Drug-coated balloons (DCBs) have emerged as a significant innovation in the treatment of coronary artery disease. Over the past two years, a growing body of evidence supports their efficacy in various clinical scenarios. In this blog post, we will delve into the practical applications of DCBs, share case studies, and discuss the advantages and challenges associated with their use. This is an essential read for healthcare professionals looking to enhance their understanding of DCBs and their role in modern cardiology.
Drug-coated balloons are specialized balloons used during angioplasty procedures to deliver medication directly to the arterial wall. This mechanism helps to prevent restenosis, which is the re-narrowing of the artery after it has been treated. The ability to leave nothing behind, as emphasized in recent discussions, is pivotal for patients at high risk of complications from traditional stenting methods.
At our center, we predominantly use Cimus DCBs, making up about 80% of our cases. Additionally, we have incorporated Calus DCBs into our practice over the past year. The choice of DCB often depends on the specific characteristics of the lesions being treated.
Let’s explore some specific cases where DCBs were utilized effectively. Each case highlights the critical steps taken and the outcomes achieved.
The first case involved a 90% lesion in the posterior descending artery (PDA). The lesion was in a medium-sized vessel, which according to the UK Bation group, is defined as less than 3 mm. However, in India, we often see vessels measuring under 3 mm.
The treatment commenced with a thorough preparation using a non-compliant (NC) balloon followed by a cutting balloon. Despite initial challenges with the slides not moving, we successfully deployed a Magic Touch DCB (2.5 x 35 mm). The final result showed minimal recoil, indicating effective treatment.
In another case, we treated a 39-year-old female patient with acute coronary syndrome (ACS). Given her age, we opted against placing a stent and instead performed a DCB procedure. After adequately preparing the lesion with a cutting balloon, we used a Magic Touch DCB (2.5 x 25 mm).
The outcome was promising, with very little recoil and an excellent result. The patient is currently doing well, demonstrating the efficacy of DCBs in younger patients.
This case involved a bifurcation lesion in the left anterior descending (LED) artery and a diagonal branch. The patient presented with a type of dual LED. We identified some calcification and undertook intravascular imaging to size the vessel accurately.
We decided to use two DCBs: one measuring 2.5 x 35 mm in the LED and another at 2.5 x 1 mm in the diagonal. The final result showed excellent remodeling with no significant recoil.
Next, we addressed a tight lesion in the right coronary artery (RCA) with a large PDA. A careful approach using a cutting balloon was crucial to prevent dissection and recoil. We then applied the Magic Touch DCB (2.5 x 3 mm) for 60 seconds.
The results were remarkable, showcasing no recoil and a well-modified lesion.
In a unique situation, we treated a 40-year-old medical student with LED ACS and a high bleeding risk due to cirrhosis and portal hypertension. We chose to proceed with a DCB to minimize the need for dual antiplatelet therapy.
After lesion preparation with a cutting balloon, we used a DCB (3 x 15 mm) post-imaging study. The outcome was favorable, with the patient remaining stable after six months.
In another case, we encountered a diffusely diseased distal RCA. Using a Pexel balloon allowed for multiple inflations, which facilitated optimal lesion preparation. The results showed a well-expanded lesion with no thrombus or dissection.
A 35-year-old patient with a history of an LED stent placement three months prior presented with an RCA bifurcation lesion. The patient opted against traditional stenting. We prepared the vessel with NC and cutting balloons, followed by the application of two DCBs using kissing balloons.
The final results exhibited good flow with some acceptable recoil in the PDA, but overall, the patient reported no symptoms.
The last case involved a complex LED lesion characterized by diffuse calcification and tortuous vessels. To manage this, we employed a hybrid percutaneous coronary intervention (PCI) strategy. The lesion was prepared with cutting balloons, followed by intravascular imaging to assess vessel size.
We then deployed a DCB (2.5 x 35 mm) from mid to distal LED while placing a stent in the proximal segment. The final results were satisfactory, showcasing the versatility of DCBs in challenging anatomies.
Through these case studies, several take-home messages emerge regarding the application of DCBs:
+(91)9810466173
info@drsanjeevgeracardiologist.com