How to treat a de novo lesion with a DEB

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How to treat an de novo lesion with a Drug Eluting Balloon (DEB)

by courtesy of Dr. Alfredo Rodriguez (Sanatorio Otamendi, Buenos Aires)

Fig.1 Diagnostic LAD

Fig.2 Balloon DEB

Fig.3 Post DEB

Fig.4 Post Stent

Fig.5 6 months follow up 1

fig. 6 6 months follow up 2


  1. This case example is related a severe lesion in the proximal LAD. We usually use the right cranial oblique, which offers a good view on the lesion and you can see the length, diameter and morphology of the lesion. (Fig.1)
  2. A pre-dilatation with a regular balloon is mandatory. The size of balloon should be around 0.7-0.8:1 (2.5 balloon in the 3.0 diameter reference vessel). The pre-dilatation balloon must be shorter than the drug-eluting balloon. Please inflate the balloon at nominal pressure. Extent dissection with balloon equal or bigger than the diameter reference and insufflations at high pressurization should be avoided.
  3. If the angiographic result is good (defined as 30% residual stenosis or less without flow-limiting dissection or the clinical need for stent implantation), then proceed to the DEB treatment with the DIOR® balloon. (Fig. 2)
  4. How do you choose de DEB? The ideal DEB is 1:1 relation balloon to reference diameter of the vessel and it should be longer at least 3 mm each side of lesion in order to avoid geographical missing.
  5. The DEB should be insufflated at least for 45 seconds to deliver almost total the drug of the paclitaxel at nominal pressure. If the patient has hemodynamic instability it can be fractionated in 3 insufflations of 20 seconds – however do not change the balloon position in between inflations. (Fig 3)
  6. In the event that a good angiographic result is not obtained post DIOR® inflation, bail-out stenting will be allowed (BMS is recommended), but those patients requiring bail-out stenting will be excluded from the final endpoint analysis. Nevertheless, these patients` data will be collected in the database. (Fig 4)
  7. Prescribe dual antiplatelet therapy for only 3 months after the procedure.
  8. A follow up at 6 – 9 months. (Fig 5 and 6)
  9. Good luck!