Antiplatelet treatment after drug-coated balloon treatment: Review of the current evidence and future perspectives.

Drug eluting stents (DES) are the standard treatment for percutaneous coronary intervention (PCI) in real-world clinical practice. However, the implantation of DES is associated with significant limitations, such as the development of neo-atherosclerosis and a persistent risk of stent failure during mid- and long-term follow-up. Currently, dual antiplatelet therapy (DAPT) after stent implantation is required for at least 1 month, with the majority of patients receiving DAPT treatment for 6 to 12 months, which carries an inherent increased risk of bleeding complications. Drug-coated balloons (DCB) are alternative to DES in some lesion settings, such as in-stent restenosis or small coronary artery disease (CAD), with promising initial results also in other clinical or lesion settings, such as acute coronary syndromes, de novo lesions and complex CAD. Although the safety of DCB has been shown in several studies, the optimal regimen and duration of antiplatelet therapy (APT) after DCB treatment remain unclear. In this study, we review the current evidence on protocol-mandated antiplatelet therapies across DCB studies and propose an antiplatelet algorithm for patients with CAD treated with DCB.