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

Abstract

Background. Provisional side branch (SB) stenting strategy is the default approach for the majority of bifurcation lesions, but outcomes of SB is suboptimal. Though drug coated balloon (DCB) improving SB outcomes attracts an increasing attention, sequence of DCB hasn’t yet been determined. We presented a novel hybrid strategy of DCB and stent for bifurcation lesions. Methods. With lesion preparation, DCB was persistently inflated in SB kissing with main branch (MB) stent deployment and balloon post-dilation of the bifurcation core. Proximal optimization technique was performed strictly not exceeding the bifurcation. Procedural and clinical adverse events were evaluated. Canadian Cardiovascular Society (CCS) angina classification was assessed at baseline and clinical follow-up. Results. Fourteen patients undergoing the hybrid technique from August 2020 to July 2021 were enrolled. The technique was successfully performed in all patients without rewiring or SB compromise. Minimal lumen diameter of SB increased from 0.60 ± 0.40 mm to 2.1 ± 0.2 mm while the percent stenosis decreased from 72.4 ± 17.9% to 19.6 ± 4.7%. In addition, intravascular ultrasound indicated comparable stent symmetry index and incomplete stent apposition between proximal and distal segments of stent. No further intervention was performed, and mean fractional flow reserve of SB (n = 12) was 0.88 ± 0.05. No major adverse cardiac events was noted in hospital and 12-month follow up. The mean CCS angina score was reduced by 84% (2.2 vs 0.4, p < .001). Conclusion. The hybrid strategy facilitates treatment of DCB and stent for bifurcation lesions, which appears to be feasible and acceptable in a short-term follow-up.

Keywords:

• Coronary bifurcation lesion
• drug coated balloon
• drug-eluting stent
• fractional flow reserve
• intravascular ultrasound

Author contributions

Concept—HY, ZH, FZ; design—HY, ZH; supervision—JQ, JG; funding—HY, ZH, JG; materials—ZH, FZ; data collection and/or processing—YS, JC, JC; analysis and/or Interpretation—HY; literature review—JQ, ZH; writing—HY; critical review—JG.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

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

Additional information

Funding

This study was supported by the National Natural Science Foundation of China [Grants number 81801374, 82070281], Shanghai Clinical Research Center for Interventional Medicine [Grant number 19MC1910300], Shanghai ‘Rising Stars of Medical Talent’ Youth Development Program [Grant number 2019-72] and Key Clinical Research Projects of National Clinical Research Center for Interventional Medicine [Grant number 2021-005].