Background: Balloon angioplasty revolutionised percutaneous treatment for coronary
artery disease four decades ago, but vessel-threatening dissections, elastic recoil and restenosis
were major drawbacks to an otherwise successful long-lasting intervention. Subsequent advances
with bare metal stents and then drug eluting stents followed, aiming to mitigate the risks of acute
vessel closure and restenosis. However, stent implantation often necessitates dual antiplatelet therapy
for a prolonged period of time, which in itself can lead to adverse outcomes, especially in the
frail elderly population at higher risk of bleeding. More recently, bioabsorbable stents have been
implemented in clinical practice enabling earlier intimal coverage of the stent and apposition.
However, another addition to the armamentarium of percutaneous coronary intervention is the use
of drug-coated balloons without the need for deploying any coronary stents or scaffolds. Drugcoated
balloons are semi-compliant balloons coated with an antiproliferative agent that is rapidly
released on contact with the vessel intima exerting an anti-restenotic effect. The absence of a metallic
scaffold means that the need for antiplatelet therapy can potentially be negated in the longer
term if required. In this article, we will review the history of percutaneous coronary intervention
and the available evidence for the appropriate use of drug-coated balloons especially in the elderly
Conclusion: We will conclude this review by demonstrating the potential use of drug-coated balloon
rather percutaneous stenting through case examples.
Keywords: Coronary artery disease, drug-coated balloons, elderly, vessel-threatening dissections, elastic recoil, restenosis.
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