Are drug-eluting balloons the new favorite treatment for small diseased coronary arteries?

This study compared the effectiveness and safety of paclitaxel drug-eluting balloon with paclitaxel drug-eluting stent in patients with coronary artery disease.

Balloon angioplasty and stenting is a surgery carried out on patients with coronary artery disease. Coronary artery disease refers to a condition caused by the narrowing of blood vessels that supply the heart with blood, oxygen and nutrients, that is often due to cholesterol buildup. 

Balloon angioplasty and stenting surgery involves the insertion of a small flexible tube into a blood vessel, normally in the groin area. The tube is moved along the blood system until it reaches the narrowed artery. A small balloon from the tube is then inflated inside the artery to dilate it and improve blood flow. Most of the time, a wire mesh, called a stent, is placed and kept within the artery to keep the artery open and help prevent it from re-narrowing.

New stents are often drug-eluting (releasing) stents that slowly release a drug over time to help prevent the blockage from recurring. However, stents are not very suitable for small blood vessels as they can cause the stent to break. Therefore, for small blood vessels, the use of drug-eluting balloons are now being considered. In this case, the artery is widenened with the balloon that quickly releases a drug and the balloon is then removed from the artery.

An example of a drug that is used in drug-eluting balloons is paclitaxel (Taxol). This drug is taken up very quickly by the cells in the artery and can stay there for up to 1 week. It is also widely used in drug-eluting stents, but in this case, the drug is released over a longer period of time. 

This study compared the effectiveness of paclitaxel–eluting balloons with paclitaxel-eluting stents in patients with coronary artery disease in small coronary arteries. 

A total of 182 patients were included in the study and were randomly assigned a drug-eluting balloon or a drug-eluting stent.

The study found that 2 years after the operation, patients that received the drug-eluting balloon had less adverse cardiac events, such as heart attack, (15% of patients), compared to the drug-eluting stent group (25% of patients). Both groups showed similar success rates in restoring blood flow. Furthermore, patients that received the drug-eluting balloon did not require repeat surgery over the 2 years. 

The study concluded that treatment of coronary artery disease in small blood vessels with a paclitaxel drug-eluting balloon is associated with slightly better outcomes over 2 years, compared to paclitaxel drug-eluting stent.

The study included a relatively small number of patients and so any adverse effects or superiority in either group may not become apparent until it is tested on a larger group of patients. 

If you or someone you know has coronary artery disease in a small blood vessel, talk to a doctor about the benefits and risks of receiving a drug-eluting balloon over a stent.