IMR Press / RCM / Volume 23 / Issue 2 / DOI: 10.31083/j.rcm2302042
Open Access Review
Drug-coated balloon for the management of coronary chronic total occlusions
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1 Cardiac department, Clinica Polispecialistica San Carlo, 20037 Milano, Italy
2 Cardiac department, Al-Zahraa University Hospital, 00961 Beirut, Lebanon
3 Cardiac department, Lebanese University, 00961 Beirut, Lebanon
4 Fondazione Ricerca e Innovazione Cardiovascolare, 20100 Milano, Italy
*Correspondence: (Bernardo Cortese)
Academic Editor: Alaide Chieffo
Rev. Cardiovasc. Med. 2022, 23(2), 42;
Submitted: 6 November 2021 | Revised: 9 December 2021 | Accepted: 17 December 2021 | Published: 24 January 2022
(This article belongs to the Special Issue Drug-Coated balloons-The “leave nothing behind” strategy)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

There is a higher rate of successful recanalization of patients with coronary chronic total occlusions, nevertheless, the rate of patients referred for revascularization remains low. In addition, there is a greater need to improve long-term outcomes of chronic total occlusions after percutaneous coronary intervention, and although the implantation of new-generation drug-eluting stents has been optimized with coronary imaging guidance, the rate of stenting failure remains a major issue and long-term vessel patency could be improved. We reviewed clinical data regarding the benefit of treating chronic total occlusions and the use of drug-coated balloons as an alternative therapeutic modality in this setting. Although clinical data is limited, the initial evidence and the daily clinical practice point towards a synergistic hybrid treatment strategy based on the combination of drug-coated balloons plus drug-eluting stents, reducing the total stent length and maintaining the scaffolding properties of stents where it is mandatory. Additionally, drug-coated balloons allow natural enlargement of the open vessel after percutaneous coronary intervention (PCI), which is a major limitation of stents in chronic total occlusion (CTO).

Drug-coated balloon
Chronic total occlusion
Coronary artery disease
Percutaneous coronary intervention
Fig. 1.
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