DCA+DCB had higher 5-year ischemia-driven target lesion revascularization (16.4% vs. 2.3%, P=0.03) and smaller lumen gain than DCA+DES in LMCA bifurcation lesions.
Does a drug-coated balloon reduce cardiovascular events compared to a newer-generation drug-eluting stent following directional coronary atherectomy in patients with left main coronary artery bifurcation lesions?
In patients undergoing directional coronary atherectomy for left main bifurcation lesions, a drug-coated balloon strategy is associated with smaller luminal gain and higher 5-year target lesion revascularization rates compared to newer-generation drug-eluting stents.
Abstract Background Directional coronary atherectomy (DCA) is a potential treatment option for left main coronary artery (LMCA) bifurcation lesions, as it may prevent side branch occlusion and reduce the need for complex stenting. Recent studies suggest that combining drug-coated balloon (DCB) with DCA can provide favorable cardiovascular outcomes. However, a recent randomized controlled trial has reported a higher incidence of cardiovascular events with DCB in large-vessel lesions compared to newer-generation drug-eluting stents (DES). Notably, no studies have directly compared the efficacy of DCB and contemporary DES following DCA for LMCA bifurcation lesions. Purpose To compare the clinical outcomes of DCB and DES following DCA for LMCA bifurcation lesions. Methods A retrospective analysis was performed on 109 patients who underwent percutaneous coronary intervention (PCI) with DCA for LMCA bifurcation lesions between 2016 and 2024. Patients were divided into two groups: DCA+DCB (n=58) and DCA+DES (n=51). Lesion characteristics were assessed using quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS). The primary endpoint was ischemia-driven target lesion revascularization (ID-TLR), while secondary outcomes was target lesion-related myocardial infarction (TLMI). Results At the end of PCI, the DCA+DCB group exhibited significantly greater residual diameter stenosis (24.4% vs. 16.3%, P0.001) on QCA, a smaller minimum lumen area (MLA) (7.33 mm² vs. 8.42 mm², P0.001), and a larger residual plaque area (48.9% vs. 45.3%, P=0.03) on IVUS compared to the DCA+DES group. Kaplan-Meier analysis revealed a higher incidence of ID-TLR at 5 years in the DCA+DCB group than in the DCA+DES group (16.4% vs. 2.3%, P=0.03), while TLMI incidence was comparable (4.7% vs. 2.3%, P=0.67). Conclusions The DCA+DCB strategy was associated with smaller luminal gain and a higher incidence of ID-TLR compared to DCA+DES. While DCA+DCB offers a stent-less alternative, its limitations highlight the need for careful patient selection and long-term monitoring.Graphical abstract
Murai et al. (2025) studied this question. DCA+DCB had higher 5-year ischemia-driven target lesion revascularization (16.4% vs. 2.3%, P=0.03) and smaller lumen gain than DCA+DES in LMCA bifurcation lesions.