Can Drug Coated Balloon Be a Valid Option for Small Vessels?

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.  

balones liberadores de droga

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. 

Read also: Left Main Coronary Artery Percutaneous Coronary Intervention: Evolution and Results over Time.

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 - Consejo Editorial SOLACI

Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.

Original Title: Drug‐coated balloon for the treatment of small vessel disease: 9 months of angiographic results and 12 months of clinical outcomes of the PEPCAD China SVD study.

Reference: Juying Qian MD, et al. Catheter Cardiovasc Interv. 2023;101:33–43.


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