Drug-Eluting Therapies in Coronary Artery Disease

Percutaneous coronary intervention has evolved markedly with the introduction of drug-eluting devices designed to inhibit neointimal proliferation and reduce the risk of restenosis. Drug-eluting stents (DES) combine a metallic scaffold with a polymer coating that releases antiproliferative agents such as sirolimus or everolimus over a controlled period. Second- and third-generation DES feature thinner struts, biocompatible or bioresorbable polymers and refined drug kinetics to minimise inflammation and late thrombosis. More recently, drug-coated balloons (DCB) have emerged as an alternative “leave-nothing-behind” strategy. DCBs deliver antiproliferative drug to the vessel wall without permanent implantation of a scaffold, which may shorten the requirement for dual antiplatelet therapy and preserve future surgical options. Clinical application spans treatment of small-vessel disease, in-stent restenosis and selected de novo lesions, including complex anatomies such as calcified and bifurcation lesions. Technological advances in balloon surface modification, drug carrier matrices and lesion preparation techniques have extended the scope of DCB use. Integration of physiological guidance with fractional flow reserve (FFR) and intravascular imaging has optimised patient selection and procedural outcomes. Together, DES and DCB therapies have reshaped revascularisation algorithms, offering tailored approaches that balance efficacy, safety and long-term vessel integrity.

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Drug-Eluting Therapies in Coronary Artery Disease publication trend

The graph below shows the total number of articles in drug-eluting therapies in coronary artery disease across all publications each year (not limited to Nature Index journals).

Technical terms

Drug-eluting stent (DES): A fixed scaffold coated with antiproliferative drug and polymer to inhibit neointimal growth and reduce restenosis.

Drug-coated balloon (DCB): An angioplasty balloon coated with an antiproliferative agent that transfers drug to the vessel wall without leaving a permanent implant.

Neointimal hyperplasia: Proliferation of smooth muscle cells and extracellular matrix within the vessel lumen following injury.

Restenosis: Re-narrowing of a treated coronary segment, typically defined as ≥50% luminal reduction on follow-up angiography.

Dual antiplatelet therapy (DAPT): Combined use of aspirin and a P2Y12 receptor inhibitor to prevent thrombotic complications after device implantation.

Fractional flow reserve (FFR): A physiological index measuring pressure gradient across a coronary lesion to guide revascularisation decisions.

References

1. Drug-coated balloon-based versus drug-eluting stent-only revascularization in patients with diabetes and multivessel coronary artery disease. Cardiovascular Diabetology (2023).
2. A Non-inferiority, Randomized Clinical Trial Comparing Paclitaxel-Coated Balloon Versus New-Generation Drug-Eluting Stents on Angiographic Outcomes for Coronary De Novo Lesions. Cardiovascular Drugs and Therapy (2021).
3. Clinical expert consensus document on drug-coated balloon for coronary artery disease from the Japanese Association of Cardiovascular Intervention and Therapeutics. Cardiovascular Intervention and Therapeutics (2023).