Treatment of coronary de novo bifurcation lesions with DCB only strategy
Antonia Schulz1, Telse Hauschild, Franz X Kleber
1Charité Universitätsmedizin Berlin, Berlin, Germany.
Insights
Drug-coated balloons (DCB) offer a safe treatment for coronary artery bifurcation lesions without additional stenting, showing low restenosis and target lesion revascularization rates.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Devices
Background:
- Drug-coated balloons (DCB) deliver paclitaxel locally, demonstrating benefits in various cardiovascular settings, including coronary bifurcations.
- Traditional bifurcation interventions often involve stenting of the main branch (MB) alongside sequential DCB application to both MB and side branch (SB).
- This study explores a novel approach using DCB intervention exclusively, without additional stenting in the MB or SB.
Purpose of the Study:
- To evaluate the efficacy and safety of a drug-coated balloon (DCB) only strategy for treating de novo coronary artery bifurcation lesions.
- To assess restenosis and target lesion revascularization (TLR) rates in patients undergoing DCB-only intervention for bifurcations.
- To report outcomes of an all-comer series of percutaneous coronary intervention (PCI) using DCB-only for bifurcations.
Main Methods:
- An observational study involving 39 consecutive patients undergoing DCB-only interventions for de novo bifurcation lesions with SB diameter ≥ 2 mm.
- Follow-up angiography was scheduled at 4 months post-procedure; telephone follow-up was conducted for patients who declined angiography.
- Data collected included procedural details, angiographic outcomes, and major adverse cardiovascular events (MACE).
Main Results:
- Follow-up angiography was available for 30 out of 39 patients (76.9%).
- The overall restenosis rate was 10% (3 out of 30), with 6.7% in the main branch and 3.3% in the side branch.
- The rate of target lesion revascularization (TLR) was 7.7% (3 out of 39 patients), with no reported deaths, myocardial infarctions, or strokes at 4-month follow-up.
Conclusions:
- A drug-coated balloon (DCB) only strategy for de novo coronary artery bifurcation lesions is a safe therapeutic option.
- This approach demonstrates low rates of restenosis and target lesion revascularization (TLR) compared to traditional stenting methods.
- DCB-only intervention offers a viable alternative for patients with bifurcations, particularly those unsuitable for coronary artery bypass grafting (CABG).
Objectives:
This observational study investigated the value of drug-coated balloons (DCB) only strategy in bifurcation lesions in a consecutive series of all comer percutaneous coronary intervention.
Background:
Local application of paclitaxcel by DCB has clinical benefits in various settings including coronary bifurcations. While so far most bifurcation studies investigated sequential application of DCBs to the main (MB) and side branch (SB) with stenting of the MB, we report first results after DCB intervention without additional stenting of the MB or SB.
Methods:
We performed 39 consecutive DCB only interventions in de novo bifurcation lesions with SB ≥ 2 mm and scheduled follow-up angiography after 4 months. Patients refusing angiography had telephone follow-up.
Results:
Follow-up angiograms were obtained in 30 out of 39 DCB only interventions. 33.3 % were located in the left main (LM) bifurcation, 28.2 % in left anterior descending (LAD), 20.5 % in left circumflex (LCX) and 17.9 % in the right coronary artery. Four months after index procedure no patient had died, experienced myocardial infarction or stroke. Follow-up angiograms showed restenosis in 3 out of 30 interventions (10 %), 2 developing in the distal main (6.7 %) and 1 in the SB (3.3 %). All three patients had been treated for LM/LAD/LCX bifurcations and suffered from most severe coronary artery disease, but had not been eligible for CABG for various reasons. Target lesion revascularization was performed in 3 out of 39 patients consistent with a MACE rate of 7.7 %.
Conclusion:
Treatment of de novo bifurcation lesions with DCB only intervention without additional stenting is a safe therapy with low rates of restenosis and TLR.
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