Role of drug-coated balloon in the management of very late stent thrombosis

Abstract

To the Editor, Very late stent thrombosis—the one occurring, at least, 1 year after stenting—is a rare complication of tremendous clinical relevance. The mechanisms underlying its physiopathology have been widely studied thanks to the use of intracoronary imaging modalities, especially optical coherence tomography. The 2 main mechanisms of action found are, in the first place, neoatherosclerosis, and secondly, no strut endothelization.1 Despite of this, its approach is still under discussion and focused on resolution or minimization of the factors leading to its appearance. On the other hand, drug-coated balloon (DCB) has been part of the therapeutic armamentarium of interventional cardiologists for quite some time. Currently, its main indications are to treat in-stent restenosis, and small vessel de novo coronary artery lesions. New indications are emerging like bifurcations (especially of the side branch) and large vessel de novo lesions. However, there is a clinical setting where its use has instilled quite a few serious doubts: ST-segment elevation acute coronary syndrome (STEACS). Since plaque rupture followed by thrombosis is its main pathogenic mechanism and it’s different from the therapeutic target of DCB—the inhibition of neointimal proliferation—the use of DCB to treat STEACS is ill-advised. Former studies on this matter have proven so.2 However, isolated,...