Journal of Vascular Medicine & Surgery

Abstract

Current Challenges of Coronary Paclitaxel-Coated Balloon Angioplasty

Kota Yamada, Tetsuya Ishikawa* and Isao Taguchi

In this mini-review, current challenges of coronary Paclitaxel-Coated Balloon (PCB) angioplasty are summarized. Since the outcomes of PCB angioplasty had to be non-inferior to those of Drug-Eluting Stents (DESs), the indications, the optimal endpoints, and the clinical and angiographic outcomes of PCB angioplasty should be reevaluated by comparing with the advances in the DESs outcomes. In our recent reports used the Propensity-Score Matched (PSM) analysis to adjust the baselines, PCB angioplasty demonstrated a similar efficacy to DESs in both of elective and emergent cases of patients with Chronic Coronary Syndromes and Acute Coronary Syndromes (CCS and ACS). PSM analysis showed the considering factors such as non-calcified lesions, lesions with a total PCB length of approximately 20 mm (non-diffuse lesion), and a maximum PCB size of approximately 3.0 mm (non-small vessels). Since all of the recent PCB angioplasty was conducted under the guidance of intravascular assessments, the mechanism of Late Lumen Enlargement (LLE) after PCB angioplasty was almost resolved. The predictor of LLE related to the residual dissection was consistent, the insignificant dissection, either the type A or B. In a daily practice, as raising the PCB angioplasty experiences in the cases of in-stent restenosis inside DES and stenotic lesions in small vessels, the indications of PCB angioplasty would gradually spread for various conditions including complex lesions and any clinical presentations. The value of post procedural % Diameter Stenosis (DS) <30, so called “stent like result,” has persisted as the optimal surrogate procedural endpoint of PCB angioplasty. However, this concept of primary Plain Old Balloon Angioplasty (POBA) for patients with acute myocardial infarction was inferior to the outcomes of routine primary stenting using bare-metal stents. Thus, the relationships between the pre procedural parameters, post procedural %DS, and the cumulative clinical outcomes after PCB angioplasty have to be newly reevaluated with the recent PCB angioplasty procedures under the intravascular assessments. PCB angioplasty would be further spread with the understanding of suitable indication, the re-evaluation of the optimal endpoint, and the longterm better outcomes with the increase in the LLE frequency along with the advances of PCI technique in comparison to DESs placement.

Published Date: 2023-07-04; Received Date: 2023-05-29