Current landscape and future directions of drug-eluting balloons in cardiovascular interventions.

Cardiovascular disease (CVD) is the leading threat to human health and has the highest morbidity and mortality rates worldwide. Compared with drug-eluting stents (DES), drug-eluting balloons (DEB) could offer better safety and efficacy in the treatment of in-stent restenosis (ISR) and small vessel disease (SVD), due to the ability to homogeneously transfer the drug into the vessel wall without leaving permanent stents in the coronary vessel. However, the high drug loss and low drug utilization limit the DEB use in clinical. The smart response technology can improve the drug delivery and targeting ability of DEB to achieve controlled drug delivery and release processes, which could address the shortcoming of DEB such as high drug loss and low drug utilization. There have been studies using light-driven, gas-driven, ultrasound (US)-responsive, reactive oxygen species (ROS)-responsive, and microneedle (MN) smart response technologies to construct smart DEB developing. This paper reviews the research progress of DEB in recent years from the smart DEB, aiming to address their limitations in clinical applications and provide guidance for the development of DEB.