Drug Coated Balloons in Acute Coronary Syndromes - Opportunities and Limitations

Currently available data on drug coated balloon (DCB) angioplasty as a clinical treatment modality for coronary and peripheral artery disease are limited but hold promise. Advantages over standard angioplasty and stent technologies include a homogeneous drug delivery to the vessel wall, an immediate drug release without the use of a polymer, the option of using balloon catheters alone or in combination with a bare metal stent, no foreign object left behind in the body, the potential of reducing anti-platelet therapy, and a lower restenosis rates in some indications. The clinical and angiographic presentation of patients with acute coronary syndromre (ACS) is heterogeneous. Therefore, different clinical scenarios of DCB application in ACS may be discussed. Frequently, thrombosis in the ACS-related lesion plays a major role. Patients in hemodynamic critical situations under catecholamine therapy may present with too small vessel diameters. Another clinically relevant scenario represents in-stent restenosis (ISR) which is frequently associated with ACS.