Applications and challenges of paclitaxel- coated balloons beyond coronary atherosclerotic heart disease.

Although drug-coated balloons (DCBs) were initially used for treating peripheral vascular diseases, with the growing popularity of the implant-free concept, they have gained increasing attention as a novel therapeutic strategy for coronary atherosclerotic heart disease. The clinical application scope of DCBs, represented by paclitaxel-coated balloons (PCBs), is constantly expanding. Their application fields are no longer limited to lesions of coronary artery and peripheral vascular diseases, and relevant research is also being actively advanced. In the field of arterial diseases, the application of PCBs has significantly extended. They are used in lower extremity arteries and hemodialysis access and play a role in renal artery fibromuscular dysplasia, and carotid/vertebrobasilar/intracranial arteries. PCBs also show unique value in the treatment of Takayasu arteritis, Kawasaki disease, coronary myocardial bridge, and pulmonary artery diseases. In the venous system, PCBs also have therapeutic potential, with research and clinical investigations now extending to lower extremity, central, and pulmonary vein diseases, and innovative solutions for graft stenosis. The application of PCBs is no longer confined to vascular diseases. They are gradually breaking through traditional boundaries in treating luminal disorders such as urethral, biliary, and esophageal strictures. This mini-review synthesizes existing clinical evidence and basic research findings to concisely analyze the mechanisms of action and biological effects of PCBs in noncoronary applications. A comprehensive analysis of current studies provides a reference for subsequent research and clinical practice in this field and explicitly identifies the challenges faced by current research, explores future directions, and facilitates the in-depth extension of DCB applications.