Related Experiment Video
Updated: Jul 1, 2025
Complete and Partial Resuscitative Endovascular Balloon Occlusion of the Aorta for Hemorrhagic Shock
Published on: May 19, 2022
Outcomes following coronary chronic total occlusion revascularization with drug-coated balloons
Mehdi Madanchi1, Matthias Bossard1, Irena Majcen1
1Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
Insights
Drug-coated balloons (DCB) for coronary chronic total occlusion (CTO) percutaneous coronary intervention (PCI) show promise. DCB treatment resulted in fewer major adverse cardiac and cerebrovascular events (MACCE) compared to drug-eluting stents (DES) alone.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomaterials in Medicine
Background:
- Coronary chronic total occlusions (CTO) present challenges for percutaneous coronary intervention (PCI).
- Drug-eluting stents (DES) have improved outcomes but high rates of repeat revascularization persist in CTO PCI.
- Drug-coated balloons (DCB) offer a stent-sparing approach, potentially reducing complications.
Purpose of the Study:
- To compare the safety and efficacy of DCBs versus DES alone for CTO PCI.
- To evaluate major adverse cardiac and cerebrovascular events (MACCE) and cardiovascular death (CV-death) in CTO PCI patients.
Main Methods:
- Prospective comparison of 157 patients undergoing CTO PCI from two registries.
- Patients were treated with either DCBs (n=112) or DES only (n=45).
- Outcomes assessed included MACCE and CV-death at 12 months.
Main Results:
- The DCB group had a significantly lower MACCE rate (11%) compared to the DES-only group (26%, P=.03).
- Mean stented segment length was shorter in the DCB group (59 mm) versus the DES-only group (87 mm, P<.001).
- Stented segment length was an independent predictor of MACCE.
Conclusions:
- DCB revascularization for CTO lesions is safe and may reduce MACCE rates compared to DES alone.
- Utilizing DCBs in CTO treatment can decrease total stent length, positively impacting PCI outcomes.
- DCBs represent a viable alternative for CTO PCI, potentially improving long-term results.
Objectives:
Despite the introduction of improved drug eluting stents (DES), the rate of repeat revascularization procedures following percutaneous coronary interventions (PCI) in coronary chronic total occlusions (CTO) remains high. By leaving vessels uncaged and limiting length of stented segments, drug-coated balloons (DCB) represent an appealing alternative to DES for CTO-PCI. Since data supporting the use of DCBs in CTO-PCI is scarce, we compared the outcomes of patients undergoing CTO-PCI involving DCBs vs DES only.
Methods:
From 2 prospective registries, outcomes of patients undergoing CTO-PCI involving DCBs and those undergoing PCI with DES only were compared. Outcomes included major adverse cardiac and cerebrovascular events (MACCE) and cardiovascular death (CV-death).
Results:
Overall, 157 patients were studied; 112 (71%) underwent CTO-PCI involving DCBs and 45 (29%) were treated with DES only. Mean J-CTO score was 1.84 ± 0.7. Most CTO-lesions involved the right coronary artery, 88 (56%), and 26 (17%) cases were in-stent occlusions. In the DCB group, 46 (41%) lesions were treated with DCBs alone. Mean lengths of the stented segments in the DCB vs DES cohorts were 59 ± 28 mm vs 87 ± 37 mm (P less than .001), respectively. After 12 months, the MACCE rate was higher in the DES only vs DCB group (26% vs 11%, P=.03). Length of the stented segment was an independent predictor for MACCE (HR 1.15 [95% CI, 1.05-1.26] per 10-mm stent length).
Conclusions:
Revascularization of CTO lesions involving DCBs appears safe and potentially lowers MACCE rates compared to treatment with DES alone. Importantly, using DCBs for CTO treatment may reduce total stent length, which determines PCI outcomes.
