Drug-Coated Balloons in Percutaneous Coronary Intervention: Beyond Evidence

Drug-coated balloons (DCBs) represent a promising alternative to drug-eluting stents (DESs) by adopting a "leave-nothing-behind" approach, avoiding the long-term implantation of metallic materials associated with vessel damage, stent thrombosis, and restenosis. Although DCBs have historically been indicated for patients with in-stent restenosis or de novo small-vessel disease, recent studies indicate the potential for broader applications in acute coronary syndromes (ACSs). Trials comparing DCB and DES treatments show that DCBs yield comparable long-term outcomes, with some studies suggesting reduced rates of secondary endpoints such as cardiac death and non-fatal myocardial infarction among ACS patients treated with DCBs. Research on DCBs in various clinical scenarios, including ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction, has shown promising results for safety and efficacy, with particular support for combining DCBs with other techniques such as excimer laser coronary atherectomy. These findings support the viability of DCBs as an effective alternative to DES for select patients. Technical guidelines and best practices for optimal DCB application have also emerged, emphasizing lesion preparation and drug delivery techniques. Further studies are anticipated to provide deeper insights into the long-term outcomes and broader clinical applications of DCBs, potentially establishing them as a primary approach in interventional cardiology.