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While devices used for percutaneous coronary intervention (PCI) continue to evolve, dual antiplatelet therapy (DAPT) remains the cornerstone medical treatment to prevent thrombotic events in patients receiving revascularization. Of the complications surrounding PCI, bleeding is critical and is not uncommon in patients at high bleeding risk (HBR). The tradeoff between the management of DAPT and the risk of thrombotic events is determined by multiple factors both determined by the characteristics of the device itself and the patient. Device factors include the design of the drug-eluting stent (DES) including the polymer used. Patient factors include lesion characteristics, such as the severity of calcification and plaque vulnerability, as well as individual predisposition toward clotting. To reduce the risk of bleeding in these patients, recent clinical trials have used shorter DAPT durations after PCI. Clinical data have also led to support for shortened DAPT in national guidelines. Drug-coated balloons (DCBs) are emerging as an innovative treatment for coronary artery disease and could reduce thrombotic events after PCI due to the “leave nothing behind” strategy, healing faster in the process versus after DES. In this review, we discuss revascularization strategies in HBR patients and whether DCBs might have distinct advantages in this population.

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Is There a Potential Advantage of DCB Over DES, on the Long Term?

  • 章节

  • 发表日期：

    2025年

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  • Takamasa Tanaka,
  • Kenji Kawai,
  • Renu Virmani,
  • Bernardo Cortese,
  • Aloke V. Finn

摘要

While devices used for percutaneous coronary intervention (PCI) continue to evolve, dual antiplatelet therapy (DAPT) remains the cornerstone medical treatment to prevent thrombotic events in patients receiving revascularization. Of the complications surrounding PCI, bleeding is critical and is not uncommon in patients at high bleeding risk (HBR). The tradeoff between the management of DAPT and the risk of thrombotic events is determined by multiple factors both determined by the characteristics of the device itself and the patient. Device factors include the design of the drug-eluting stent (DES) including the polymer used. Patient factors include lesion characteristics, such as the severity of calcification and plaque vulnerability, as well as individual predisposition toward clotting. To reduce the risk of bleeding in these patients, recent clinical trials have used shorter DAPT durations after PCI. Clinical data have also led to support for shortened DAPT in national guidelines. Drug-coated balloons (DCBs) are emerging as an innovative treatment for coronary artery disease and could reduce thrombotic events after PCI due to the “leave nothing behind” strategy, healing faster in the process versus after DES. In this review, we discuss revascularization strategies in HBR patients and whether DCBs might have distinct advantages in this population.