Drug-coated balloon therapy in coronary and peripheral artery disease

Nonstent-based local drug delivery with drug-coated balloons (DCBs) can achieve rapid transfer of a drug to surrounding tissue, and durable antirestenotic efficacyTheoretical advantages of DCBs over drug-eluting stents (DESs) include broad surface contact, homogenous drug distribution, absence of stent footprint or polymer residue, and restoration of normal vessel anatomy and functionPreclinical studies have shown that DCB delivery of paclitaxel combined with a hydrophilic spacer (excipient) results in clinically effective local tissue drug concentrations and sustained inhibition of neointimal growthAmong patients with coronary bare-metal or drug-eluting stent restenosis, DCBs show similar results to standard-of-care treatment (repeat stenting with a DES) and obviate the need for further stent implantsAmong patients with de novo coronary artery disease, convincing data from randomized trials to support DCB therapy is lacking, and the use of DCBs for this indication requires further investigationIn peripheral artery disease, DCB therapy has proven superior to balloon angioplasty for treatment of de novo femoropopliteal and below-the-knee disease