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

Abstract

Coronary artery disease (CAD) is currently the leading cause of death globally, and the prevalence of this
disease is growing more rapidly in the Asia-Pacific region than in Western countries. Although the use
of metal coronary stents has rapidly increased thanks to the advancement of safety and efficacy of newer
generation drug eluting stent (DES), patients are still negatively affected by some the inherent limitations
of this type of treatment, such as stent thrombosis or restenosis, including neoatherosclerosis, and
the 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 not
limited by stent thrombosis and long-term DAPT; it directly delivers an anti-proliferative drug which
is coated on a balloon after improving coronary blood flow. At present, DCB treatment is recommended
as 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 such
as 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 larger
coronary artery lesions and showed good long-term outcomes. Therefore, the aim of these recommendations
of the consensus group was to provide adequate guidelines for patients with CAD based on objective
evidence, and to extend the application of DCB to a wider variety of coronary diseases and guide their
most effective and correct use in actual clinical practice.