Beyond the stent ("leave-nothing-behind") drug-coated balloons in acute coronary syndrome: a narrative review
Zaghloul, Sheref Shahin, Ahmed Agamy, Salaheldin Ioakim, Kalliopi J Aly, Mohamed Candilio, Luciano
Zaghloul, Sheref
Shahin, Ahmed
Agamy, Salaheldin
Ioakim, Kalliopi J
Aly, Mohamed
Candilio, Luciano
Abstract
Background: Drug-coated balloons (DCBs) have emerged as a "leave-nothing-behind" strategy in percutaneous coronary intervention (PCI), with potential advantages over drug-eluting stents (DES) in selected patients with acute coronary syndrome (ACS). Methods: We performed a narrative review of randomized controlled trials, registries, and meta-analyses evaluating DCB therapy in ACS, including PEPCAD NSTEMI, REVELATION, BASKET-SMALL 2, AGENT IDE, REC-CAGEFREE I/II, and the ongoing TRANSFORM II trial. Articles were identified through searches of PubMed/MEDLINE, Embase, Scopus, Web of Science, and Cochrane CENTRAL covering January 2005 to February 2026. Results: Across published studies, DCBs have shown outcomes that are non-inferior to those of DES in selected ACS subsets, together with a lower risk of major bleeding attributable to shorter dual antiplatelet therapy (DAPT) requirements. Advances in intravascular imaging and lesion preparation, alongside emerging applications of artificial intelligence (AI) and robotic-assisted PCI, may further improve DCB performance, although evidence specific to DCB use in ACS remains limited for these adjunctive technologies. Conclusions: DCBs are a reasonable alternative to DES in selected patients with ACS, particularly those at high bleeding risk or with lesion subsets in which DES perform less well (small vessels, in-stent restenosis, bifurcations, diffuse disease). Adequately powered randomized trials with long-term follow-up are required before broader recommendations can be made.
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Date
2026-06-10
Type
Article
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Citation
Zaghloul S, Shahin A, Agamy S, Ioakim KJ, Aly M, Candilio L. Beyond the Stent ("Leave-Nothing-Behind") Drug-Coated Balloons in Acute Coronary Syndrome: A Narrative Review. J Clin Med. 2026 Jun 10;15(12):4491. doi: 10.3390/jcm15124491.