Intervention in Small Vessels
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Anum Ijaz M.B.B.S., M.D.[2]
Overview
Small vessel coronary artery disease is one of the most frequent lesion subsets encountered during percutaneous coronary intervention, and it is more common in women, in patients with diabetes mellitus or chronic kidney disease, in distal coronary segments and in bifurcation lesions. There is no single accepted definition; randomized trials have used reference vessel diameter thresholds between 2.5 mm and 3.0 mm, and a standardized cut-off below 2.5 mm, measured preferably by intracoronary imaging, has been proposed. Angiography frequently underestimates the true diameter of these vessels, so intravascular imaging is useful to confirm that a vessel is genuinely small before a treatment strategy is chosen.
Small vessels carry a higher risk of restenosis and target lesion failure after stent implantation than larger vessels. New-generation drug-eluting stents remain the default treatment, and thinner stent struts are associated with fewer repeat revascularizations. A drug-coated balloon strategy, which leaves no permanent metallic scaffold and permits a shorter course of dual antiplatelet therapy, is the best-supported alternative in de novo small vessel disease: paclitaxel-coated balloons, used after adequate lesion preparation, have produced clinical outcomes comparable to second-generation drug-eluting stents up to three years. The benefit does not extend to vessels of 3.0 mm or larger and is not a class effect across devices: sirolimus-coated balloon performance depends on the coating formulation, and no sirolimus-coated balloon has yet been shown to match drug-eluting stents specifically in small vessels. Diabetes mellitus and high bleeding risk are the settings in which avoiding further metal and shortening dual antiplatelet therapy are most appealing, although the supporting data come from subgroup analyses.
Because small vessels are prone to restenosis, in-stent restenosis is the second major small vessel indication for a drug-coated balloon, which treats the lesion without adding a further layer of metal. A paclitaxel-coated balloon is superior to uncoated balloon angioplasty for in-stent restenosis, with a consistent effect in small vessels, and received US Food and Drug Administration approval for this indication in 2024; the 2024 ESC guidelines, however, recommend a drug-eluting stent over a drug-coated balloon for restenosis within a drug-eluting stent. Intravascular imaging is useful beyond sizing: guidance of drug-coated balloon angioplasty improves the angiographic result, and imaging guidance is recommended for anatomically complex lesions. No ACC/AHA/SCAI or ESC guideline currently carries a recommendation specific to small vessel intervention.
Definition
- There is no universally accepted definition of small vessel coronary artery disease; randomized trials have used reference vessel diameter thresholds of less than 2.5 mm, 2.75 mm or less, and less than 3.0 mm, which limits comparison between studies.[1]
- A standardized cut-off of a reference vessel diameter below 2.5 mm has been proposed, measured preferably by intracoronary imaging, with quantitative coronary angiography or visual estimation used only when imaging is not available.[1]
- Consensus documents on drug-coated balloons apply the small vessel evidence to vessels of 2.75 mm or less, or less than 3.0 mm,[2] or to a reference diameter below 2.75 mm.[3]
Epidemiology and Demographics
- Small vessel disease is present in roughly 30% to 67% of patients undergoing percutaneous coronary intervention, the range reflecting the different definitions in use.[1]
- It is more common in women and in patients with diabetes mellitus or chronic kidney disease, and it clusters in distal coronary segments and in the side branches of bifurcation lesions.[1]
Prognosis
- Stent implantation in small vessels carries a higher risk of target lesion failure and other adverse cardiovascular events than stenting of larger vessels.[1][4]
- New-generation drug-eluting stents have substantially reduced restenosis in small vessels compared with earlier devices, but small vessel disease remains an unmet clinical need.[1]
Lesion Assessment
- Coronary angiography frequently underestimates the true diameter of a vessel that appears small, and positive and negative remodeling are common in small vessels, making the angiographic lumen particularly misleading.[1]
- Intravascular ultrasound and optical coherence tomography define the true lumen shape and size better than angiography and should be used, where available, to confirm vessel size before a small vessel strategy is chosen.[1]
- Intracoronary imaging guidance by intravascular ultrasound or optical coherence tomography is recommended for percutaneous coronary intervention of anatomically complex lesions, in particular the left main stem, true bifurcations and long lesions, settings in which small vessels are frequently involved.[5][1]
- Imaging also guides the intervention itself: intravascular ultrasound-guided drug-coated balloon angioplasty produces less late lumen loss and a larger minimal lumen diameter than angiography-guided treatment of de novo lesions in vessels of 2.0 mm to 4.0 mm, although a reduction in clinical events has not been shown.[6]
- Few patients in the randomized comparisons of drug-coated balloons and drug-eluting stents in small vessels underwent physiological or intravascular imaging guidance, so whether imaging improves the clinical outcome of a drug-coated balloon strategy specifically in small vessels has not been established.[7]
Treatment
Drug-Eluting Stents
- New-generation drug-eluting stents perform well in small vessel disease and remain the default treatment.[1]
- Thinner stent struts are associated with lower rates of angiographic restenosis and clinically driven revascularization in small vessels.[1]
- In small vessels, ultrathin-strut sirolimus-eluting stents reduce repeat target lesion revascularization compared with previous-generation thin-strut zotarolimus-eluting stents, without a difference in cardiac death, target vessel myocardial infarction or stent thrombosis.[4]
- The evidence is not uniform: a thin composite-wire-strut zotarolimus-eluting stent and an ultrathin-strut sirolimus-eluting stent have produced similar target vessel failure and target lesion revascularization in small vessels.[8]
- Drug-eluting stent platforms of 2.0 mm and 2.25 mm diameter are available and are associated with low rates of target lesion revascularization in vessels of 2.25 mm or less.[1]
Drug-Coated Balloon and Hybrid Strategies
- A drug-coated balloon strategy leaves no permanent metallic scaffold in the vessel and allows a shorter course of dual antiplatelet therapy, both of particular relevance in small vessels.[1]
- De novo small vessel disease is the de novo indication with the strongest randomized support for drug-coated balloons, which are non-inferior to second-generation drug-eluting stents in vessels of 2.75 mm or less or less than 3.0 mm.[2]
- After successful predilatation, a paclitaxel-coated balloon is non-inferior to a second-generation drug-eluting stent for the composite of cardiac death, non-fatal myocardial infarction and target vessel revascularization at one year in vessels of less than 3.0 mm.[9]
- This equivalence is maintained to three years, with similar rates of cardiac death, myocardial infarction, target vessel revascularization and all-cause death.[10]
- Paclitaxel-coated balloons produce less angiographic late lumen loss than everolimus-eluting stents in vessels of 2.75 mm or less,[11] and in one trial this was accompanied by fewer major adverse cardiac events and vessel thromboses at three years.[12]
- Paclitaxel-coated balloons also produce less late lumen loss than paclitaxel-eluting stents in vessels below 2.8 mm,[13] and are angiographically non-inferior to zotarolimus-eluting stents in vessels of 2.25 mm to 2.75 mm, with comparable one-year target lesion failure.[14]
- Pooled patient-level data suggest fewer major adverse cardiac events with paclitaxel-coated balloons than with drug-eluting stents at three years, driven by less myocardial infarction and target vessel revascularization. This signal is not robust across analytic methods, target lesion failure does not differ, and no advantage is seen when the comparison is limited to second-generation drug-eluting stents, so a drug-coated balloon should be regarded as an alternative to, not an improvement on, a contemporary drug-eluting stent.[15]
- Diabetes mellitus is common among patients with small vessel disease; in a prespecified diabetic subgroup, drug-coated balloons produced major adverse cardiac event rates similar to drug-eluting stents with less target vessel revascularization at three years, but this is supported only by subgroup data and should not be regarded as established.[16][1]
- The evidence is not uniformly positive. In a large trial of unselected non-complex de novo lesions, paclitaxel-coated balloon angioplasty with rescue stenting failed to show non-inferiority to intended drug-eluting stent implantation; the excess in device-oriented events was concentrated in vessels of 3.0 mm or larger and was much smaller in vessels below 3.0 mm.[17]
- The excess target lesion revascularization with drug-coated balloons in that population persisted to three years without a difference in cardiac death or target vessel myocardial infarction; a drug-eluting stent should be preferred in de novo vessels of 3.0 mm or larger.[18]
- There is no class effect among drug-coated balloons: balloon design, drug dose, coating formulation and release kinetics all influence results, so outcomes from one device should not be extrapolated to another.[2]
- The performance of sirolimus-coated balloons depends on the coating formulation. In de novo small vessels, one sirolimus-coated balloon produced greater late lumen loss and more restenosis than a paclitaxel-coated balloon,[19] whereas a crystalline sirolimus coating was angiographically non-inferior to a paclitaxel-coated balloon in de novo vessels of 2.5 mm or larger.[20]
- In de novo lesions of 2.0 mm to 5.0 mm, a strategy of a sirolimus-eluting balloon with provisional stenting is non-inferior to systematic drug-eluting stent implantation for one-year target vessel failure, at the cost of more clinically driven target vessel revascularization, and non-inferiority was not confirmed in the per-protocol analysis.[21]
- Equivalence of any sirolimus-coated balloon to a drug-eluting stent specifically in small vessel disease has not been established.[7][21]
Lesion Preparation and Drug-Coated Balloon Technique
- Lesion preparation is required before drug-coated balloon treatment.[2]
- Predilatation should use a semi-compliant balloon at a 1:1 balloon-to-vessel ratio, adding cutting or scoring balloons for resistant lesions.[3]
- Coronary lithotripsy balloons are available only in diameters of 2.5 mm to 4.0 mm, which limits their use in the smallest calcified vessels; atherectomy is an alternative when a lithotripsy catheter cannot cross the lesion.[22]
- A drug-coated balloon should be applied only when predilatation leaves a residual stenosis of 30% or less and any dissection is non-flow-limiting with TIMI 3 flow.[3][9]
- A fractional flow reserve above 0.80 may help confirm that a residual dissection is acceptable.[2]
- The drug-coated balloon should extend at least 2 mm proximal and distal to the prepared segment, the manufacturer's maximum transit time and minimum inflation time should be observed, and the same balloon should generally not be reinserted.[2]
- Lesions that do not meet these criteria after preparation should be treated with a drug-eluting stent.[9][17]
In-Stent Restenosis in Small Vessels
- Small vessels carry a higher risk of restenosis after stenting, and a drug-coated balloon allows in-stent restenosis to be treated without implanting a further layer of metal inside the failed stent.[1][23]
- Drug-coated balloons are an established treatment for restenosis of both bare-metal and drug-eluting stents.[2]
- A paclitaxel-coated balloon reduces target lesion failure, target lesion revascularization and target vessel myocardial infarction compared with uncoated balloon angioplasty for in-stent restenosis in vessels of 2.0 mm to 4.0 mm,[24] and the benefit is consistent in vessels of 2.75 mm or less, with no interaction by vessel size.[25]
- This paclitaxel-coated balloon was approved by the US Food and Drug Administration in 2024 for coronary in-stent restenosis.[26]
- The evidence is not uniformly positive. European guidance previously gave drug-coated balloons the highest class of recommendation for in-stent restenosis, but the 2024 ESC guidelines recommend a drug-eluting stent over a drug-coated balloon for restenosis within a drug-eluting stent; the trial supporting US approval compared the balloon with uncoated balloon angioplasty, not with a drug-eluting stent.[5][7][24]
Adjunctive Antiplatelet Therapy
- After drug-coated balloon-only treatment of a de novo lesion in chronic coronary syndrome, four weeks of dual antiplatelet therapy is recommended by consensus, which makes the strategy attractive in patients at high bleeding risk; this duration rests on expert opinion rather than randomized evidence.[2][27]
- In small vessels, drug-coated balloons are as effective as drug-eluting stents regardless of bleeding risk, but a reduction in major bleeding has not been shown in patients at high bleeding risk, and the overall trend towards less major bleeding did not reach significance.[28][10]
- In acute coronary syndrome treated with drug-coated balloons alone, stepwise de-escalation (aspirin plus ticagrelor for one month, ticagrelor monotherapy to six months, then aspirin monotherapy) is non-inferior to 12 months of dual antiplatelet therapy for net adverse clinical events and reduces major bleeding; this evidence comes from a predominantly East Asian population and was not restricted to small vessels.[29]
Management Algorithm
The algorithm below summarizes the management steps supported by the evidence cited in this chapter.[1][18][24][5][3][22][9][10][15][19][2]
Lesion in a small coronary vessel Angiographic reference diameter below 3.0 mm | |||||||||||||||||||||||||||||||||||||||||||||||
Measure the reference diameter Use intravascular ultrasound or optical coherence tomography where available, because angiography tends to underestimate vessel size | |||||||||||||||||||||||||||||||||||||||||||||||
True reference diameter 3.0 mm or larger Treat as a standard-size vessel with a drug-eluting stent | De novo lesion, reference diameter below 3.0 mm | In-stent restenosis Paclitaxel-coated balloon or repeat drug-eluting stent; the 2024 ESC guidelines prefer a drug-eluting stent for restenosis within a drug-eluting stent | |||||||||||||||||||||||||||||||||||||||||||||
Prepare the lesion ❑ Semi-compliant balloon at a 1:1 balloon-to-vessel ratio ❑ Cutting or scoring balloon for resistant lesions ❑ Atherectomy for severe calcification in vessels below 2.5 mm, or when a lithotripsy catheter cannot cross | |||||||||||||||||||||||||||||||||||||||||||||||
Assess the result of lesion preparation | |||||||||||||||||||||||||||||||||||||||||||||||
Residual stenosis 30% or less, no flow-limiting dissection, TIMI 3 flow A drug-coated balloon-only strategy may be chosen as an alternative to a drug-eluting stent, using a paclitaxel-coated device with randomized small vessel data | Criteria not met Implant a new-generation thin-strut drug-eluting stent | ||||||||||||||||||||||||||||||||||||||||||||||
After drug-coated balloon application: residual stenosis above 30% or a flow-limiting dissection? | |||||||||||||||||||||||||||||||||||||||||||||||
Yes Bailout drug-eluting stent | No Finish without a stent; four weeks of dual antiplatelet therapy for a de novo lesion, as recommended by consensus | ||||||||||||||||||||||||||||||||||||||||||||||
Complications
- Bailout stent implantation after drug-coated balloon treatment of small vessels is needed in roughly 5% to 20% of lesions, most often for a flow-limiting dissection or an inadequate residual lumen.[14][13]
- Thrombotic events are uncommon after either strategy. The absence of a permanent scaffold was associated with fewer vessel thromboses in one trial, but a consistent reduction in stent thrombosis or vessel thrombosis has not been shown.[12][10]
- Restenosis requiring repeat target lesion revascularization is more frequent with drug-coated balloons than with drug-eluting stents in vessels of 3.0 mm or larger.[18]
- Observational registry data have associated drug-coated balloon treatment with a higher risk of restenosis than drug-eluting stent implantation, in contrast to the randomized small vessel trials; this signal is supported only by observational data and should not be regarded as established.[1]
References
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 Sanz-Sánchez J, Chiarito M, Gill GS, van der Heijden LC, Piña Y, Cortese B; et al. (2022). "Small Vessel Coronary Artery Disease: Rationale for Standardized Definition and Critical Appraisal of the Literature". Journal of the Society for Cardiovascular Angiography & Interventions. 1 (5): 100403. doi:10.1016/j.jscai.2022.100403. Retrieved 2026-09-23.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 Jeger RV, Eccleshall S, Wan Ahmad WA, Ge J, Poerner TC, Shin ES; et al. (2020). "Drug-Coated Balloons for Coronary Artery Disease: Third Report of the International DCB Consensus Group". JACC: Cardiovascular Interventions. 13 (12): 1391–1402. doi:10.1016/j.jcin.2020.02.043. PMID 32473887 Check
|pmid=value (help). Retrieved 2026-09-23. - ↑ 3.0 3.1 3.2 3.3 Fezzi S, Serruys PW, Cortese B, Scheller B, Alfonso F, Jeger R; et al. (2025). "Indications for Use of Drug-Coated Balloons in Coronary Intervention: Academic Research Consortium Position Statement". Journal of the American College of Cardiology. 86 (15): 1170–1202. doi:10.1016/j.jacc.2025.07.049. Retrieved 2026-09-23.
- ↑ 4.0 4.1 Buiten RA, Ploumen EH, Zocca P, Doggen CJM, van der Heijden LC, Kok MM; et al. (2019). "Outcomes in Patients Treated With Thin-Strut, Very Thin-Strut, or Ultrathin-Strut Drug-Eluting Stents in Small Coronary Vessels". JAMA Cardiology. 4 (7): 659. doi:10.1001/jamacardio.2019.1776. Retrieved 2026-09-23.
- ↑ 5.0 5.1 5.2 Vrints C, Andreotti F, Koskinas KC, Rossello X, Adamo M, Ainslie J; et al. (2024). "2024 ESC Guidelines for the management of chronic coronary syndromes". European Heart Journal. 45 (36): 3415–3537. doi:10.1093/eurheartj/ehae177. Retrieved 2026-09-24.
- ↑ Gao XF, Ge Z, Kong XQ, Chen X, Han L, Qian XS; et al. (2024). "Intravascular Ultrasound vs Angiography-Guided Drug-Coated Balloon Angioplasty: The ULTIMATE III Trial". JACC: Cardiovascular Interventions. 17 (13): 1519–1528. doi:10.1016/j.jcin.2024.04.014. PMID 38842991 Check
|pmid=value (help). Retrieved 2026-09-24. - ↑ 7.0 7.1 7.2 Lalani C, Secemsky EA, Yeh RW (2025). "Drug-coated balloons in small vessel de novo coronary artery disease: better than DES?". European Heart Journal. 46 (17): 1600–1602. doi:10.1093/eurheartj/ehaf083. PMID 40036794 Check
|pmid=value (help). Retrieved 2026-09-23. - ↑ Buiten RA, Ploumen EH, Zocca P, Doggen CJM, Jessurun GAJ, Schotborgh CE; et al. (2020). "Thin Composite-Wire-Strut Zotarolimus-Eluting Stents Versus Ultrathin-Strut Sirolimus-Eluting Stents in BIONYX at 2 Years". JACC: Cardiovascular Interventions. 13 (9): 1100–1109. doi:10.1016/j.jcin.2020.01.230. Retrieved 2026-09-23.
- ↑ 9.0 9.1 9.2 9.3 Jeger RV, Farah A, Ohlow MA, Mangner N, Möbius-Winkler S, Leibundgut G; et al. (2018). "Drug-coated balloons for small coronary artery disease (BASKET-SMALL 2): an open-label randomised non-inferiority trial". The Lancet. 392 (10150): 849–856. doi:10.1016/S0140-6736(18)31719-7. Retrieved 2026-09-23.
- ↑ 10.0 10.1 10.2 10.3 Jeger RV, Farah A, Ohlow MA, Mangner N, Möbius-Winkler S, Weilenmann D; et al. (2020). "Long-term efficacy and safety of drug-coated balloons versus drug-eluting stents for small coronary artery disease (BASKET-SMALL 2): 3-year follow-up of a randomised, non-inferiority trial". The Lancet. 396 (10261): 1504–1510. doi:10.1016/S0140-6736(20)32173-5. Retrieved 2026-09-23.
- ↑ Cortese B, Di Palma G, Guimaraes MG, Piraino D, Silva Orrego P, Buccheri D; et al. (2020). "Drug-Coated Balloon Versus Drug-Eluting Stent for Small Coronary Vessel Disease: PICCOLETO II Randomized Clinical Trial". JACC: Cardiovascular Interventions. 13 (24): 2840–2849. doi:10.1016/j.jcin.2020.08.035. PMID 33248978 Check
|pmid=value (help). Retrieved 2026-09-23. - ↑ 12.0 12.1 Cortese B, Testa G, Rivero F, Erriquez A, Alfonso F (2023). "Long-Term Outcome of Drug-Coated Balloon vs Drug-Eluting Stent for Small Coronary Vessels: PICCOLETO-II 3-Year Follow-Up". JACC: Cardiovascular Interventions. 16 (9): 1054–1061. doi:10.1016/j.jcin.2023.02.011. Retrieved 2026-09-23.
- ↑ 13.0 13.1 Latib A, Colombo A, Castriota F, Micari A, Cremonesi A, De Felice F; et al. (2012). "A Randomized Multicenter Study Comparing a Paclitaxel Drug-Eluting Balloon With a Paclitaxel-Eluting Stent in Small Coronary Vessels: The BELLO (Balloon Elution and Late Loss Optimization) Study". Journal of the American College of Cardiology. 60 (24): 2473–2480. doi:10.1016/j.jacc.2012.09.020. PMID 23158530. Retrieved 2026-09-23.
- ↑ 14.0 14.1 Tang Y, Qiao S, Su X, Chen Y, Jin Z, Chen H; et al. (2018). "Drug-Coated Balloon Versus Drug-Eluting Stent for Small-Vessel Disease: The RESTORE SVD China Randomized Trial". JACC: Cardiovascular Interventions. 11 (23): 2381–2392. doi:10.1016/j.jcin.2018.09.009. PMID 30522667. Retrieved 2026-09-23.
- ↑ 15.0 15.1 Fezzi S, Giacoppo D, Fahrni G, Latib A, Alfonso F, Colombo A; et al. (2025). "Individual patient data meta-analysis of paclitaxel-coated balloons vs. drug-eluting stents for small-vessel coronary artery disease: the ANDROMEDA study". European Heart Journal. 46 (17): 1586–1599. doi:10.1093/eurheartj/ehaf002. PMID 39981922 Check
|pmid=value (help). Retrieved 2026-09-23. - ↑ Wöhrle J, Scheller B, Seeger J, Farah A, Ohlow MA, Mangner N; et al. (2021). "Impact of Diabetes on Outcome With Drug-Coated Balloons Versus Drug-Eluting Stents: The BASKET-SMALL 2 Trial". JACC: Cardiovascular Interventions. 14 (16): 1789–1798. doi:10.1016/j.jcin.2021.06.025. Retrieved 2026-09-24.
- ↑ 17.0 17.1 Gao C, He X, Ouyang F, Zhang Z, Shen G, Wu M; et al. (2024). "Drug-coated balloon angioplasty with rescue stenting versus intended stenting for the treatment of patients with de novo coronary artery lesions (REC-CAGEFREE I): an open-label, randomised, non-inferiority trial". The Lancet. 404 (10457): 1040–1050. doi:10.1016/S0140-6736(24)01594-0. PMID 39236727 Check
|pmid=value (help). Retrieved 2026-09-23. - ↑ 18.0 18.1 18.2 Tao L, He X, Shen G, Wu M, He Y, Ma L; et al. (2026). "Drug-Coated Balloon Angioplasty vs Up-Front Stenting for De Novo CAD: 3-Year Follow-Up of REC-CAGEFREE I Trial". Journal of the American College of Cardiology. 87 (3): 312–329. doi:10.1016/j.jacc.2025.10.027. Retrieved 2026-09-23.
- ↑ 19.0 19.1 Ninomiya K, Serruys PW, Colombo A, Reimers B, Basavarajaiah S, Sharif F; et al. (2023). "A Prospective Randomized Trial Comparing Sirolimus-Coated Balloon With Paclitaxel-Coated Balloon in De Novo Small Vessels". JACC: Cardiovascular Interventions. 16 (23): 2884–2896. doi:10.1016/j.jcin.2023.09.026. Retrieved 2026-09-23.
- ↑ Scheller B, Mangner N, Jeger RV, Afan S, Mahfoud F, Woitek FJ; et al. (2024). "A randomised trial of sirolimus- versus paclitaxel-coated balloons for de novo coronary lesions". EuroIntervention. 20 (21): e1322–e1329. doi:10.4244/EIJ-D-23-00868. Retrieved 2026-09-24.
- ↑ 21.0 21.1 Spaulding C, Krackhardt F, Bogaerts K, Abdelaal E, Alfonso F, Briguori C; et al. (2026). "Sirolimus-Eluting Balloon With Provisional Stenting Versus Systematic Drug-Eluting Stent Implantation to Treat De Novo Coronary Lesions: A Randomized, Open-Label, Noninferiority Trial". Circulation. 154 (3): 185–197. doi:10.1161/CIRCULATIONAHA.126.079033. Retrieved 2026-09-24.
- ↑ 22.0 22.1 Sorini Dini C, Tomberli B, Mattesini A, Ristalli F, Valente S, Stolcova M; et al. (2019). "Intravascular lithotripsy for calcific coronary and peripheral artery stenoses". EuroIntervention. 15 (8): 714–721. doi:10.4244/EIJ-D-18-01056. Retrieved 2026-09-24.
- ↑ Unverdorben M, Vallbracht C, Cremers B, Heuer H, Hengstenberg C, Maikowski C; et al. (2009). "Paclitaxel-Coated Balloon Catheter Versus Paclitaxel-Coated Stent for the Treatment of Coronary In-Stent Restenosis". Circulation. 119 (23): 2986–2994. doi:10.1161/CIRCULATIONAHA.108.839282. Retrieved 2026-09-24.
- ↑ 24.0 24.1 24.2 Yeh RW, Shlofmitz R, Moses J, Bachinsky W, Dohad S, Rudick S; et al. (2024). "Paclitaxel-Coated Balloon vs Uncoated Balloon for Coronary In-Stent Restenosis: The AGENT IDE Randomized Clinical Trial". JAMA. 331 (12): 1015. doi:10.1001/jama.2024.1361. Retrieved 2026-09-24.
- ↑ Wen J, Dohad S, Shlofmitz R, Moses J, Bachinsky W, Rudick S; et al. (2025). "Paclitaxel-Coated Balloon for the Treatment of Small Vessel In-Stent Restenosis: A Subgroup Analysis of the AGENT IDE Randomized Trial". JACC: Cardiovascular Interventions. 18 (22): 2701–2710. doi:10.1016/j.jcin.2025.09.032. PMID 41297981 Check
|pmid=value (help). Retrieved 2026-09-24. - ↑ "AGENT Paclitaxel-Coated Balloon Catheter – P230035". U.S. Food and Drug Administration. Retrieved 2026-09-24.
- ↑ Fezzi S, Scheller B, Cortese B, Alfonso F, Jeger R, Colombo A; et al. (2025). "Definitions and standardized endpoints for the use of drug-coated balloon in coronary artery disease: consensus document of the Drug Coated Balloon Academic Research Consortium". European Heart Journal. 46 (26): 2498–2519. doi:10.1093/eurheartj/ehaf029. Retrieved 2026-09-24.
- ↑ Scheller B, Rissanen TT, Farah A, Ohlow MA, Mangner N, Wöhrle J; et al. (2022). "Drug-Coated Balloon for Small Coronary Artery Disease in Patients With and Without High-Bleeding Risk in the BASKET-SMALL 2 Trial". Circulation: Cardiovascular Interventions. 15 (4). doi:10.1161/CIRCINTERVENTIONS.121.011569. PMID 35411792 Check
|pmid=value (help). Retrieved 2026-09-24. - ↑ Gao C, Zhu B, Ouyang F, Wen S, Xu Y, Jia W; et al. (2025). "Stepwise dual antiplatelet therapy de-escalation in patients after drug coated balloon angioplasty (REC-CAGEFREE II): multicentre, randomised, open label, assessor blind, non-inferiority trial". BMJ. 388: e082945. doi:10.1136/bmj-2024-082945. Retrieved 2026-09-23.