Instent restenosis (ISR) remains the weak point of coronary angioplasty despite the advent of drug-eluting stents.The drug eluting balloon (DEB), which in contact of the artery wall releases an antiproliferative agent, could be an option to treat ISR or some de novo lesions.

Between October 2013 and December 2014 in our center, all patients treated with DEB for RIS or de novo lesions were identified. ISR was defined as a stenosis of more than 50% or a measuring FFR≤0,8 to a site previously treated by stent. The lesion was first treated by compliant balloon then DEB (SeQuent Please^® laboratory Braun^® B) was inflated for 30 seconds and then removed. Angiographic control was achieved and, in case of incomplete result or complication, a stent could be implanted.

Among the 48 patients treated with DEB, 23 were for ISR and 25 for de novo lesions. The average age of patients was 75.7 years. 31% of patients were part of a long-term anticoagulation for atrial fibrillation. The clinical presentation was mostly a stable angina (62%). In 26% of ISR, there was in DES restenosis, the average time of ISR was 2 years±3.9. The average diameter of the DEB used was 2.4mm±0.4 for an average length of 17mm±4.7mm. For five patients (10%) has a complement of stent implantation (DES in 60% of cases). The double antiaggregation was continued during 3.8 months. In-hospital, one death appeared. In the mean follow up of 6.5 months (maximum one year) no deaths were reported. After revascularization 8% of patients had a clinical relapse, 12.5% had a positive ischemic test. In 10.4% of cases, a significant rest-enosis in angioplasty site DEB (TLR) has been highlighted, and requiring a new revascularization.The average period for TLR was 7.6 months±4.

The DEB is a safe option mainly for ISR and for small caliber arteries, or bifurcation lesions or in the elderly or in long-term anticoagulation. The clinical course is often satisfactory.