rafael A. Meneguz-Moreno, J. Ribamar Costa Jr., and Alexandre Abizaid declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Interventional Cardiology

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Meneguz-Moreno, R.A., Ribamar Costa, J. & Abizaid, A. Drug-Coated Balloons: Hope or Hot Air: Update on the Role of Coronary DCB. Curr Cardiol Rep 20, 100 (2018). https://doi.org/10.1007/s11886-018-1025-4

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  • DOI: https://doi.org/10.1007/s11886-018-1025-4

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