Drug-coated balloons in complex coronary interventions: From bench to bedside, evidence, limitations, and future directions

Drug-coated balloon (DCB) technology has become an increasingly transformative option in percutaneous coronary intervention. By locally delivering antiproliferative drugs without leaving a permanent scaffold, DCBs address several limitations associated with drug-eluting stents (DES), including late thrombosis, neoatherosclerosis, impaired vasomotion, and the long duration of dual antiplatelet therapy. The “leave nothing behind” concept aligns with current trends in interventional cardiology, focusing on vascular healing and long-term safety. Expanding evidence has positioned DCBs as a credible alternative to DES across a wide range of coronary pathologies.Although DCBs are well established for in-stent restenosis, their application in more complex coronary subsets such as de novo disease, bifurcations, diffuse and long lesions, and small vessel disease continues to evolve. Advances in coating technology, imaging techniques, and lesion preparation methods have significantly improved procedural outcomes, yet important gaps remain. Current practice still varies across centers, and long-term registry data are needed to confirm sustained benefit and clarify patient and lesion characteristics that predict success. Understanding the mechanistic basis for DCB performance and integrating standardized procedural strategies remain priorities in this field.This Research Topic aims to bring together current knowledge from bench studies, clinical registries, and real-world experience to define how DCBs can be effectively used in complex coronary interventions. It encourages a comprehensive examination of patient selection, device performance, lesion preparation, and long-term outcomes. The goal is to connect mechanistic insights with everyday clinical practice, providing clear evidence on where DCBs offer the greatest value and where further research is required.To gather further insights into the use of DCBs in complex coronary interventions, we welcome submissions addressing, but not limited to, the following themes:o Mechanistic and pharmacological studies: Drug transfer kinetics, excipients, coating durability, and vessel wall interactions across DCB platformso De novo and small-vessel disease: Head-to-head comparisons of DCB versus contemporary DES across different clinical settingso Bifurcation and multivessel approaches: DCB-only and hybrid approaches for side branch and main vessel disease, including procedural algorithms to minimize restenosiso Diffuse and long lesions: Management strategies for extensive disease while avoiding long metallic scaffolds and preserving surgical optionso Lesion preparation strategies: The role of scoring and cutting balloons, atherectomy, and intravascular lithotripsy in optimizing DCB outcomeso All-comer and high-risk populations: Multicenter registry and real-world data from patients with diabetes, chronic kidney disease, or high bleeding risko Imaging-guided interventions: Use of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) for procedural planning and post-intervention evaluationo Mid- and long-term outcomes: Target lesion failure, vessel remodeling, and clinical endpoints beyond 12 monthso Limitations and predictors of failure: Geographic miss, flow-limiting dissection, and procedural refinements to reduce bailout stentingo Cost-effectiveness and future technologies: Resource use, treatment economics, and advancements in pharmacology and coating materialsThis Research Topic will provide a comprehensive and authoritative resource on the evolving role of DCBs in complex coronary interventions. By integrating foundational science with clinical expertise, it will serve as a roadmap for the next generation of interventional cardiology research and practice. Topic editors: Horea-Laurentiu Onea, Calin Homorodean Source: https://www.frontiersin.org/research-topics/84392/drug-coated-balloons-in-complex-coronary-interventions-from-bench-to-bedside-evidence-limitations-and-future-directions