Angiographic and clinical outcomes after percutaneous coronary intervention using a drug coated balloon in small coronary artery disease

    Authors

    Keywords

    coronary artery disease, percutaneous coronary intervention, drug coated balloon

    DOI

    https://doi.org/10.15836/ccar2021.43

    Full Text

    Introduction : Smaller stent diameter represents risk factor for target lesion failure (TLF). Drug coated balloons (DCB) could represent valid substitution for stents in selected patients. ( 1 ) The aim of the study was to assess clinical and angiographic outcomes after percutaneous coronary interventions (PCI) using DBC in treatment of coronary arteries ≤ 2.5 mm. Patients and Methods : Study included 222 patients treated with DCB between January 2012 and June 2019. All baseline procedures and consecutive coronary angiographies were reviewed to determine indication, lesion complexity, vessel size and procedural success. Baseline and follow up clinical data were extracted from hospital digital database. Results : Mean patient age was 63.8±10.6 years, with the majority being men (N=162, 73%). In total 108 (48.6%) patients were hospitalized due to acute coronary syndrome (ACS), of which 28 (12.6%) had ST segment elevation myocardial infarction. Altogether, 107 (48.2%) patients had multivessel disease and 84 (37.8%) had bifurcation stenosis. DCB was most often used (59%, N=131) in the treatment of side branches. Mean DCB diameter and length were 2.18±0.23 mm and 20.4±5.4 mm, respectively. Overall, procedural success was 92.8%, with 16 (7.2%) cases requiring “bail out” stent implantation. Regarding angiographic follow up, 111 (50%) patients underwent repeated coronary angiography (21 (19%) due to ASC). Mean time to repeated coronary angiography was 12.4±15.9 months. TLF was observed in 14 (12.6%) patients, of which 9 (8.2%) underwent target lesion PCI. After multivariable analysis, longer baseline procedure and fluoroscopy duration, higher volume of contrast administered and total Kerma air exposure were in positive correlation with TLF. Mean time of clinical follow up was 30.3±25.8 months, with 43 (19.4%) patients lost in follow up. Regarding clinical outcomes, angina improvement was observed in 149 (28.2%) of cases. Out of 53 (29.6%) patients examined in emergency department, 36 (20.1) were urgently hospitalized and 4 (2.2%) died. Conclusion : Utilization of DCB in treatment of coronary arteries ≤ 2.5 mm, when stent implantation is not feasible, provides good angiographic and clinical long-term outcome. More complex interventions represent risk factor for TLF. Further studies are needed to confirm presented results.

    Cardiologia Croatica
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    Angiographic and clinical outcomes after percutaneous coronary intervention using a drug coated balloon in small coronary artery disease

    Extended Abstract
    Issue1-2
    Published
    Pages43
    PDF via DOIhttps://doi.org/10.15836/ccar2021.43
    coronary artery disease
    percutaneous coronary intervention
    drug coated balloon

    Authors

    Zvonimir Ostojić*ORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Klara KlarićORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Marijan PašalićORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Kristina Marić BešićORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Maja StrozziORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Ivan ŠkorakORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Hrvoje JurinORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Bosko SkorićORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Eduard MargetićORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia
    Joško BulumORCIDUniversity of Zagreb School of Medicine, Zagreb, Croatia

    Full Text

    Introduction : Smaller stent diameter represents risk factor for target lesion failure (TLF). Drug coated balloons (DCB) could represent valid substitution for stents in selected patients. ( 1 ) The aim of the study was to assess clinical and angiographic outcomes after percutaneous coronary interventions (PCI) using DBC in treatment of coronary arteries ≤ 2.5 mm. Patients and Methods : Study included 222 patients treated with DCB between January 2012 and June 2019. All baseline procedures and consecutive coronary angiographies were reviewed to determine indication, lesion complexity, vessel size and procedural success. Baseline and follow up clinical data were extracted from hospital digital database. Results : Mean patient age was 63.8±10.6 years, with the majority being men (N=162, 73%). In total 108 (48.6%) patients were hospitalized due to acute coronary syndrome (ACS), of which 28 (12.6%) had ST segment elevation myocardial infarction. Altogether, 107 (48.2%) patients had multivessel disease and 84 (37.8%) had bifurcation stenosis. DCB was most often used (59%, N=131) in the treatment of side branches. Mean DCB diameter and length were 2.18±0.23 mm and 20.4±5.4 mm, respectively. Overall, procedural success was 92.8%, with 16 (7.2%) cases requiring “bail out” stent implantation. Regarding angiographic follow up, 111 (50%) patients underwent repeated coronary angiography (21 (19%) due to ASC). Mean time to repeated coronary angiography was 12.4±15.9 months. TLF was observed in 14 (12.6%) patients, of which 9 (8.2%) underwent target lesion PCI. After multivariable analysis, longer baseline procedure and fluoroscopy duration, higher volume of contrast administered and total Kerma air exposure were in positive correlation with TLF. Mean time of clinical follow up was 30.3±25.8 months, with 43 (19.4%) patients lost in follow up. Regarding clinical outcomes, angina improvement was observed in 149 (28.2%) of cases. Out of 53 (29.6%) patients examined in emergency department, 36 (20.1) were urgently hospitalized and 4 (2.2%) died. Conclusion : Utilization of DCB in treatment of coronary arteries ≤ 2.5 mm, when stent implantation is not feasible, provides good angiographic and clinical long-term outcome. More complex interventions represent risk factor for TLF. Further studies are needed to confirm presented results.