One of the challenges of percutaneous coronary interventions (PCI) are <2.5 mm vessels, since complications and restenosis complications rate are higher than with >3.0 mm vessels.
Drug Coated Balloons (DCB) can be a useful tool, but their efficacy and safety [vs. plain old balloon angioplasty] remains unclear.
PEPCAD China SVD is a prospective and multicenter study that looked at 268 patients with severe lesions in vessels measuring 2.0 to 2.75 mm in diameter and <30 mm length. 181 of these patients (67.5%) received DCB and 87 plain old balloon angioplasty (POBA) in de novo lesions.
Primary end point was late lumen loss (LLL) at 9 months.
The groups were similar, mean age was 63, 72% were men, 70% had hypertension, 35% diabetes, 43% had prior PCI and very few had received myocardial revascularization surgery (CABG).
There were no differences in clinical symptoms leading to PCI.
Neither were there differences in vessel diameter, obstruction degree, compromised artery, or the need for stenting, which was quite low.
Primary end point resulted in favor of DCB (0.10 ± 0.33mm vs. 0.25 ± 0.38mm p= 0.0037), but there was no difference in MACE, MI related to the treated vessel, ischemia or thrombosis driven TLR.
Conclusion
Treating de novo lesions in small vessels with DCB was superior to POBA with lower late lumen loss at 9 months. Clinical events rate was comparable between devices.
Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.
Reference: Juying Qian MD, et al. Catheter Cardiovasc Interv. 2023;101:33–43.
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