Percutaneous Coronary Intervention of Complex Calcified Lesions With Drug-Coated Balloon After Rotational Atherectomy

Area of Science:

• Interventional Cardiology
• Vascular Medicine
• Cardiovascular Devices

Background:

• Drug-coated balloons (DCB) are established treatments for in-stent restenosis, small vessels, and bifurcations.
• DCB technology allows for a reduced duration of dual antiplatelet therapy to one month.
• No prior studies have evaluated DCB use following rotational atherectomy.

Purpose of the Study:

• To assess the safety and efficacy of percutaneous coronary intervention (PCI) using drug-coated balloons (DCB) after rotational atherectomy.
• To evaluate this strategy in patients with calcified de novo coronary lesions.
• To determine outcomes in a patient population with a high prevalence of bleeding risk factors.

Main Methods:

• A retrospective single-center study involving 65 patients (82 PCIs) with calcified de novo coronary lesions.
• Rotational atherectomy was performed, followed by DCB treatment.
• Median follow-up was 17 months, with assessment of major adverse cardiovascular events (MACE) and bleeding incidence.

Main Results:

• MACE occurred in 14% at 12 months and 20% at 24 months.
• Ischemia-driven target-lesion revascularization (TLR) rates were low: 1.5% at 12 months and 3.0% at 24 months.
• Significant bleeding occurred in 9% of patients at 12 months; no acute vessel closure was observed, and bailout stenting was required in 10% of cases.

Conclusions:

• PCI with DCB following rotational atherectomy is a safe and effective approach for calcified coronary lesions.
• This strategy offers a potential treatment option for patients with increased bleeding risk, including those on oral anticoagulants.
• The findings support the consideration of this novel PCI strategy in selected patient populations.