Drug-Eluting Balloons: A Game-Changer in Minimally Invasive Cardiac Care

One invention in the recent decade is the Drug-Eluting Balloon (DEB), also known as a Drug-Coated Balloon (DCB), a medical device used in percutaneous coronary or peripheral procedures to treat restricted or obstructed blood arteries.

Cardiovascular diseases are the leading cause of mortality worldwide. Innovations in technology have s made it possible not only to decrease mortality but also to improve the quality of life. 

One such innovation that has occurred in the last decade is the use of Drug-Eluting Balloon (DEB), also sometimes called a Drug-Coated Balloon (DCB),a specialised medical device used primarily in percutaneous coronary or peripheral interventions to treat narrowed or blocked blood vessels.

How it works

The DEB delivers an anti-proliferative drug to the vessel wall without leaving a permanent metal like stent inside.

It uses a balloon coated with a medication (typically an anti-restenotic agent like Paclitaxel or Sirolimus) mixed with a carrier

During angioplasty, the drug coating is rapidly transferred and absorbed into the vessel wall. The balloon is inflated for 60 to 90 seconds keeping the artery open and the drug dose deposited in the tissue inhibits the growth of new scar tissue (neointimal hyperplasia) that causes re-narrowing (restenosis).

Advantages over Stent

DEBs were developed to overcome some limitations associated with permanent drug-eluting stents (DES).

1. No Permanent Implant: By avoiding a permanent metal, the vessel retains its natural anatomy, flexibility, and ability to expand and contract (vasomotion). This eliminates the future risks of stent thrombosis, restenosis and chronic inflammation associated with stent.

2. Reduced Need for Prolonged Medication: Because no permanent implant is left behind to cause chronic inflammation, DEB therapy may potentially reduce the need for dual anti-platelet therapy which has its own limitations over long term like bleeding.

Indications

DEBs are especially appropriate in specific clinical scenarios:

In-Stent Restenosis (ISR): The re-narrowing of an artery within a stented area.

Small Vessels: The use of a stent in small coronary arteries is associated with higher rates of restenosis.

Bifurcation Lesions: Blockages found at a point of branching from the vessel can make stenting difficult. DEBs can treat the side branch without affecting the overall main vessel.

High Bleeding Risk Patients: A DEB may be an option for patients who cannot tolerate the long-term DAPT required with a DES.

Authored Article by Dr. M Sudhakar Rao, Consultant – Cardiology, Manipal Hospital Sarjapur Road