Drug-coated balloon treatment in coronary artery disease: Recommendations from an Asia-Pacific Consensus Group

Abstract

Coronary artery disease (CAD) is currently the leading cause of death globally, and the prevalence of this disease is growing more rapidly in the Asia-Pacific region than in Western countries. Although the use of metal coronary stents has rapidly increased thanks to the advancement of safety and efficacy of newer generation drug eluting stent (DES), patients are still negatively affected by some the inherent limitations of this type of treatment, such as stent thrombosis or restenosis, including neoatherosclerosis, and the obligatory use of dual antiplatelet therapy (DAPT) with unknown optimal duration. Drug-coated balloon (DCB) treatment is based on a leave-nothing-behind concept and therefore it is not limited by stent thrombosis and long-term DAPT; it directly delivers an anti-proliferative drug which is coated on a balloon after improving coronary blood flow. At present, DCB treatment is recommended as the first-line treatment option in metal stent-related restenosis linked to DES and bare metal stent. For de novo coronary lesions, the application of DCB treatment is extended further, for conditions such as small vessel disease, bifurcation lesions, and chronic total occlusion lesions, and others. Recently, several reports have suggested that fractional flow reserve guided DCB application was safe for larger coronary artery lesions and showed good long-term outcomes. Therefore, the aim of these recommendations of the consensus group was to provide adequate guidelines for patients with CAD based on objective evidence, and to extend the application of DCB to a wider variety of coronary diseases and guide their most effective and correct use in actual clinical practice.

Keywords: Asia-Pacific; coronary artery disease; de novo lesion; drug-coated balloon; in-stent restenosis.

Conflict of interest statement

Conflict of interest: None declared

Figures

Figure 1

Treatment recommendations for in-stent restenosis. This flow chart shows the recommendations of drug-coated balloon (DCB) treatment for instent restenosis. If a non-compliant or scoring balloon or cutting balloon does not pass into the lesion, balloon angioplasty with a smaller sized semi-compliant balloon can be applied; DES — drug eluting stent.

Figure 2

Treatment recommendations for de novo lesions. This flow chart shows the recommendations of drug-coated balloon (DCB) treatment for de novo lesion. If a non-compliant or scoring balloon or cutting balloon does not pass into the lesion, balloon angioplasty with a smaller sized semi-compliant balloon can be applied; DES — drug eluting stent.