Drug-coated balloons come as latest technique in angioplasty

They can be used in some settings when stents may not be needed, says expert

Drug-coated balloons (DCB), when used in settings where stents may not be needed, will simplify the procedure, do away with the need for a foreign body in the artery and make medications post-procedure more simple, according to Antonio Colombo, Director of Cardiac Cath Lab and Interventional Cardiology, EMO Centro Cuore Columbus, Italy.

“DCB is not an innovation replacing stents. It can be used in some settings when stents may not be needed. We need studies, follow-ups and summaries in a couple of years,” Professor Colombo said at Kauvery Hospital where doctors performed a complex coronary angioplasty procedure using DCB on a 74-year-old man.

Tracing the evolution of angioplasty procedures, he said stents prevent re-narrowing of the arteries and restenosis. Then came drug-eluting stents that have special medication on the tip of the metal to prevent re-narrowing by decreasing hyperplasia and scar formation around the stent. It brought re-narrowing after stenting that was 30% down to 10% or even less,” he said.

But 10% is not zero, he observed. “When we implant a stent in a person with diabetes, the 10% becomes 20%. We solved the problem but not completely….In the last two to three years came a balloon that is able to deliver the same drug as the stent without the need for a stent. If the result of balloon dilatation is good, there is a possibility to deliver a healing drug without putting a foreign body in,” he explained.

DCB releases a drug (Sirolimus) from the balloon surface within 60 seconds of inflation, eliminating the risks associated with stenting, a press release said.

The patient came to the hospital with recurrent chest pain and had previously undergone left main bifurcation stenting in 2018 elsewhere. Coronary angiogram showed severe in-stent restenosis of both stents - re-narrowing in the stents placed earlier leading to narrowing of arteries. A team of cardiologists performed an image-guided procedure using DCB alone without adding new stents.

K.P. Suresh Kumar, chief cardiologist, Kauvery Hospital, said DCB could replace stent usage in up to 25% of angioplasty procedures. The technique helps eliminate the dual antiplatelet therapy after three to six months post-procedure. “We have performed close to 100 procedures with DCB,” he said, according to the release.