A novel hybrid strategy of drug coated balloon and stent for coronary bifurcation lesions

Figures & data

Figure 1. Schematic image depicting the key steps of the hybrid technique. (A) Coronry bifurcation lesion. (B) Preparation for main branch. (C) Preparation for side branch. (D) Stent deployment kissing inflation with drug coated balloon (DCB). (E) Persistent inflation of DCB when removing stent balloon. (F) Balloon post-dilation of bifurcation core kissing with DCB. (G) Proximal optimization technique. (H) Final results.

Table 1. Clinical characteristics (n = 14).

Age, y	63 ± 10
Male, n(%)	12(85.7)
Hypertension, n(%)	8(57.1)
Diabetes, n(%)	7(50.0)
Hyperlipidemia, n(%)	4(28.6)
Smoking, n(%)	6(42.9)
Prior PCI, n(%)	1(7.1)
CCS classification
Class I, n(%)	3(21.4)
Class II, n(%)	7(50.0)
Class III, n(%)	2(14.3)
Class IV, n(%)	2(14.3)
eGFR, mL/min/1.73m^2	76 ± 8
LVEF, %	64 ± 4

Note: CCS: Canadian Cardiovascular Society.

Table 2. Quantitative coronary angiography assessment (n = 14).

	Main branch	Side branch
Pre-procedure
Reference diameter, mm	3.19 ± 0.33	2.27 ± 0.23
Minimal lumen diameter, mm	0.33 ± 0.20	0.60 ± 0.40
Percent diameter stenosis, %	89.8 ± 7.3	72.4 ± 17.9
Lesion length, mm	29.9 ± 12.9	9.6 ± 3.3
Procedure
Kissing stent/balloon length, mm	27.8 ± 6.3	16.8 ± 2.5
Stent/balloon diameter, mm	3.0 ± 0.3	2.1 ± 0.2
Number of stents/balloons	1.6 ± 0.5	1.1 ± 0.3
Kissing inflation pressure, atm	10.3 ± 0.7	10.3 ± 1.3
Post-procedure
Minimal lumen diameter, mm	2.95 ± 0.33	1.83 ± 0.23
Percent diameter stenosis, %	7.3 ± 2.9	19.6 ± 4.7
Acute gain, mm	2.62 ± 0.45	1.23 ± 0.48

Table 3. Intravascular ultrasound analysis (n = 14).

Proximal main branch
Proximal optimal technique balloon size (mm)	3.3 ± 0.4
External elastic membrane area (mm^2)	14.67 ± 3.75
Minimum stent cross sectional area (mm^2)	8.11 ± 1.52
Stent symmetry index	0.89 ± 0.03
Incomplete stent apposition (%)	1(7.1)
Distal main branch
Post-stent dilation balloon size (mm)	2.9 ± 0.2
External elastic membrane area (mm^2)	11.48 ± 3.27
Minimum stent cross sectional area (mm^2)	6.67 ± 1.32
Stent symmetry index	0.88 ± 0.04
Incomplete stent apposition (%)	1(7.1)

Figure 2. Step-by-step procedures of the hybrid technique in one representative patient. (A) Bifurcation lesion of left anterior descending artery (LAD) and first diagonal branch (D1). (B) Deployment of stent (10 atm) and DCB (10 atm). (C) Withdrawal of stent balloon but sustained inflation of DCB. (D) Post-dilation of bifurcation core (18 atm) simultaneously with DCB (10 atm). (E) Proximal optimization technique. (F) Final coronary angiography. (G) Distal and (H) proximal minimum stent cross sectional area images. (I) Fractional flow reserve test of D1. LAD: left anterior descending artery; D1: first diagonal branch; DCB: drug coated balloon.

Data availability statement

The data that support the findings of this study are available from the corresponding author, Zheyong Huang, upon reasonable request.