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Drug-Coated Balloon in Acute Coronary Syndromes: Ready for the Prime Time?

  • Interventional Cardiology (SR Bailey and T Helmy, Section Editors)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Acute coronary syndromes (ACS) are a major global health concern. Percutaneous coronary intervention (PCI) with new-generation drug-eluting stents (DES) has been endorsed as safe and effective in the management of culprit and non-culprit lesions of ACS. However, permanent metallic implants may have drawbacks, including the need for prolonged dual antiplatelet therapy (DAPT) and the risk of long-term stent-related complications. An alternative approach using drug-coated balloons (DCBs) is gaining growing interest, having the potential of delivering therapy directly to vulnerable plaques, avoiding the need for permanent metallic implants, and potentially allowing for better long-term medical treatment. Despite limited evidence, DCB is being explored in several patients’ subgroups. This review aims to discuss the existing evidence regarding DCB in ACS management.

Recent Findings

DCB appears to be a promising strategy in the management of ACS, showing comparable angiographic and clinical results as compared to new-generation DES in relatively small clinical trials or large prospective registries. The advantage of avoiding permanent implants is particularly appealing in this setting, where DCB has the potential of delivering anti-atherogenic local therapy directly to vulnerable plaques still amenable to atherogenic regression. This review seeks to underline the theoretical background of DCB use and reports the available evidence in its support in the specific setting of ACS.

Summary

In the context of ACS, the use of DCB is highly attractive, offering a dedicated anti-atherogenic local therapy, capable of addressing a broad range of vulnerable plaques and patients.

Graphical Abstract

A snapshot of the entire manuscript demonstrating DCB technology with potential benefits in ACS settings and particularly its role in vulnerable plaques with a scheme defining these vulnerable plaques and identifying the patient population who benefits the most from DCB approach treatment.

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Data Availability

No datasets were generated or analyzed during the current study.

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Author information

Author notes

  1. Simone Fezzi and Sara Malakouti equally contributed and are joint first author for this manuscript.

Authors and Affiliations

  1. Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy

    Simone Fezzi & Bernardo Cortese

  2. DCB Academy, Milan, Italy

    Sara Malakouti, Jegan Sivalingam, Jacinthe Khater & Bernardo Cortese

  3. Hannah Joseph Hospital, Madurai, India

    Jegan Sivalingam

  4. Faculty of Medical Sciences, Lebanese University Rafic Hariri University Campus, Hadath, Lebanon

    Jacinthe Khater

  5. University of Verona, Verona, Italy

    Simone Fezzi & Flavio Ribichini

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  1. Simone Fezzi
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  2. Sara Malakouti
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Contributions

S.F. and S.M. equally contributed and are joint first author for this manuscript.

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Correspondence to Bernardo Cortese.

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Dr. Cortese serves as advisor and consultant for several companies working in interventional cardiology. The other authors have no disclosures to report.

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Fezzi, S., Malakouti, S., Sivalingam, J. et al. Drug-Coated Balloon in Acute Coronary Syndromes: Ready for the Prime Time?. Curr Cardiol Rep (2024). https://doi.org/10.1007/s11886-024-02037-2

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