Drug-coated balloon catheters. Discussing mortality from the coronary perspective

Abstract

INTRODUCTION The history of coronary balloon angioplasty began in 1997 with the first percutaneous transluminal coronary angioplasty (PTCA) ever performed by Andreas Grüntzig.1 Some of the limitations of this technology were solved with the introduction of stents.2 Added to an improved pharmacological concomitant therapy in the form of dual platelet inhibition,3 the local drug delivery initially through stents (drug-eluting stents, DES)4 and then balloons (drug-coated balloons, DCB)5 improved long-term outcomes significantly. The history of coronary angioplasty was summarized in detail in various articles on the 40th anniversary of this technology.6,7 The local application of paclitaxel through DCB had begun to revolutionize the treatment of peripheral arterial disease (PAD).8 This advance was very helpful for patients regarding primary patency and quality of life, but received a severe setback in a meta-analysis that claimed that the use of paclitaxel DES and DCB was associated with a higher mortality rate at the 2- and 5-year follow-up.9 The objective of this editorial is to discuss the safety profile of drug-coated devices in the historical context of the 2006 “European Society of Cardiology (ESC) firestorm” on coronary DES, data available on the coronary use of paclitaxel coated devices, and the potential role of limus-based agents in DCB.