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Drug-Coated Balloon-Based Treatment of Left Main True Bifurcation Lesion

Ae-Young Her1, Tae Hyun Kim2, Eun-Seok Shin3

  • 1Division of Cardiology, Department of Internal Medicine, Kangwon National University College of Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|January 22, 2025
PubMed

Insights

Drug-coated balloon (DCB) treatment is a safe and effective alternative for unprotected left main (LM) true bifurcation lesions. This study found comparable 2-year outcomes between DCB-based and drug-eluting stent (DES) treatments, supporting DCB use in select patients.

Area of Science:

  • Interventional Cardiology
  • Vascular Medicine
  • Biomaterials in Medicine

Background:

  • Limited data exists on drug-coated balloon (DCB) use for left main (LM) true bifurcation lesions.
  • Unprotected LM lesions pose significant treatment challenges.

Purpose of the Study:

  • To assess the safety and efficacy of DCB-based strategies in treating unprotected LM true bifurcation lesions.
  • To compare DCB-based treatment outcomes with traditional drug-eluting stent (DES) approaches.

Main Methods:

  • Retrospective analysis of 39 patients treated with DCB (alone or with DES) for LM true bifurcation lesions.
  • Comparison with 39 propensity-matched patients treated with second-generation DES from the COBIS III registry.
  • Primary endpoint: Major adverse cardiovascular events (MACE) at 2-year follow-up, including cardiac death, MI, stent thrombosis, and target lesion revascularization.

Main Results:

  • Baseline characteristics were similar, though the DCB group had more in-stent restenosis (ISR) lesions.
  • 59% of patients in the DCB group received DCB-only treatment; no abrupt vessel closure occurred.
  • Comparable 2-year MACE rates between the DCB-based group (12.8%) and the DES-only group (17.9%) (p=0.861).

Conclusions:

  • DCB-based treatment shows comparable clinical outcomes to DES-only treatment for unprotected LM true bifurcation lesions at 2 years.
  • DCB-based therapy is a potentially safe and effective alternative for carefully selected patients with suitable predilation.
  • Further research, like the NCT04619277 trial, is warranted to confirm these findings.
Abstract

Keywords:
angioplastyballooncoronary artery diseasepercutaneous coronary intervention

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