Drug-eluting Balloons in Coronary Artery Disease: Past, Present and Future

Percutaneous treatment of complex coronary lesions like small vessel disease, diabetics and long diffuse disease, remain hampered by suboptimal results, even with the use of drug-eluting stents (DES). The paclitaxel drug-eluting balloon (DEB) is an interesting emerging device to optimise the clinical outcomes in these specific lesions. In order to inhibit coronary restenosis, and revascular- isation, the DEB may become a viable alternative treatment option by means of a high concentration,local release of an anti-restenotic drug, paclitaxel, into the coronary vessel without using a metalscaffold or durable polymers.Several studies have already shown promising and consistent results in the treatment of in-stent restenosis. Even when compared to certain DES, the DEB has demonstrated its added value. Inspired by these results, an increasing number of studies have been started in different coronary lesion subsets, exploring the value of the DEB in a broader range of lesions.It will be interesting to see whether the DEB will find more indications beyond in-stent resteno- sis treatment. Moreover, as several DEB produced by different manufacturers, are present on the market, specific investigations are needed to address whether these devices offer the same added value, or show relevant differences.As accounted for DES development in the past, now the puzzle pieces have to be put together for DEB.