Drug-coated balloons in the treatment of femoro- and infra-popliteal lesions

Despite initially encouraging technical success after femoropopliteal percutaneous transluminal angioplasty (PTA), postprocedural restenosis remains the major challenge. Antiproliferative drugs applied via drug-coated balloons (DCBs) or drug-eluting stents suppress neointimal hyperplasia, the main cause of restenosis. The present article summarizes results of DCB treatments of femoropopliteal and infrapopliteal lesions and points out open questions. Major advantage of the DCB technology is leaving no stent scaffold behind and an immediate release of high drug concentrations. The superiority of DCB versus PTA was shown in several randomized clinical trials. Moreover, calcified lesions seem to impair the efficacy of DCB. Although mechanical abrasions have shown favorable periprocedural results, short and long-term impact is still controversial. Combinations of preceding debulking methods (atherectomy) with DCBs have shown promising results.