Drug eluting balloons for the treatment of in-stent restenosis

The problem of in-stent re-stenosis continues to be the principle factor limiting the durability of percutaneous arterial interventions. Pharmacologic solutions to the problem of neointimal hyperplasia have been used successfully in the coronary arteries in the form of drug-eluting stents. In the lower extremity, drug eluting stents are becoming more widely accepted and evidence now supports their efficacy in the periphery. As the technology evolves, the ability to deliver drug to an arterial segment without leaving behind metal scaffolding has become an appealing prospect. Based on studies in animal and human arteries, paclitaxel delivered to an artery via contrast medium or balloon surface provides enough drug concentration to impact the process of neo-intima formation. The favorable pharmacokinetics of drug elution via balloon allow the clinician to deliver effective concentrations of drug in reasonable inflation times without the need for stents. The results thus far are very encouraging in native as well as in-stent restenotic lesions. Studies ongoing in the coronary and peripheral literature should validate the role of drug-eluting balloons in arterial intervention.