Gherasie Flavius-Alexandru, Ciomag Ianula Raluca, Gherasie Luana-Maria
Department of Cardiology, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania.
Emergency Clinical Hospital Dr. Bagdasar-Arseni, 050474 Bucharest, Romania.
Biomedicines. 2025 Jun 14;13(6):1472. doi: 10.3390/biomedicines13061472.
The evolution of percutaneous coronary intervention (PCI) has led to significant advances in drug-coated balloon (DCB) technology, offering a stent-free alternative for treating coronary artery disease. While paclitaxel-coated balloons (PCBs) have been the standard, sirolimus-coated balloons (SCBs) are emerging as a viable alternative with distinct pharmacokinetic and clinical benefits. This review explores the mechanisms of action of paclitaxel and sirolimus, their impact on different plaque morphologies, and the clinical implications of DCB selection. Paclitaxel facilitates positive vascular remodeling and is particularly effective in fibrotic and lipid-rich plaques, but its poor penetration in calcified lesions remains a limitation. Sirolimus, with its homogeneous tissue distribution and anti-inflammatory properties, is better suited for unstable, lipid-rich, and inflammatory plaques, where it promotes plaque stabilization. Recent randomized trials and meta-analyses have compared SCBs vs. PCBs in both de novo lesions and in-stent restenosis, showing non-inferior outcomes. Additionally, DCBs demonstrate comparable efficacy to DES in small vessel disease, reducing the need for permanent metallic scaffolds. This review summarizes the current evidence on DCB selection based on plaque characteristics and highlights areas for further investigation in personalized PCI strategies. Given the narrative review design, the authors conducted a comprehensive literature search using databases such as PubMed and MEDLINE. Keywords included "drug-coated balloon", "paclitaxel-coated balloon", "sirolimus-coated balloon", "in-stent restenosis", and "plaque morphology". Studies were selected based on relevance, including randomized controlled trials, registries, and meta-analyses. No formal inclusion/exclusion criteria or systematic screening were applied due to the nature of narrative synthesis.
经皮冠状动脉介入治疗（PCI）的发展推动了药物涂层球囊（DCB）技术的重大进步，为治疗冠状动脉疾病提供了一种无支架的替代方案。虽然紫杉醇涂层球囊（PCB）一直是标准治疗手段，但西罗莫司涂层球囊（SCB）正作为一种可行的替代方案崭露头角，具有独特的药代动力学和临床优势。本综述探讨了紫杉醇和西罗莫司的作用机制、它们对不同斑块形态的影响以及DCB选择的临床意义。紫杉醇有助于实现积极的血管重塑，在纤维化和富含脂质的斑块中尤其有效，但其在钙化病变中的穿透性较差仍是一个限制因素。西罗莫司具有均匀的组织分布和抗炎特性，更适合不稳定、富含脂质和炎症性斑块，可促进斑块稳定。最近的随机试验和荟萃分析比较了SCB与PCB在初发病变和支架内再狭窄中的应用，结果显示疗效相当。此外，DCB在小血管疾病中显示出与药物洗脱支架（DES）相当的疗效，减少了对永久性金属支架的需求。本综述总结了基于斑块特征选择DCB的当前证据，并强调了个性化PCI策略中有待进一步研究的领域。鉴于本叙述性综述的设计，作者使用PubMed和MEDLINE等数据库进行了全面的文献检索。关键词包括“药物涂层球囊”“紫杉醇涂层球囊”“西罗莫司涂层球囊”“支架内再狭窄”和“斑块形态”。根据相关性选择研究，包括随机对照试验、登记研究和荟萃分析。由于叙述性综合的性质，未应用正式的纳入/排除标准或系统筛选。
