Intracoronary imaging guidance for de novo coronary lesion treatment with drug-coated balloons

The use of drug-coated balloons (DCB) for percutaneous coronary interventions (PCI) in de novo lesions is receiving increasing attention from the interventional cardiology community. This technology aims to restore coronary lumen caliber in a sustainable manner, without the risk of neointimal hyperplasia and without leaving metallic stents in situ; this theoretically avoids the risk of stent thrombosis while restoring vessel physiology1. The type of lesions most likely to benefit from DCB are still under debate; apart from small vessels, the use of this technology has been proposed in long, diffuse lesions, side branch ostia in bifurcations, and even highly calcified and thrombotic lesions. More recently, their role in large vessels with de novo lesions has also been considered, with conflicting clinical results in large, randomised trials powered for clinical endpoints23. Potential candidates are any complex lesion for which the operator believes that stent implantation will not produce optimal results or may even pose a risk of subsequent complications4.

The most recent consensus documents strongly support the use of intracoronary imaging (ICI), either by intravascular ultrasound (IVUS) or...