Drug-Coated Balloon Performance in a Calcified Coronary Bifurcation Complicated by Cardiogenic Shock

Complex coronary disease in frail patients requires balancing procedural efficacy, safety, and permanent metallic implantation.

A 76-year-old frail woman presented with non-ST-segment elevation acute coronary syndrome and triple-vessel disease, including a calcified left anterior descending artery-diagonal bifurcation, circumflex culprit lesion, and right coronary artery chronic total occlusion. After circumflex stenting, the bifurcation lesion underwent extensive preparation with balloons and intravascular lithotripsy. The procedure was complicated by acute diagonal occlusion with hemodynamic instability. Flow was restored using drug-coated balloons (DCBs) in both branches, avoiding complex stenting. At a staged procedure, the right coronary artery chronic total occlusion was recanalized with a hybrid DCB and focal stent strategy. Repeat angiography demonstrated positive remodeling.

This case illustrates a scaffold-minimizing hybrid strategy for complex calcified coronary disease.

DCBs may be effective in selected high-risk patients. In selected cases, acute flow compromise during complex percutaneous coronary intervention can be managed with DCB angioplasty without resorting to bailout stenting.