Is There a Role for Drug-Eluting Balloons in Treatment of Acute Coronary Syndromes?

Due to the introduction of the coronary care unit, and with the successful pharmacological and later percutaneous reperfusion of occluded coronary arteries, mortality rates in patients with an acute coronary syndrome have reduced considerably. However, reinterventions because of restenosis in the treated segment have hampered outcomes. With the introduction of drug-eluting stents, fewer reinterventions are needed, with a more effective inhibition of neointimal hyperplasia than with bare metal stents. Nevertheless, safety concerns regarding the use of drug-eluting stents in acute coronary syndrome patients, especially the associated increased risk of late stent thrombosis, due to delayed neo-endothelialization, and chronic inflammation with late-acquired malapposition remain a drawback. Consequently, the search for a device that can reduce the number of reinterventions, while sustaining the safety profile of a bare metal stent, is ongoing. A relatively new device is the drug-eluting balloon which is an angioplasty balloon with a drug coating, with antirestenotic properties. By delivering the antirestenotic drug during short drug-eluting balloon dilations, reinterventions might be reduced without a sustained drug release as for drug-eluting stents. By avoiding ongoing drug release and chronic inflammation due to the absence of polymers, the risk of stent thrombosis could potentially be reduced with drug-eluting balloonswhile at the same time limiting the restenosis rates.