Drug-eluting balloons for side branch stenting during bifurcation percutaneous coronary intervention

Drug-eluting balloons (DEB) were developed to address in-stent restenosis among other indications but have also recently been shown safe and efficacious in the context of bifurcation. By eliminating both the stent and the polymer, stent thrombosis can be avoided, while still delivering an antiproliferative agent to reduce the risk of restenosis. Bifurcation lesions account for approximately 15% to 20% of all percutaneous coronary interventions and reflect a higher risk of in-stent restenosis. Complex 2-stent techniques have been shown to increase the periprocedural myocardial infarction and stent thrombosis, while side branch restenosis rates remain a drawback for even provisional stenting. In-stent restenosis of complex bifurcation lesions can increase the complexity of the intervention strategy at a rate of about 14%, often caused by DES restenosis. Drug-eluting balloons have been shown to be a good interventional option in several randomized clinical trials to prevent and treat coronary in-stent restenosis as well as in nonrandomized series in the treatment of de novo lesions in small coronary vessels and bifurcation lesions. The next generation of DEB are being designed with improved coating platforms to provide more precise drug delivery to the tissue, which will enhance their efficacy.