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Chapter 32. Drug-Coated Balloon Technologies: Technical Features and Clinical Applications

Commercially available DCBs developed to date use the anti-proliferative drug, paclitaxel. Which of the following paclitaxel formulations is more effective in maintaining the drug in the vessel wall for a longer time?

A. Solid phase (crystalline) paclitaxel

B. Amorphous phase paclitaxel

C. High dose of liquid phase paclitaxel

D. Crystalline paclitaxel without a carrier

The correct answer is A

Solid phase drug provides a reproducible pharmacokinetic profile after balloon delivery and the drug stays in the vessel wall after the balloon inflation for a longer time compared with liquid phase drug that diffuses quickly into tissues. Addition of a carrier to crystalline paclitaxel keeps the drug in the vessel wall for a longer time and enhances drug intake.

Which of the following statements is true regarding the application of DCBs in coronary diseases?

A. DCB has shown to be superior to EES for the treatment of in-stent restenosis

B. DCB and BMS combination is superior to BMS in acute myocardial infarction

C. DCB has shown to be superior to standard angioplasty for the treatment of in-stent restenosis

D. The DCB-only has no benefit to treat atherosclerotic disease involving small coronary vessels

The correct answer is C

Randomized clinical trials have demonstrated the safety and efficacy profile of DCB over PTA for the treatment of in-stent restenosis. DCB appear to be as effective as paclitaxel-eluting stents in this particular application, however, re-intervention using EES was shown to be more effective in reducing angiographic restenosis compared to DCB. Small clinical studies support their use in other de novo clinical settings such small vessels, diffuse lesions and bifurcation lesions, but until further refinements in DCB technology are made and larger randomized clinical trials are performed, the role of this technology remains to be completely understood.

Which of the following statements is false regarding the potential advantages of DCB over DES?

A. Polymer-free single time drug delivery

B. Completely prevents the use of ancillary stents

C. Allow the treatment of long segments leaving nothing behind

D. Does not preclude re-intervention of the treated segment in case re-stenosis occurs

The correct answer is B

Potential advantages of DCB include ...

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