The Role of Drug-Eluting Balloons as a ‘Leave Nothing Behind’ Strategy in Patients with Chronic Kidney Disease Undergoing Percutaneous Coronary Intervention

Abstract

Background: Patients with chronic kidney disease (CKD) have a high cardiovascular risk and face specific challenges during percutaneous coronary intervention (PCI), including restenosis, chronic vascular inflammation, and bleeding risk related to limitations in long-term antiplatelet therapy. Case: This article discusses the role of drug-eluting balloons (DEB) as a revascularization strategy based on the leave nothing behind concept in CKD patients undergoing PCI. DEB allows local delivery of antiproliferative drugs without leaving a permanent metallic scaffold, thereby potentially reducing long-term inflammation and stentrelated complications. This approach is particularly relevant in conditions such as instent restenosis, small-vessel disease, selected bifurcation lesions, and patients with a high bleeding risk. Results: Clinical evidence shows that DEB provides angiographic and clinical outcomes comparable to drug-eluting stents (DES) in selected indications, with the advantage of potentially shortening the duration of dual antiplatelet therapy. However, the incidence of major adverse cardiovascular events in CKD patients remains higher and is largely influenced by the underlying systemic disease burden