Drug-Coated Balloons in Contemporary Coronary Interventions: A Systematic Review of Current Evidence

Abstract

Drug-coated balloons (DCBs) are a percutaneous coronary intervention technology that enables rapid and homogeneous delivery of antiproliferative agents to the vessel wall without leaving a permanent metallic scaffold. With the accumulation of clinical evidence and the development of new-generation devices, the use of DCBs has expanded beyond the treatment of in-stent restenosis (ISR) to include a wide range of clinical settings such as small vessel disease, bifurcation lesions, acute coronary syndromes (ACS), and chronic total occlusions (CTO). Contemporary DCB platforms are primarily based on paclitaxel- or sirolimus-coated technologies, while advances in carrier systems and coating techniques have improved drug transfer efficiency, safety, and long-term outcomes. Appropriate lesion preparation, optimal device selection, and the integration of intravascular imaging techniques remain essential determinants of procedural success. Randomized trials support DCB use in ISR and in small-vessel coronary disease, although current European guidelines favor repeat drug-eluting stent (DES) implantation over DCB for restenosis of DES. Evidence in bifurcation lesions, ACS, and CTO is more limited and derives largely from trials powered for angiographic rather than clinical endpoints; in unrestricted de novo lesions, a DCB-based strategy did not meet non-inferiority against DES in the REC-CAGEFREE I trial. This review summarizes the fundamental principles of DCB technology, contemporary device characteristics, technical considerations, major clinical indications, and the most relevant evidence from current literature. DCB technology is an established component of the “leave nothing behind” strategy in selected indications, whereas its role in several de novo settings remains to be defined by adequately powered randomized trials with long-term clinical endpoints.

Cite This Article: Gülyiğit H, Koca Ç, Gürsoy MO. Drug-coated Balloons in Contemporary Coronary Interventions: A Systematic Review of Current Evidence. Koşuyolu Heart J 2026;29(3):219–227.