Consensus Statement on Drug-Coated Balloons in Coronary Artery Disease from the Cardiovascular Intervention Association of Thailand

Abstract

Background: Drug-coated balloons (DCBs) have transformed percutaneous coronary intervention (PCI) by delivering antiproliferative drugs without leaving a permanent scaffold. DCB is initially indicated for in-stent restenosis (ISR) and now has expanded indication for treating small vessel disease and bifurcation lesions. However, there is a heterogeneity in the patient and lesion selection, lesion preparation techniques, and the optimal duration of dual antiplatelet therapy after DCB angioplasty. The Cardiovascular Intervention Association of Thailand (CIAT) developed a consensus statement on DCB use in coronary interventions. Methods: The CIAT expert panel systematically reviewed randomized controlled trials, meta-analyses, and real-world studies evaluating DCB therapy. Procedural strategies, imaging guidance, physiologic assessment, and antiplatelet therapy protocols were appraised. The recommendations were developed and put to an online vote. Consensus was defined when the recommendation reached 80% of votes in support of “agree” or “neutral”. Results: Clinical evidence demonstrates that DCBs achieve comparable outcomes to drug-eluting stents (DESs) in selected lesions while enabling shorter durations of dual antiplatelet therapy (DAPT), particularly beneficial for high-bleeding-risk patients. Optimal outcomes require meticulous lesion preparation, appropriate balloon sizing, and controlled vessel dissection. Intravascular imaging and physiologic assessment further refine procedural precision, while hybrid strategies combining DCBs and DESs address complex lesions and multivessel disease. The final document presents 15 consensus statements addressing indications, procedural techniques, imaging and physiologic guidance, and antiplatelet therapy recommendations. Conclusions: DCB angioplasty can be an alternative or complement to therapeutic options to DESs across multiple clinical and anatomical scenarios. The CIAT consensus provided structured recommendations to support DCB therapy in contemporary practice.