Paclitaxel-coated balloons for vulnerable lipid-rich plaques

Acute coronary syndrome (ACS) predominantly arises from vulnerable lipid-rich plaques (LRPs). Despite contemporary systemic medical therapy, 30% of ACS patients have a recurrent event within 5 years, prompting interest in local prophylactic treatment options aimed at plaque stabilisation1. Near-infrared spectroscopy (NIRS) combined with intravascular ultrasound (IVUS) enables the identification of LRPs at risk for future coronary events2. Paclitaxel-coated balloons (PCBs) allow for targeted intracoronary pharmacological treatment without leaving behind a permanent implant. Preclinical studies have shown the potential of PCBs to serve as a local plaque-stabilising therapy3. We therefore investigated the safety and feasibility of using a PCB as a pre-emptive treatment for non-flow-limiting, non-culprit LRPs in patients presenting with non-ST-segment elevation ACS (NSTE-ACS).

The Intravascular Identification and Drug-Eluting Balloon Treatment of Vulnerable Lipid-Rich Plaques (DEBuT-LRP) study was an investigator-initiated, first-in-human proof-of-concept study conducted at the Amsterdam University Medical Centers (ClinicalTrials.gov: NCT04765956). The study design and rationale have been previously published4. Briefly, patients with NSTE-ACS underwent three-vessel IVUS-NIRS (Makoto TVC-MC10 imaging system, with a 50 MHz catheter [both Infraredx]) after successful percutaneous coronary intervention (PCI) of all...