Balão eluidor de fármaco: o caminho faz-se caminhando

The concept behind drug-eluting balloons (DEB) is local vascular release of an antiproliferative drug without the need for a metal structure or a polymer, which is certainly an attractive idea and an important innovation in interventional cardiology. Their use in the treatment of coronary artery disease is relatively recent, but DEB angioplasty has grown rapidly, in fact outstripping the evidence in this area. The history of interventional cardiology is full of such examples of action ahead of large trials and the guidelines based on them. The development of this alternative was prompted by the fact that the use of stents is not advisable in certain situations or is likely to achieve less favorable results. DEB angioplasty has been shown to be most useful for the treatment of in-stent restenosis, bifurcations and small vessel disease, particularly in patients with diabetes. All these situations are a challenge for interventional cardiology for which there is as yet no standard treatment, unlike conventional lesions for which stenting has become universally accepted. A return to simple balloon angioplasty but with DEBs to reduce the risk of restenosis appears to be a path worth exploring and for which it is important to gather more evidence. The multicenter series presented in the article by Calé et al. in this issue of the Journal provides interesting information on the use of DEBs, particularly in patients with small vessel disease, on whom there have been few largescale studies.