Outcomes From Drug-coated Balloons For De Novo Large Coronary Vessels

BackgroundWith the development of drug-eluting stents(DES),the restenosis rate of patients with coronary artery disease has been significantly improved.At present,drug-eluting stent is the standard way of percutaneous coronary interventional for coronary artery disease.However,drug-eluting stents leave metal polymer permanently in the blood vessels,thus depriving them of normal contractile and diastolic functions.Antiproliferative drugs released by drug-eluting stents can inhibit the proliferation of smooth muscle cells and endothelial cells,which lead to delayed endothelialization and increase the probability of late stent thrombosis.Inflammatory reactions induced by polymer coatings on the surface of drug-eluting stents can promote the formation of new atherosclerosis,leading to an increase in the incidence of long-term adverse clinical events.Drug-coated balloon is a new treatment device and has become one of the preferred options for in-stent restenosis.Current research results show that drug-coated balloon has its unique advantages in the treatment of in-stent restenosis,small vessel and bifurcation lesions,but the data regarding drug-coated balloon treated lesions in large coronary vessels is limited.ObjectiveThe aim of this study was to evaluate the effectiveness and safety of DCB in large coronary vessels.Methods102 patients with 104 lesions whose reference lumen diameter of target vessel is more than 2.8mm and treated with DCB in de novo lesions were retrospectively enrolled in this study during May 2015 and July 2017.Quantitative coronary angiography was done for follow-up patients.The observed endpoints are late lumen loss(LLL)at 12 nd month,and major adverse cardiac events(MACE),consisting of cardiac death,myocardial infarction(MI),target lesion revascularization(TLR)and stent or target lesion thrombosis.All data were analyzed by SPSS 22.0.Results1.The age was 52.4 ± 10.8 years.There were 57(55.9%)acute coronary syndrome patients,30(29.4%)patients had suffered from myocardial infarction and 35(34.3%)had hypercholesterolemia.2.Cutting balloons and NSE balloons were used in 65%(68/104)and 26%(27/104)of all lesions.The lesion length was 12.57±3.58 mm.The DCB length and diameter was 19.9±4.6mm and 3.4±0.4 mm.3.Ninety-eight lesions were treated with DCB only.And there are 6(5.9%)bailout drug-eluting stent(DES)were used because of severe coronary dissection and blood flow limitation.2 patients(2.0%)experienced revascularization driven by acute ischemic events during hospitalization.4.The TLR rate and overall MACE rate was 3.9%(4/102)and 3.9%(4/102)and there was no death,MI and target lesion thrombosis at follow up.5.The coronary angiography follow up was performed in 82 of 102(80.4%)patients.The quantitative coronary angiography(QCA)measurement showed the data of late lumen loss was 0.01±0.52 mm.ConclusionThe treatment of DCB for de novo large coronary vessels is effective and safe.