Drug-Coated Balloon Angioplasty in In-Stent Restenosis and Small-Vessel Coronary Disease: Insights from a Bangladeshi Cohort

Background:
Drug-eluting stents (DES) remain the cornerstone of percutaneous coronary intervention; however, their limitations include in-stent restenosis (ISR) and suboptimal performance in de-novo small-vessel disease. Drug-coated balloons (DCB) offer a metal-free alternative, delivering antiproliferative therapy directly to the vessel wall. Data from South Asia on DCB outcomes are limited.

Objectives:
To evaluate the  safety and efficacy of DCB angioplasty in patients with chronic coronary syndrome (CCS) presenting with either ISR or de-novo small-vessel lesions.

Methods:
In this prospective observational study conducted at the National Institute of Cardiovascular Diseases (NICVD), Dhaka, from January 2023 to July 2024, 110 consecutive CCS patients underwent DCB angioplasty. Patients were followed for 12 months to assess major adverse cardiac events (MACE) and target lesion revascularization (TLR).

Results:
Among 110 patients, 42 (38.2%) had ISR lesions and 68 (61.8%) had de-novo small-vessel lesions. Angiographic success was achieved in 93.6% and procedural success in 91.8% of cases. Over one-year follow-up, MACE occurred in 5.5% (n = 6), TLR in 2.7% (n = 3), death in 1.8% (n = 2), and myocardial infarction in 0.9% (n = 1). MACE and TLR rates were numerically higher in the ISR subgroup but did not reach statistical significance (MACE 9.5% vs 2.9%, p = 0.32; TLR 4.8% vs 1.5%, p = 0.327).

Conclusion:
Drug-coated balloon angioplasty demonstrated excellent procedural success and favorable one-year outcomes in both ISR and small-vessel coronary disease. These findings suggest that DCB represents a safe and effective revascularization strategy for CCS patients in the Bangladeshi population.

Keywords: Drug-coated balloon, In-stent restenosis, Small-vessel coronary disease, Chronic coronary syndrome, Bangladesh.