Drug-coated balloon angioplasty for de novo small vessel disease including chronic total occlusion and bifurcation in real-world clinical practice

Onishi, Takayuki; Onishi, Yuko; Kobayashi, Isshi; Umezawa, Shigeo; Niwa, Akira

doi:10.1007/s12928-018-0534-9

Cited by 11 publications

(7 citation statements)

References 22 publications

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“…All these factors together resulted in better vascular remodeling and then less lumen loss diameter and greater lumen enlargement in the DCB group. 34–36 On the other hand, there were no significant differences in the incidence of target lesion revascularization, myocardial infarction, and cardiac death between the two groups during follow-up, also suggesting that DCB is non-inferior to DES in long-term outcomes.…”

Section: Discussionmentioning

confidence: 90%

Safety and Efficacy of Drug-Coated Balloons in Patients with Acute Coronary Syndromes and Vulnerable Plaque

Zhang

Liu

Xing

et al. 2022

Clin Appl Thromb Hemost

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Background Percutaneous coronary intervention (PCI) is the main treatment option for acute coronary syndromes (ACS) often related to the progression and rupture of vulnerable plaques. While drug-eluting stents (DES) are now routinely used in PCI, drug-coated balloons (DCB) are a new strategy to PCI and their practice in the treatment of ACS with vulnerable plaques has not been reported. This study aimed to evaluate the safety and efficacy of DCB in ACS complicated with vulnerable plaque lesions. Methods 123 patients were retrospectively analyzed and diagnosed with ACS and given PCI in our Cardiology Department from December 2020 to July 2022. Vulnerable plaques were confirmed by intravenous ultrasound (IVUS) in all patients. According to individual treatment plan, patients were entered into either DCB (n = 55) or DES (n = 68) groups. The results of coronary angiography and IVUS before and immediately after percutaneous coronary intervention were analyzed. The occurrence of major adverse cardiovascular events (MACE) and the results of coronary angiography were also evaluated during follow-up. Results There were no significant differences in baseline clinical characteristics, preoperative minimal luminal diameter (MLD), and preoperative diameter stenosis (DS) between the two groups. Also, there were no differences in IVUS plaque burden (PB), vessel area, and lumen area in the two groups before and immediately after PCI. The efficacy analysis showed that immediately after PCI, the DCB group had smaller MLD and higher degrees of lumen stenosis than the DES group ( P < 0.05). However, during follow-up, no significant differences in MLD and DS were seen in two groups; relatively, late loss in luminal diameter（LLL）in the DCB group was smaller ( P＜0.05). Safety analysis showed that during follow-up, 9 patients developed restenosis after DCB implantation while restenosis occurred in 10 patients with DES treatment, no statistical difference in the incidence of restenosis in the two groups. Besides, there was no statistical difference in the incidence of major adverse cardiac events（MACE）during hospitalization and follow-up in the DCB group (7.3% (4/55)) and the DES group (8.8% (6/68)). Conclusion DCB is safe and effective for ACS complicated with vulnerable plaque and has an advantage over DES in LLL.

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Section: Discussionmentioning

confidence: 90%

Safety and Efficacy of Drug-Coated Balloons in Patients with Acute Coronary Syndromes and Vulnerable Plaque

Zhang

Liu

Xing

et al. 2022

Clin Appl Thromb Hemost

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“…Meanwhile evidence regarding the use of DCB in treating small vessels and bifurcation lesions is accumulating (11). Previous studies have demonstrated that the DCB-only strategy for CTO is a feasible and well-tolerated approach (12,13). We aimed to investigate the impact of long-term angiographic and clinical outcomes of DCB treatment (DCB alone or combined with DES) in de novo CTO lesions.…”

Section: Discussionmentioning

confidence: 99%

“…In terms of small vessel disease, DCB is also demonstrably safe and effective, and increasing evidence supports DCB in treating acute myocardial infarction (MI), bifurcation lesions, and large vessel disease (11). However, only a few studies with a small sample size and short follow-up duration have evaluated DCB in treating de novo CTO lesions (12)(13)(14). We aimed to compare the efficacy and safety of less DES strategy (DCB-only or combined with DES) and DES-only strategy in treating de novo CTO lesions in a prospective, multicenter, observational study with long-term follow-up.…”

Section: Introductionmentioning

confidence: 99%

Long-term outcomes of less drug-eluting stents by the use of drug-coated balloons in de novo coronary chronic total occlusion intervention: A multicenter observational study

Wang

Yang²,

Liu³

et al. 2023

Front. Cardiovasc. Med.

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BackgroundData on drug-coated balloons (DCB) for de novo coronary chronic total occlusion (CTO) are limited. We aimed to investigate the long-term outcomes of substitution of drug-eluting stents (DES) by DCB.MethodsWe compared the outcomes of less DES strategy (DCB alone or combined with DES) and DES-only strategy in treating de novo coronary CTO in this prospective, observational, multicenter study. The primary endpoints were major adverse cardiovascular events (MACE), target vessel revascularization, myocardial infarction, and death during 3-year follow-up. The secondary endpoints were late lumen loss (LLL) and restenosis until 1-year after operation.ResultsOf the 591 eligible patients consecutively enrolled between January 2015 and December 2019, 281 (290 lesions) were treated with DCB (DCB-only or combined with DES) and 310 (319 lesions) with DES only. In the DCB group, 147 (50.7%) lesions were treated using DCB-only, and the bailout stenting rate was relatively low (3.1%). The average stent length per lesion in the DCB group was significantly shorter compared with the DES-only group (21.5 ± 25.5 mm vs. 54.5 ± 26.0 mm, p < 0.001). A total of 112 patients in the DCB group and 71 patients in the DES-only group (38.6% vs. 22.3%, p < 0.001) completed angiographic follow-up until 1-year, and LLL was much less in the DCB group (−0.08 ± 0.65 mm vs. 0.35 ± 0.62 mm, p < 0.001). There were no significant differences in restenosis occurrence between the two groups (20.5% vs. 19.7%, p > 0.999). The Kaplan–Meier estimates of MACE at 3-year (11.8% vs. 12.0%, log-rank p = 0.688) was similar between the groups.ConclusionPercutaneous coronary intervention with DCB is a potential “stent-less” therapy for de novo CTO lesions with satisfactory long-term clinical results compared to the DES-only approach.

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“…This expanded LLL is related to the confined capability of the small vessel to address to even small neointimal proliferation after stent implantation. Diabetes mellitus is also a strong predictor of awful consequences after PCI and there is a well-documented link amongst small vessel coronary disease and this condition [14][15][16]. Drug-coating balloons (DCB) have been superior as a manner to skip the troubles seen with DES, and there is now evidence to indicate they may be a probable opportunity for treating small vessel disease [17].…”

Section: Introductionmentioning

confidence: 99%

Drug-Coated Balloon-Only Angioplasty Outcomes in Diabetic and Nondiabetic Patients with De Novo Small Coronary Vessels Disease

Rahman¹,

Khan²,

Amin³

et al. 2022

PJMHS

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Background: It is still difficult to use drug-eluting stents for the revascularization of small arteries. For patients with diabetes, treatment with a drug-covered balloon for de novo lesions in small coronary vessels are an appealing restoration option. The cause of this research ends up to evaluate the efficacy of DCB-simplest angioplasty for treating small-vessel sickness. Place of study and duration: Conducted at Cardiology department of Hayatabad Medical Complex Peshawar for the duration from Feb 2019 to Feb 2022. Methods: A fashionable of 1198 patients with small vascular illness treated with DCB-best approach were observed at Hayatabad Medical Complex Peshawar from Feb 2019 to Feb 2022. Patients were classified as each having diabetes or now not having diabetes. Clinical and angiographical follow-up were organise at 12 months. Target lesion failure and non-primary good sized damaging cardiac activities were used as primary outcomes. Results: Diabetic patients had a greater hazard of intention lesion failure (17.9% vs. 11.4%, P=0.006), and the charge of intention lesion revascularization (9.2% vs. 4.5%, P=0.014) emerge as moreover considerably unique many of the 2 companies even as analysed independently. Adjusting for exclusive factors did now not reduce the significance of diabetes mellitus as a predictor of every TLF (HR: 2.712, CI: 1.254-5.864, P=0.011) and intention lesion revascularization (HR: 3.698, CI: 1.112-12.298, P=0.033). However, there had been no vast versions amongst companies for MACE (19% vs. 2.7%, P=0.120) or for intention vessel myocardial infarction (0.6% vs. 0.1%, P=0.110). Conclusion: Reductions in TLF and MACE fees had been seen with drug-coated balloon treatment alone. At three hundred and sixty-five days after treatment with DCBs, diabetes is an independent predictor of intention lesion failure and intention lesion revascularization in small coronary arteries. Within a year, we observed no essential variations in MACE some of the corporations.

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Drug-coated balloon angioplasty for de novo small vessel disease including chronic total occlusion and bifurcation in real-world clinical practice

Cited by 11 publications

References 22 publications

Safety and Efficacy of Drug-Coated Balloons in Patients with Acute Coronary Syndromes and Vulnerable Plaque

Safety and Efficacy of Drug-Coated Balloons in Patients with Acute Coronary Syndromes and Vulnerable Plaque

Long-term outcomes of less drug-eluting stents by the use of drug-coated balloons in de novo coronary chronic total occlusion intervention: A multicenter observational study

Drug-Coated Balloon-Only Angioplasty Outcomes in Diabetic and Nondiabetic Patients with De Novo Small Coronary Vessels Disease

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