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Composite outcomes of drug-coated balloon using in left main bifurcation lesions: a systematic review
Yang Cheng1, Yong Chen1, Bao-Tao Huang1
1Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
Insights
Drug-coated balloons (DCBs) show promising results for treating left main coronary bifurcation lesions, offering comparable or better outcomes than traditional methods. Further research, including randomized controlled trials, is recommended.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Devices
Background:
- Left main coronary bifurcation lesions represent a significant challenge in coronary artery disease, accounting for 50% of cases.
- Drug-coated balloons (DCBs) offer potential advantages like direct drug delivery and absence of permanent struts.
Purpose of the Study:
- To systematically review the efficacy and safety of drug-coated balloons (DCBs) in treating left main coronary bifurcation lesions.
- To compare DCB outcomes with drug-eluting stents and conventional balloons.
Main Methods:
- A systematic review adhering to PRISMA guidelines was performed.
- Included 18 retrospective and 2 prospective studies on left main bifurcation lesions treated with DCBs.
- Studies were categorized into 'DCB only' and 'DCB + stent' groups.
Main Results:
- Midterm follow-up indicated non-inferior or superior angiographic and clinical outcomes for DCBs compared to drug-eluting stents or conventional balloons.
- DCBs demonstrated effectiveness in both de novo and in-stent restenosis lesions.
- Observed side branch late lumen enlargement suggests a potential protective effect of DCBs on side branches.
Conclusions:
- The DCB technique presents a favorable safety and efficacy profile for left main bifurcation lesion treatment.
- Further investigation, particularly randomized controlled trials, is necessary to establish definitive standards for DCB use.
Background:
Left main coronary bifurcation lesions account for 50% of left main coronary artery disease cases. Although a drug-coated balloon (DCB) has the advantages of immediate release of the drug to the arterial wall and no remaining struts, there is no conclusive evidence to support DCB use.
Methods & Results:
We conducted a systematic review in compliance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. Eighteen retrospective studies and two prospective studies in which left main bifurcation lesions were treated with DCBs were included in our qualitative analysis. The studies were divided into two groups according to the type of DCB used: DCB only and DCB + stent. At the midterm follow-up, the use of DCBs had noninferior or even superior angiographic and clinical outcomes in treating left main bifurcation lesions compared with the use of drug-eluting stents or conventional balloons, whether for de novo or in-stent restenosis lesions. Additionally, side branch late lumen enlargement was observed in several of the included studies, which indicates that DCBs may have the advantage of side branch protection.
Conclusions:
According to our descriptive analysis, the DCB technique has a favorable safety and efficacy profiles for the treatment of left main bifurcation lesions. However, additional studies, especially randomized controlled trials, are needed to establish standards for the DCB technique.
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