Advances of drug-coated balloon in percutaneous coronary intervention

Percutaneous coronary intervention is a novel therapy aiming to expand the narrow coronary arteries, relieving stenosis and improving myocardial blood supply with the usage of various techniques. Interventional materials evolve from bare metal stents to drug-eluting stents and, more recently, drug-coated balloons. Though metal stents largely solve the problem of coronary artery stenosis, long-term anti-platelet therapy and stent restenosis remain troubling. The drug coated balloon (DCB) platform offers several theoretical benefits over stent-based technologies. It has emerged as an additional tool in the arsenal of interventional cardiology devices. It allows the homogenous transfer of an anti-proliferative drug to reduce neo-intimal hyperplasia whilst potentially maintaining normal vessel anatomy and function, leaving no implant behind. The body of evidence supporting the role of DCB in the treatment of in-stent restenosis is more substantial and appears to yield similar results to DES without the introduction of an additional stent layer. Therefore, the concept of permanent implantation of stents can be better represented by the treatment of drug coated balloon. Meanwhile, DCB exerts beneficial effects in the treatment of some lesion subsets, including small vessel diseases, side branch bifurcations, chronic total occlusions and diffuse lesions. This review focuses on the rationale for DCB usage, effectiveness of DCBs in different clinical and lesion settings, and provides practical tips for their correct use in everyday clinical practice.