University Hospital Basel, University of Basel, Basel, Switzerland.
Norfolk and Norwich University Hospital, Norwich, United Kingdom.
JACC Cardiovasc Interv. 2020 Jun 22;13(12):1391-1402. doi: 10.1016/j.jcin.2020.02.043. Epub 2020 May 27.
Although drug-eluting stents are still the default interventional treatment of coronary artery disease, drug-coated balloons (DCBs) represent a novel alternative therapeutic strategy in certain anatomic conditions. The effect of DCBs is based on the fast and homogenous transfer of antiproliferative drugs into the vessel wall during single balloon inflation by means of a lipophilic matrix without the use of permanent implants. Although their use is established for in-stent restenosis of both bare-metal and drug-eluting stents, recent randomized clinical data demonstrate a good efficacy and safety profile in de novo small-vessel disease and high bleeding risk. In addition, there are other emerging indications (e.g., bifurcation lesions, large-vessel disease, diabetes mellitus, acute coronary syndromes). Because the interaction among the different delivery balloon designs, doses, formulations, and release kinetics of the drugs used is important, there seems to be no "class effect" of DCBs. On the basis of the amount of recently published data, the International DCB Consensus Group provides this update of previous recommendations summarizing the historical background, technical considerations such as choice of device and implantation technique, possible indications, and future perspectives.
虽然药物洗脱支架仍然是冠状动脉疾病的默认介入治疗方法，但药物涂层球囊（DCB）在某些解剖条件下代表了一种新的治疗策略。DCB 的作用基于在单次球囊充气过程中通过亲脂基质将抗增殖药物快速且均匀地转移到血管壁中，而无需使用永久性植入物。尽管它们的用途已在裸金属支架和药物洗脱支架的支架内再狭窄中确立，但最近的随机临床试验数据显示在新出现的小血管疾病和高出血风险中具有良好的疗效和安全性。此外，还有其他新兴的适应证（例如，分叉病变、大血管疾病、糖尿病、急性冠状动脉综合征）。由于不同输送球囊设计、剂量、配方和使用的药物释放动力学之间的相互作用很重要，因此 DCB 似乎没有“类别效应”。基于最近发表的数据量，国际 DCB 共识小组提供了对上一次建议的更新，总结了历史背景、技术考虑因素（如设备和植入技术的选择）、可能的适应证以及未来展望。
