What is Drug-Coated Balloon Angioplasty?
Drug-coated balloon angioplasty (DCB) is a medical procedure used to treat narrowed or blocked arteries, particularly in the context of coronary artery disease or peripheral artery disease. The procedure combines traditional balloon angioplasty with the delivery of a drug to help prevent the re-narrowing of the treated artery.
Indications for Drug-Coated Balloon Angioplasty
Some common indications for drug-coated balloon angioplasty include:
- Peripheral Artery Disease (PAD):
- Femoropopliteal Arteries: DCB is often used in the treatment of peripheral artery disease affecting the femoropopliteal arteries, which are the arteries in the thigh and knee region.
- Below-the-Knee Arteries: In some cases, DCB may be considered for treating blockages in arteries below the knee.
- Coronary Artery Disease (CAD):
- In-Stent Restenosis: DCB may be used in cases of in-stent restenosis, where a previously placed stent has developed significant blockage due to tissue overgrowth.
- Small Vessel Disease: DCB may be considered in situations where traditional stenting may be challenging, such as in small vessels or arteries with complex anatomy.
- High Restenosis Risk Patients: Patients who are at a higher risk of restenosis may be candidates for DCB to improve the long-term success of the angioplasty procedure.
- Single Lesion Treatment: DCB is commonly used for treating single, discrete lesions in arteries.
Preparation for Drug-Coated Balloon Angioplasty
Preparation for drug-coated balloon angioplasty may involve the following steps:
- A thorough physical examination and review of your medical history
- Diagnostic tests, such as blood work and imaging
- Informing your doctor of any medications or supplements you are taking
- Refraining from blood thinners, aspirin, or NSAIDs, if indicated
- Informing your doctor of any allergies to medications, anesthesia, or contrast dye
- Refraining from solids or liquids at least 8 hours prior to the procedure
- Arranging for someone to drive you home after the procedure
- Signing an informed consent form
Procedure for Drug-Coated Balloon Angioplasty
The procedure for drug-coated balloon angioplasty is generally similar to standard balloon angioplasty but involves the use of a specialized balloon coated with an anti-proliferative drug. The procedure may be performed in a catheterization lab (cath lab) or an interventional radiology suite. In general, the procedure involves the following steps:
- You will be given local anesthesia to numb the area where the catheter will be inserted.
- A thin, flexible tube called a catheter is inserted through a blood vessel, usually in the groin or wrist, and guided toward the target artery using fluoroscopy (real-time X-ray imaging).
- A guidewire is threaded through the catheter and directed to the location of the narrowed or blocked artery.
- Contrast dye is injected through the catheter to provide a clear X-ray image (angiogram) of the affected artery, helping your physician visualize the blockage.
- The drug-coated balloon is then advanced over the guidewire to the target area and is positioned at the site of the blockage or narrowing.
- The balloon is inflated to compress the plaque or blockage against the arterial wall, widening the vessel. As the balloon expands, the anti-proliferative drug on its surface is released onto the arterial wall.
- The drug comes into direct contact with the artery, inhibiting the growth of smooth muscle cells and reducing the risk of restenosis.
- After a specific duration, the balloon is deflated and withdrawn from the artery.
- The catheter and guidewire are removed, and pressure is applied to the puncture site to prevent bleeding. The puncture site may be closed using manual pressure, a closure device, or other techniques.
Post-Procedure Care and Recovery
In general, post-procedure care and recovery for drug-coated balloon angioplasty will involve the following steps:
- You will be transferred to the recovery area where the medical staff will closely monitor your vital signs to ensure stability. The medical staff will also monitor the catheter insertion site for signs of bleeding or hematoma.
- You will be advised to remain on bed rest for a specified period to minimize the risk of bleeding from the catheter insertion site.
- Activity restrictions, such as avoiding strenuous physical activity, may be recommended for a certain period.
- Instructions on how to care for the site, including any dressing changes, will be provided.
- You may experience mild discomfort or soreness at the catheter insertion site or in the treated area. Pain medications or analgesics may be prescribed to manage any discomfort. Blood thinners/ antiplatelet medications (such as aspirin) are usually prescribed to prevent blood clot formation.
- Patients may experience some discomfort or pain at the puncture site. Pain medications may be provided as needed.
- Follow-up appointments with the healthcare provider are typically scheduled to monitor the patient's progress.
Risks and Complications
Drug-coated balloon angioplasty is a relatively safe procedure; however, as with any surgery some risks and complications may occur, such as:
- Bleeding/hematoma formation
- Infection
- Damage to artery
- Allergic reactions
- Blood clot formation
- Restenosis
- Stroke
- Kidney damage
Benefits
Some of the benefits of drug-coated balloon angioplasty include:
- Reduced restenosis rates
- Minimized need for additional stents
- Preservation of vessel architecture
- Improved long-term outcomes
- Treatment options for challenging lesions
- Reduced risk of in-stent restenosis
