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Drug-Coated Balloons in Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the PROGRESS-CTO
Deniz Mutlu1, Athanasios Rempakos2, Dimitrios Strepkos1
1Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
Insights
Drug-coated balloons (DCBs) are increasingly used in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). A DCB-only strategy shows similar short-term outcomes but lower long-term major adverse cardiac events (MACE) compared to other approaches.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Limited data exists on drug-coated balloon (DCB) utilization in chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
- Understanding DCB use patterns and outcomes in CTO PCI is crucial for optimizing treatment strategies.
Purpose of the Study:
- To evaluate the frequency and clinical outcomes of using DCBs in a large, multicenter CTO PCI registry.
- To compare the effectiveness of DCB-only versus hybrid (DCB and drug-eluting stent) strategies in CTO PCI.
Main Methods:
- Analysis of 12,157 successful CTO PCIs from 59 centers between 2018 and 2025.
- Assessment of DCB usage frequency, patient characteristics, lesion complexity (J-CTO score), and procedural outcomes.
- Comparison of technical success, in-hospital MACE, and long-term MACE between DCB-only, hybrid, and drug-eluting stent (DES) strategies.
Main Results:
- DCBs were used in 3.7% of CTO PCI cases, with increasing frequency over time.
- DCB-only strategy was associated with less complex lesions (lower J-CTO score) and comparable technical success and in-hospital MACE to hybrid or DES strategies.
- Patients treated with DCB-only strategy experienced significantly lower long-term MACE compared to other strategies (HR 0.39; p=0.032) after multivariable adjustment.
Conclusions:
- Drug-coated balloons are increasingly adopted in CTO PCI, with both DCB-only and hybrid strategies showing feasibility.
- A DCB-only approach in less complex CTO lesions is associated with similar short-term safety and efficacy.
- The DCB-only strategy demonstrates a significant reduction in long-term major adverse cardiac events, suggesting a potential benefit for selected CTO patients.
Background:
There is limited information on the use of drug-coated balloons (DCBs) in chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
Aims:
To assess the frequency and outcomes of DCB use in CTO PCI.
Objective:
This study evaluated the frequency and outcomes of DCB use in a large, multicenter CTO PCI registry.
Methods:
We analyzed 12,146 patients who underwent 12,157 successful CTO PCIs at 59 centers from 2018 to 2025.
Results:
DCBs were used in 454 patients (3.7%) with increasing frequency over time (p = 0.020). A DCB-only strategy was used in 48.4% of the patients and a hybrid strategy combining DCBs and drug-eluting stents (DES) was used in 51.6% of patients. Patients treated with DCB (both strategies) had low prevalence of comorbidities. Compared with the DES cases, DCB only cases had favorable angiographic characteristics, lower mean J-CTO (Japanese CTO) score (1.83 ± 1.03 vs. 2.27 ± 1.23; p < 0.001), and similar technical success (96.3% vs. 97.3%; p = 0.640), and in-hospital major adverse cardiac events (MACE). The hybrid and DCB-only strategies had comparable technical success and in-hospital MACE. During a median follow-up of 323 (170-429) days, DCB only cases had lower MACE than the other strategies (hazard ratio [HR] 0.41, 95% CI 0.17-0.96, p = 0.040). After multivariable adjustment, the association remained significant (HR 0.39, 95% CI 0.16-0.92, p = 0.032).
Conclusions:
DCBs are increasingly being used in CTO PCI. A DCB only strategy was used in less complex lesions and was associated with similar technical success and in-hospital MACE compared with hybrid or DES strategies. A DCB only strategy was associated with lower long-term MACE.
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