Drug-coated balloon treatment in coronary artery disease: Recommendations from an Asia-Pacific Consensus Group

Coronary artery disease (CAD) is currently the leading cause of death globally, and the prevalence of thisdisease is growing more rapidly in the Asia-Pacific region than in Western countries. Although the useof metal coronary stents has rapidly increased thanks to the advancement of safety and efficacy of newergeneration drug eluting stent (DES), patients are still negatively affected by some the inherent limitationsof this type of treatment, such as stent thrombosis or restenosis, including neoatherosclerosis, andthe obligatory use of dual antiplatelet therapy (DAPT) with unknown optimal duration.Drug-coated balloon (DCB) treatment is based on a leave-nothing-behind concept and therefore it is notlimited by stent thrombosis and long-term DAPT; it directly delivers an anti-proliferative drug whichis coated on a balloon after improving coronary blood flow. At present, DCB treatment is recommendedas the first-line treatment option in metal stent-related restenosis linked to DES and bare metal stent.For de novo coronary lesions, the application of DCB treatment is extended further, for conditions suchas small vessel disease, bifurcation lesions, and chronic total occlusion lesions, and others. Recently,several reports have suggested that fractional flow reserve guided DCB application was safe for largercoronary artery lesions and showed good long-term outcomes. Therefore, the aim of these recommendationsof the consensus group was to provide adequate guidelines for patients with CAD based on objectiveevidence, and to extend the application of DCB to a wider variety of coronary diseases and guide theirmost effective and correct use in actual clinical practice

Drug Coated Balloon-Only Strategy in De Novo Lesions of Large Coronary Vessels

Objectives. We analyzed the efficacy of drug coated balloons (DCB) as a stand-alone-therapy in de novo lesions of large coronary arteries. DCBs seem to be an attractive alternative for the stent-free interventional treatment of de novo coronary artery disease (CAD). However, data regarding a DCB-only approach in de novo CAD are currently limited to vessels of small caliber. Methods. By means of propensity score (PS) matching 234 individuals with de novo CAD were identified with similar demographic characteristics. This patient population was stratified in a 1:1 fashion according to a reference vessel diameter cut-off of 2.75 mm in small and large vessel disease. The primary endpoint was the rate of clinically driven target lesion revascularization (TLR) at 9 months. Results. Patients with small vessel disease had an average reference diameter of 2.45 ± 0.23 mm, while the large vessel group averaged 3.16 ± 0.27 mm. Regarding 9-month major adverse cardiac event (MACE), 5.7% of the patients with small and 6.1% of the patients with large vessels had MACE (p=0.903). Analysis of the individual MACE components revealed a TLR rate of 3.8% in small and 1.0% in large vessels (p=0.200). Of note, no thrombotic events in the DCB treated coronary segments occurred in either group during the 9-month follow-up. Conclusions. Our data demonstrate for the first time that DCB-only PCI of de novo lesions in large coronary arteries (>2.75 mm) is safe and as effective. Interventional treatment for CAD without permanent or temporary scaffolding, demonstrated a similar efficacy for large and small vessels