KOCHI: Cardiovascular diseases (CVDs) remain the leading cause of mortality worldwide, claiming an estimated 17.9 million lives annually. Among these, coronary artery disease (CAD), which causes blockages in the arteries supplying blood to the heart, is a significant contributor. For decades, medical science has been innovating to provide effective solutions for CAD, and stent-less angioplasty with Drug Coated Balloons (DCB) is emerging as a game-changer in the current era.
The evolution of angioplasty
The journey of angioplasty began in the late 1970s with the pioneering work of Andreas Gruentzig, who introduced balloon angioplasty. While effective in opening blocked arteries, issues like vessel recoiling, dissection, and early re-blockage affected nearly half of the patients. This paved the way for the development of metallic stents, first implanted in 1986, which offered stability by addressing vessel recoiling.
The subsequent introduction of Drug Eluting Stents (DES) revolutionised the field by significantly reducing the risk of in-stent restenosis (ISR). However, challenges persisted, particularly in cases involving complex lesions, small or diffuse vessels, and the need for lifelong dual antiplatelet therapy. Many patients also expressed concerns about carrying permanent metallic implants in their bodies, further driving innovation.
Drug-Coated Balloons
DCBs represent a novel approach to interventional cardiology. These balloons, coated with drugs similar to those used in DES, deliver the medication directly into the vessel wall during inflation. This technique minimises the risk of ISR without leaving behind any permanent implants.
DCBs have shown promising results in managing small vessel disease. Emerging data also highlight their potential in de novo large vessel disease and acute coronary syndromes.
Advantages
With the rising prevalence of diabetes mellitus and the associated increase CAD, DCBs provide a much-needed solution. They appeal to younger patients who face the prospect of living with metallic stents for decades.
The era of stent-less angioplasty is here, offering a glimpse into the future of minimally invasive, patient-focused cardiac care. With DCBs, the emphasis is on treating the disease without leaving a permanent mark, ensuring a healthier and more comfortable life for those affected by CAD.
Mind and body
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DR SHIFAS BABU M
The writer is a senior consultant of cardiology at SP Medifort