Technical Mastery: Guidance on Proper Imaging, Lesion Preparation, and Deployment for Coronary Drug-Coated Balloons. Part 2: Coronary DCBs in De Novo Lesions, Small Vessel, and Bifurcation: The European Experience-Slides, Dr. Colombo

Slides, Dr. Colombo

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Antonio Colombo from EMO-GVM Centro Cuore Columbus and Humanitas Research Hospital in Italy discusses a pragmatic approach to using drug-coated balloons (DCB) in percutaneous coronary interventions. The primary goals of this approach are to simplify the procedure, avoid "full metal jacket" stenting especially in the left anterior descending artery (LAD), and reduce extensive drug-eluting stent (DES) implantation in patients at high bleeding risk, thereby minimizing the duration of dual antiplatelet therapy (DAPT).<br /><br />Colombo emphasizes lesion preparation with careful predilatation using various non-compliant (NC) balloons sized according to vessel segments, guided by imaging tools such as intravascular ultrasound (IVUS) and measurements like Pd/Pa ratios to assess lumen adequacy before DCB use. For example, proximal and mid-LAD segments may be dilated with 3.0 to 3.5 mm NC balloons at 20 atm pressure, while distal segments receive smaller balloons.<br /><br />He notes that despite optimal results after predilatation and evidence of sufficient lumen by IVUS, operators may still favor stenting, particularly if there is contrast persistence indicating a dissection flap. In certain cases, focal stenting is used to manage dissections despite the theoretical advantage of DCB-only treatment, especially when the dissection poses a risk. The incremental benefit of DCB may be reduced in large vessels, influencing the decision to implant a DES.<br /><br />The approach aims to balance procedural simplification with patient safety, minimizing metal burden and prolonged antiplatelet therapy while using imaging to guide treatment. Overall, Colombo advocates for selective use of DCB based on lesion characteristics and patient bleeding risk as part of an individualized, pragmatic treatment strategy.

Keywords

drug-coated balloons

percutaneous coronary interventions

full metal jacket stenting

left anterior descending artery

drug-eluting stents

high bleeding risk

dual antiplatelet therapy

lesion preparation

intravascular ultrasound

focal stenting