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Review
. 2025 May 21;14(10):3608.
doi: 10.3390/jcm14103608.

Drug-Coated Balloons in All-Comer Population-Are We There Yet?

Florin-Leontin Lazar  1   2 , Horea Laurentiu Onea  1   2 , Calin Homorodean  1   3 , Ioan Cornel Bitea  2 , Diana Raluca Lazar  4 , Mihai Claudiu Ober  3 , Dan Tataru  1   3 , Maria Olinic  1   3 , Mihail Spinu  1   3 , Teodor Paul Kacso  3 , Dan-Mircea Olinic  1   3
Affiliations
Review

Drug-Coated Balloons in All-Comer Population-Are We There Yet?

Florin-Leontin Lazar et al. J Clin Med. .

Abstract

With the advancement of interventional coronary procedures, drug-coated balloons have become an increasingly common alternative to drug-eluting stents in the treatment of various lesions. This paradigm shift stems from several advantages that DCBs entail, including a reduction in stent length burden, the possibility of late vessel positive remodeling, and the preservation of bifurcation anatomy. Conversely, several studies compared the efficacy of DCB treatment to stents or POBA in various scenarios. In this review, we will discuss the areas in which a DCB can be of paramount importance. We will begin by examining the role of DCBs in in-stent restenosis, for which the current practice guidelines do not clearly state the role of this technology, as opposed to the previous ones, in which it was mentioned as a first-line armamentarium. We will then discuss the indications and advantages of using DCBs in de novo lesions, concerning both small and large vessels, with growing emphasis on diffuse lesions. Lastly, we will address the current data on the use of DCBs in special scenarios such as the treatment of chronic total occlusion and left main and bifurcation lesions, without forgetting the primordial role of drug-eluting stents in all these lesions.

Keywords: coronary artery disease; drug-coated balloon; drug-eluting stent; percutaneous coronary interventions.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Performance of drug-coated balloons in different complex settings.
Figure 2
Figure 2
DCB role in small vessel disease. (A) Diagnostic angiography revealing 70% stenosis in a 2.5 mm diagonal (white arrow). (B) Paclitaxel-coated balloon well expanded in the lesion (after proper lesion preparation). (C) Final good angiographic result.
Figure 3
Figure 3
DCB role in large coronary arteries. (A) Diagnostic angiography revealing an ostial lesion of a 3.2 mm diagonal (white arrow). (B) Predilatation using a scoring balloon of 3.0 mm. (C) DCB inflation in the diagonal branch. (D) Good final angiographic result.
Figure 4
Figure 4
DCB in CTO lesions. (A) Diagnosis: CTO of RCA. (B) Lesion preparation. (C) Result after predilatation (D) DCB treatment of the CTO segment. (E) Result after DCB. Notice residual ostial stenosis. (F) Result after ostial stenting.
Figure 5
Figure 5
One-year follow-up of RCA CTO treated by a hybrid approach, showing important LLL in the DCB-treated segment.
Figure 6
Figure 6
Ostial LAD stenosis treated by an LM-LAD DCB approach. (A) Angiographic aspect of a severe ostial LAD stenosis. (B) The aspect of the vessel after predilatation. (C) Final angiographic result.
See this image and copyright information in PMC

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