DRUG COATED BALLOON - DEB, WHAT'S NEW?

I first heard about the drug coated balloon three years ago, and have always wondered how a balloon coated with a drug, and then passing the balloon to the site of treatment, and attaching or contacting the balloon ( drug coated ) with the vessel wall for 30 secs, could allow the drug to work and cause less restenosis. Apparently it does. I was not convinced at first. Over many meetings, I had many occasions to meet Dr Martin, a pleasant German. He convinced me to try it. So I had actually used it on three patients over the last two years. These patients all had recurrent in-stent restenosis on drug eluting stents, on a previous bare metal stent. Since there was so much metal over the injured coronary arterial site, I thought that I will try the DEB ( Drug Eluting Balloon ). So far so good. They have all gone pass one year and no evidence problem. Stress test-wise ok.
This June 1 issue of Circulation carried an article by Dr Martin Unverdorben, on the use of the drug coated ( eluting ) balloon in the treatment of in-stent restenosis. The study, known as the Paclitaxel-Eluting PTCA-Balloon Catheter in Coronary Artery Disease-2 In-Stent Restenosis (PEPCAD-2 ISR) trial, was previously presented at the American College of Cardiology 2008 Scientific Sessions/i2 Summit-SCAI Annual Meeting. This study compared the use of the BBruan DEB against the Taxus stent in the treatment of in-stent restenosis. He studied 131 patients, divided into the treatment arm and the control arm ( Taxus stent ). After six months followup, the DEB arm has less MACE events, although the binary restenosis were the same.
I must say that in an earlier study, their competitor ( Eurocor ) DEB did not do so well.
The DEB, if proven longterm to be good offers many advantages in terms of cost, less metal implanted and maybe less longterm implications. However, 131 patients and 6 months followup is to smal and too short a time. We look forward to more patients being studied , over a longer period of time, to allow us to be more confident and to know how to use it.
For the moment, the BBruan DEB, Sequent Please, holds promise , in the treatment of in-stent restenosis, especially those that occurs after the implantation of a DES.