Stentless Angioplasty with Drug-Coated Balloons (DCB)

Stentless angioplasty (also called drug-coated balloon, or DCB, angioplasty) is a catheter-based coronary intervention that opens a narrowed artery using a balloon coated with an anti-restenotic drug (a drug that helps prevent the artery from narrowing again at that spot), instead of a permanent stent. The balloon delivers the drug to the vessel wall and is then withdrawn, leaving nothing implanted.

Coronary Angioplasty/PCI

DCB stands for Drug-Coated Balloon. In simple terms, here's how it works:

• A catheter is guided to the coronary blockage.
• The blockage is prepared and opened using standard balloon angioplasty.
• A drug-coated balloon is positioned across the treated segment.
• The balloon is inflated to deliver an anti-restenotic drug directly to the vessel wall.
• The balloon is removed.
• No permanent stent is left behind.

Drug-Coated Balloon (DCB) and stentless angioplasty are closely related terms. DCB angioplasty uses a balloon coated with an anti-restenotic drug. When a coronary lesion is successfully treated this way without implanting a stent, it may be described as stentless PCI or DCB-only PCI. These terms are used somewhat interchangeably by patients and referring physicians alike.

In-Stent Restenosis DCB is well established for treating in-stent restenosis (a blockage that recurs inside a previously placed stent) in appropriately selected cases.

Small-Vessel Coronary Disease In smaller coronary arteries, avoiding a second permanent metal layer can be particularly relevant, and DCB is a routinely considered option here.

Selected De Novo Lesions Some previously untreated blockages (de novo lesions: blockages that haven't been treated before) can also be suitable for DCB-only treatment, when adequate lesion preparation and a good angiographic result are achieved.

Calcified Coronary Lesions Calcium doesn't automatically rule out DCB. With adequate preparation, including rotablation in more heavily calcified vessels, DCB can still be used to complete the treatment.

Chronic Total Occlusions (CTO) DCB is also used as part of treating CTOs (arteries that have been completely blocked, often for an extended period), once the occlusion has been successfully crossed and prepared.

Left Main Bifurcation Lesions The left main coronary artery, where it splits into two branches (a bifurcation), is treated differently: Dr. Kulin Sheth generally uses a combination of a drug-eluting stent (DES) and DCB here, rather than DCB alone.

Complex & High-Risk PCI

DCB doesn't provide mechanical scaffolding. It treats the vessel wall but doesn't hold the artery open the way a stent does. A stent becomes necessary when:

DCB is a lesion-specific strategy, not a general preference to avoid stents. The result achieved after preparing the lesion is what actually determines whether the artery can safely be left without a stent.

• There's significant vessel recoil after the balloon is removed
• A flow-limiting or significant dissection occurs
• Lesion preparation doesn't achieve an adequate result
• Significant narrowing persists despite balloon treatment

The choice comes down to more than "stent vs. no stent." A drug-coated balloon provides no mechanical scaffolding, so the artery has to stay open on its own after treatment. DCB avoids a permanent implant, but it isn't appropriate for every lesion.

Where there's a meaningful risk of the artery recoiling or a significant dissection, Dr. Kulin generally recommends a conventional stent. Where either approach is clinically reasonable, he lays out both options and decides with the patient rather than defaulting to one. In more complex anatomy (a heavily calcified vessel or a CTO), DCB is often used in combination with another technique, such as rotablation for calcium, rather than on its own.

The decision typically weighs: vessel size, lesion location, calcium burden, how the lesion responds to initial preparation, vessel recoil, any dissection, and the overall angiographic result achieved during the procedure itself.

Similar to conventional angioplasty: a catheter reaches the blockage, the lesion is prepared with a standard balloon, and the drug-coated balloon is then positioned and inflated at the site to treat the vessel wall before being withdrawn.

Preparing for Procedures

Recovery is generally comparable to a standard angioplasty procedure.

Recovery & Follow-up

Risks are broadly similar to those of conventional angioplasty, reviewed with you ahead of the procedure based on the specific case.

Dr. Kulin performs approximately 80–100 DCB procedures a year at Apollo CVHF. That covers most lesion types suited to DCB, including CTOs and calcified lesions prepared with rotablation before DCB treatment. Left main bifurcation disease is treated differently: he generally uses a combination of a drug-eluting stent and DCB rather than DCB alone. Where the choice between DCB and a stent is genuinely close, he discusses both options directly with the patient as part of the treatment decision.

Apollo CVHF Hospital is a high-volume centre for DCB/Stentless PCI procedures in India.