Updated PCR Textbook chapter on Drug-Coated Balloons (DCB)

The PCR Textbook

Summary

Drug-coated balloons (DCB) are gaining attraction worldwide for the treatment of peripheral and coronary lesions. The basic prerequisite for this therapy is the best possible lesion preparation. DCBs cannot replace drug-eluting stents, but will play an important role in the reduction of permanent implants in interventional vascular medicine in the future.

Introduction 

Andreas Grüntzig introduced coronary angioplasty into clinical use in 1977. For the field of coronary interventions, the introduction of stents represented a major milestone. Stenting overcomes the major limitations of balloon angioplasty, namely, acute recoil, dissections, abrupt vessel closure and longer-term negative vessel remodelling. However, restenosis may be accelerated due to continued or increased neointimal proliferation associated with the permanent implant. Local intravascular drug delivery by drug-eluting stents (DES) that elute paclitaxel, sirolimus, or their associated analogues have successfully addressed this cellular basis of restenosis in the coronary territory.

However, delayed or incomplete re-endothelialisation with the need for long-term dual antiplatelet therapy (DAPT) to reduce the risk of stent thrombosis can limit the use of this technology. Sustained drug release seems to be essential for stent-based local drug delivery because of the inhomogeneous drug distribution from a DES to the arterial wall , with the consequence of delayed and incomplete re-endothelialisation of the stent struts . Even with the latest generation of DES, device-associated annual event rates of 2 to 3 % are seen beyond the first year. The risk of long-term events increases with the number and length of DES. Therefore, new alternative concepts aim at local drug delivery without permanent scaffolding.

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