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At least 18 different drug-eluting balloons are being developed by medical device companies for treatment of either de novo or restenotic coronary artery disease. This re-emergence of enthusiasm for balloon-only treatment rather then stent implantation, might be considered surprising by those cardiologists who experienced the vagaries of ‘stentless’ coronary intervention in the late 1980s. Plain old balloon angioplasty (POBA) was unpredictable because of its tendency to create eccentric, potentially occlusive dissection flaps and the impact of early vessel recoil within the first few hours of the procedure. Restenosis after POBA was common and it reflected adverse vessel remodelling and some neointimal proliferation and extracellular matrix production by vascular smooth muscle cells.1 The advent of stent implantation provided the opportunity to scaffold dissection, optimising acute lumen gain and preventing early recoil and late remodelling. However, for stenting to be successful in the long term these gains in lumen area had to exceed the inevitable increase in neointima formation caused by the presence of the stent. Using polymer technology to bind antiproliferative drugs to stents has significantly improved the likelihood that drug-eluting stent (DES) implantation will be beneficial, by reducing the volume of neointima that is generated by the presence of the stent. However, DES implantation necessarily attenuates the vessel's healing processes, resulting in delayed and sometimes incomplete endothelialisation and a risk of catastrophic stent thrombosis, particularly if antiplatelet therapy is …
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