Current state of knowledge on the use of drug-coated balloon in coronary bifurcation lesions

Abstract

The use of drug-coated balloons (DCB) to treat stenotic coronary artery lesions is a treatment strategy whose main asset is to avoid leaving a permanent intracoronary stent device. Although highly effective in the percutaneous coronary intervention setting, it is associated with a risk of acute thrombosis, future events like restenosis, and late thrombosis following processes known as neointimal proliferation, neoatherosclerosis or fractures of material. This could be even more relevant in younger patients with a long trajectory of possible coronary events ahead of them. The use of DCB is widely accepted to treat in-stent restenosis and de novo lesions in small vessels1, and it is considered an interesting option in patients with high risk of bleeding. Another possible indication currently under scrutiny due to its possible potential is the management of bifurcations—one of the most interesting indications of all. However, clearly defined recommendations have not been established yet.2 Over the last few years, small clinical trials have been published on the use of DCB in this indication; although they have not proven definitive for a strong guideline recommendation, they provide valuable data. In general, trials have grouped into those looking into the safety and efficacy profile of DCB—without comparison group—and trials that...