Sirolimus-Eluting Balloons in Coronary PCI: Key Insights from Recent Evidence-Sirolimus-Eluting Balloons in Coronary PCI: Key Insights from Recent Evidence

Video Transcription

Video Summary

The webinar focused on sirolimus-eluting balloons in coronary PCI and reviewed current evidence, indications, and practical use. Dr. Lateeb opened by explaining that drug-coated balloon (DCB) technologies are not interchangeable; paclitaxel- and sirolimus-based balloons differ in drug dose, attachment, transfer, and vessel-wall retention. He emphasized that in the U.S., the strongest current indication is in-stent restenosis (ISR), where DCBs can help avoid adding more stent layers. He also highlighted emerging and promising uses in small vessels, bifurcations, long lesions, STEMI, diabetes, and high-bleeding-risk patients, while noting that more randomized U.S. trials are still needed.<br /><br />Dr. Spalding reviewed the Solutions de Novo trial, a large randomized non-inferiority study comparing a sirolimus-eluting balloon strategy with provisional stenting versus conventional DES. In this all-comer population, the DCB strategy met non-inferiority at one year for target vessel failure, with low acute and late safety events. Most patients treated with the DCB did not require a stent, and operator experience reduced bailout stenting over time.<br /><br />Dr. Cutlip presented the Solutions for ISR trial, which found that the sirolimus-eluting balloon was non-inferior to usual care for ISR overall, though DES showed a numerical advantage in single-layer ISR. The discussion emphasized lesion preparation, imaging, and choosing DCB versus DES based on mechanism of failure, residual stenosis, and whether there is a mechanical issue such as stent fracture.<br /><br />Dr. McEntegart closed with real-world case examples showing how DCBs can be integrated into complex ISR, bifurcation, CTO, and de novo PCI. The panel agreed that careful preparation, imaging, and accepting small non-flow-limiting dissections are key to safe DCB use.

Keywords

sirolimus-eluting balloon

coronary PCI

drug-coated balloon

in-stent restenosis

DES non-inferiority

bifurcation lesions

small vessels

lesion preparation

intracoronary imaging

high bleeding risk