IJCS | Volume 31, Nº4, July / August 2018

456 Garcia-Guimarães et al. Sirolimus-DEB at distal LIMA bypass anastomosis Int J Cardiovasc Sci. 2018;31(4)454-456 Case Report This is an open-access article distributed under the terms of the Creative Commons Attribution License deviceswith limus-type drugs andmoremodern carrying systems, are available. 3 We selected a novel sirolimus- DEB with a carrying system based on nanoparticles that enable an efficient drug transfer. Preclinical studies have shown that these nanocarriers have better bio-availability and in-tissue uptake, therefore, allowing a reduction in the drug dosage, therefore, potentially diminishing vessel toxicity. 3 Preliminary experience with these novel devices appears highly promising. 4 Our findings suggest the value of sirolimus-DEB in the treatment of de novo lesions at the distal anastomosis of LIMA bypass grafts. This therapymay represent a safe and valid alternative to current-generation DES in this setting. However, further studies with long-term clinical and angiographic follow- up are required to fully elucidate the relative value of this novel strategy in this unique anatomic scenario. Novel sirolimus-DEB technology seems to be an alternative to current DES at curious scenarios such as distal LIMA bypass anastomosis. OCTmay be helpful to assess the results after DEB treatment. Author contributions Conception and design of the research: Garcia- Guimarães M. Acquisition of data: Garcia-Guimarães M. Writing of the manuscript: Garcia-Guimarães M, Alfonso F. Critical revision of the manuscript for intellectual content: Maruri-Sanchez R, Cuesta J, Rivero F, Bastante T, Alfonso F. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associated with any thesis or dissertation work. 1. Byrne RA, Joner M, Alfonso F, Kastrati A. Drug-coated balloon therapy in coronary and peripheral artery disease. Nat Rev Cardiol. 2014;11(1):13-23. 2. Cortese B, Piraino D, Buccheri D, Alfonso F. Treatment of bifurcation lesions with drug-coated balloons: a review of currently available scientific data. Int J Cardiol. 2016;220:589-94. 3. Granada JF, Tellez A, Baumbach WR, Bingham B, Keng YF, Wessler J, et al. In vivo delivery and long-term tissue retention of nano- encapsulated sirolimus using a novel porous balloon angioplasty system. EuroIntervention. 2016;12(6):740-7. 4. Clever YP, Peters D, Calisse J, Bettink S, Berg MC, Sperling C, et al. Novel sirolimus–coated balloon catheter in vivo evaluation in a porcine coronary model. Circ Cardiovasc Interv. 2016;9(4):e003543. References