Clinical applications of drug-coated balloon: what have we learned and where are we going?

Since the introduction of coronary stents, in-stent restenosis has been one of the main stumbling blocks for its application in coronary artery disease. The drug-eluting stents have effectively reduced and become the mainstay of the interventional therapy of coronary artery disease. However, concerns of delayed stent thrombosis, dependency on prolonged dual antiplatelet therapy, and recurrent restenosis led to a quest for new treatment modalities that could address restenosis rates without drug-eluting-stent-related drawbacks. The drug-coated balloon has emerged as an additional tool in the armamentarium of interventional cardiology. It is usually a semicompliant balloon coated with antiproliferative agents encapsulated in a polymer matrix, which is released into the wall after inflation and contact with the intima, leaving no implant behind. This review highlights the rationale for drug-coated balloon use, its effectiveness in different clinical and lesion settings, and the future perspective.