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. 2023 Mar 3:10:1045859.
doi: 10.3389/fcvm.2023.1045859. eCollection 2023.

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

Xi Wang  1 , Xinyue Yang  1 , Wenjie Lu  1 , Liang Pan  1 , Zhanying Han  1 , Sancong Pan  2 , Yingguang Shan  1 , Xule Wang  1 , Xiaolin Zheng  1 , Ran Li  1 , Yongjian Zhu  1 , Peng Qin  3 , Qiangwei Shi  1 , Shuai Zhou  1 , Wencai Zhang  1 , Sen Guo  1 , Peisheng Zhang  4 , Xiaofei Qin  1 , Guoju Sun  1 , Zhongsheng Qin  2 , Zhenwen Huang  1 , Chunguang Qiu  1
Affiliations

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

Xi Wang et al. Front Cardiovasc Med. .

Abstract

Background: Data 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.

Methods: We 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.

Results: Of 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.

Conclusion: Percutaneous 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.

Keywords: chronic total occlusion; coronary heart disease; drug-coated balloon; drug-eluting stent; percutaneous coronary intervention.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Study population. CTO, chronic total occlusion; DCB, drug-coated balloon; DES, drug-eluting stent; ISR, in-stent restenosis; MI, myocardial infarction; PCI, percutaneous coronary intervention.
Figure 2
Figure 2
The comparisons of cumulative events between DCB and DES-only group. Kaplan–Meier estimates of the rates of (A) major adverse cardiovascular events (MACE), (B) target lesion revascularization (TLR), (C) target vessel revascularization (TVR), and (D) death. DCB, drug-coated balloon; DES, drug-eluting stent.
See this image and copyright information in PMC

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