Clinical Research in Cardiology

, Volume 103, Issue 6, pp 451–456 | Cite as

Treatment of coronary de novo bifurcation lesions with DCB only strategy

  • Antonia Schulz
  • Telse Hauschild
  • Franz X. Kleber
Original Paper



This observational study investigated the value of drug-coated balloons (DCB) only strategy in bifurcation lesions in a consecutive series of all comer percutaneous coronary intervention.


Local application of paclitaxcel by DCB has clinical benefits in various settings including coronary bifurcations. While so far most bifurcation studies investigated sequential application of DCBs to the main (MB) and side branch (SB) with stenting of the MB, we report first results after DCB intervention without additional stenting of the MB or SB.


We performed 39 consecutive DCB only interventions in de novo bifurcation lesions with SB ≥2 mm and scheduled follow-up angiography after 4 months. Patients refusing angiography had telephone follow-up.


Follow-up angiograms were obtained in 30 out of 39 DCB only interventions. 33.3 % were located in the left main (LM) bifurcation, 28.2 % in left anterior descending (LAD), 20.5 % in left circumflex (LCX) and 17.9 % in the right coronary artery. Four months after index procedure no patient had died, experienced myocardial infarction or stroke. Follow-up angiograms showed restenosis in 3 out of 30 interventions (10 %), 2 developing in the distal main (6.7 %) and 1 in the SB (3.3 %). All three patients had been treated for LM/LAD/LCX bifurcations and suffered from most severe coronary artery disease, but had not been eligible for CABG for various reasons. Target lesion revascularization was performed in 3 out of 39 patients consistent with a MACE rate of 7.7 %.


Treatment of de novo bifurcation lesions with DCB only intervention without additional stenting is a safe therapy with low rates of restenosis and TLR.


Balloon angioplasty Drug-coated balloon Percutaneous coronary intervention Bifurcation lesion De novo lesion 


Conflict of interest

Franz X. Kleber is consultant to B. Braun and received unrestricted scientific grants from B. Braun, Medtronic and Eurocor. Antonia Schulz received travel expenses from B. Braun. Telse Hauschild declares no conflict of interest.


  1. 1.
    Meier B, Gruentzig AR, King SB 3rd, Douglas JS Jr, Hollmann J, Ischinger T, Aueron F, Galan K (1984) Risk of side branch occlusion during coronary angioplasty. Am J Cardiol 53:10–14PubMedCrossRefGoogle Scholar
  2. 2.
    Tanabe K, Hoye A, Lemos PA, Aoki J, Arampatzis CA, Saia F, Lee CH, Degertekin M, Hofma SH, Sianos G, McFadden E, Smits PC, van der Giessen WJ, de Feyter P, van Domburg RT, Serruys PW (2004) Restenosis rates following bifurcation stenting with sirolimus-eluting stents for de novo narrowings. Am J Cardiol 94:115–118PubMedCrossRefGoogle Scholar
  3. 3.
    Colombo A, Moses JW, Morice MC, Ludwig J, Holmes DR Jr, Spanos V, Louvard Y, Desmedt B, Di Mario C, Leon MB (2004) Randomized study to evaluate sirolimus-eluting stents implanted at coronary bifurcation lesions. Circulation 109:1244–1249PubMedCrossRefGoogle Scholar
  4. 4.
    Hoye A, Iakovou I, Ge L, van Mieghem CA, Ong AT, Cosgrave J, Sangiorgi GM, Airoldi F, Montorfano M, Michev I, Chieffo A, Carlino M, Corvaja N, Aoki J, Rodriguez Granillo GA, Valgimigli M, Sianos G, van der Giessen WJ, de Feyter PJ, van Domburg RT, Serruys PW, Colombo A (2006) Long-term outcomes after stenting of bifurcation lesions with the “crush” technique: predictors of an adverse outcome. J Am Coll Cardiol 47:1949–1958PubMedCrossRefGoogle Scholar
  5. 5.
    Unverdorben M, Vallbracht C, Cremers B, Heuer H, Hengstenberg C, Maikowski C, Werner GS, Antoni D, Kleber FX, Bocksch W, Leschke M, Ackermann H, Boxberger M, Speck U, Degenhardt R, Scheller B (2009) Paclitaxel-coated balloon catheter versus paclitaxel-coated stent for the treatment of coronary in-stent restenosis. Circulation 119:2986–2994PubMedCrossRefGoogle Scholar
  6. 6.
    Habara S, Mitsudo K, Kadota K, Goto T, Fujii S, Yamamoto H, Katoh H, Oka N, Fuku Y, Hosogi S, Hirono A, Maruo T, Tanaka H, Shigemoto Y, Hasegawa D, Tasaka H, Kusunose M, Otsuru S, Okamoto Y, Saito N, Tsujimoto Y, Eguchi H, Miyake K, Yoshino M (2011) Effectiveness of paclitaxel-eluting balloon catheter in patients with sirolimus-eluting stent restenosis. JACC Cardiovasc Interv 4:149–154PubMedCrossRefGoogle Scholar
  7. 7.
    Rittger H, Brachmann J, Sinha AM, Waliszewski M, Ohlow M, Brugger A, Thiele H, Birkemeyer R, Kurowski V, Breithardt OA, Schmidt M, Zimmermann S, Lonke S, von Cranach M, Nguyen TV, Daniel WG, Wöhrle J (2012) A randomized, multicenter, single-blinded trial comparing paclitaxel-coated balloon angioplasty with plain balloon angioplasty in drug-eluting stent restenosis: the PEPCAD-DES study. J Am Coll Cardiol. United States: American College of Cardiology Foundation. Published by Elsevier Inc, pp 1377–1382Google Scholar
  8. 8.
    Indermuehle A, Bahl R, Lansky AJ, Froehlich GM, Knapp G, Timmis A, Meier P (2013) Drug-eluting balloon angioplasty for in-stent restenosis: a systematic review and meta-analysis of randomised controlled trials. Heart 99:327–333PubMedCrossRefGoogle Scholar
  9. 9.
    Scheller B, Clever YP, Kelsch B, Hehrlein C, Bocksch W, Rutsch W, Haghi D, Dietz U, Speck U, Böhm M, Cremers B (2012) Long-term follow-up after treatment of coronary in-stent restenosis with a paclitaxel-coated balloon catheter. JACC Cardiovasc Interv 5:323–330PubMedCrossRefGoogle Scholar
  10. 10.
    Byrne RA, Neumann FJ, Mehilli J, Pinieck S, Wolff B, Tiroch K, Schulz S, Fusaro M, Ott I, Ibrahim T, Hausleiter J, Valina C, Pache J, Laugwitz KL, Massberg S, Kastrati A, ISAR-DESIRE 3 investigators (2013) Paclitaxel-eluting balloons, paclitaxel-eluting stents, and balloon angioplasty in patients with restenosis after implantation of a drug-eluting stent (ISAR-DESIRE 3): a randomised, open-label trial. Lancet 381:461–467PubMedCrossRefGoogle Scholar
  11. 11.
    Fröhlich GM, Lansky AJ, Ko DT, Archangelidi O, De Palma R, Timmis A, Meier P (2013) Drug eluting balloons for de novo coronary lesions—a systematic review and meta-analysis. BMC Med 11:123PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Belkacemi A, Agostoni P, Voskuil M, Stella PR (2011) Coronary bifurcation lesions treated with the drug-eluting balloon: a preliminary insight from the DEBIUT study. EuroIntervention 7(Suppl K):K66–K69PubMedCrossRefGoogle Scholar
  13. 13.
    Latib A, Colombo A, Castriota F, Micari A, Cremonesi A, De Felice F, Marchese A, Tespili M, Presbitero P, Sgueglia GA, Buffoli F, Tamburino C, Varbella F, Menozzi A (2012) A randomized multicenter study comparing a paclitaxel drug-eluting balloon with a paclitaxel-eluting stent in small coronary vessels: the BELLO (Balloon Elution and Late Loss Optimization) study. J Am Coll Cardiol 60:2473–2480PubMedCrossRefGoogle Scholar
  14. 14.
    Unverdorben M, Kleber FX, Heuer H, Figulla HR, Vallbracht C, Leschke M, Cremers B, Hardt S, Buerke M, Ackermann H, Boxberger M, Degenhardt R, Scheller B (2010) Treatment of small coronary arteries with a paclitaxel-coated balloon catheter. Clin Res Cardiol 99:165–174PubMedCrossRefGoogle Scholar
  15. 15.
    Mathey DG, Wendig I, Boxberger M, Bonaventura K, Kleber FX (2011) Treatment of bifurcation lesions with a drug-eluting balloon: the PEPCAD V (paclitaxel eluting PTCA balloon in coronary artery disease) trial. EuroIntervention 7 Suppl K:K61–K65PubMedCrossRefGoogle Scholar
  16. 16.
    Kleber FX, Mathey DG, Rittger H, Scheller B, German Drug-eluting Balloon Consensus Group (2011) How to use the drug-eluting balloon: recommendations by the German consensus group. EuroIntervention 7 (Suppl K):K125–K128PubMedCrossRefGoogle Scholar
  17. 17.
    Kleber FX, Rittger H, Bonaventura K, Zeymer U, Wöhrle J, Jeger R, Levenson B, Möbius-Winkler S, Bruch L, Fischer D, Hengstenberg C, Pörner T, Mathey D, Scheller B (2013) Drug-coated balloons for treatment of coronary artery disease: updated recommendations from a consensus group. Clin Res Cardiol 102:785–797PubMedCrossRefGoogle Scholar
  18. 18.
    Huber MS, Mooney JF, Madison J, Mooney MR (1991) Use of a morphologic classification to predict clinical outcome after dissection from coronary angioplasty. Am J Cardiol 68:467–471PubMedCrossRefGoogle Scholar
  19. 19.
    Holmes DR Jr, Vlietstra RE, Smith HC, Vetrovec GW, Kent KM, Cowley MJ, Faxon DP, Gruentzig AR, Kelsey SF, Detre KM (1984) Restenosis after percutaneous transluminal coronary angioplasty (PTCA): a report from the PTCA Registry of the National Heart, Lung, and Blood Institute. Am J Cardiol 53:77C–81CPubMedCrossRefGoogle Scholar
  20. 20.
    Clever YP, Cremers B, von Scheidt W, Böhm M, Speck U, Scheller B (2013) Compassionate use of a paclitaxel coated balloon in patients with refractory recurrent coronary in-stent restenosis. Clin Res Cardiol 103(1):21–27Google Scholar
  21. 21.
    Navarese EP, Austin D, Gurbel PA, Andreotti F, Tantry U, James S, Buffon A, Kozinski M, Obonska K, Bliden K, Jeong YH, Kubica J, Kunadian V (2013) Drug-coated balloons in treatment of in-stent restenosis: a meta-analysis of randomised controlled trials. Clin Res Cardiol 102(4):279–287. doi: 10.1007/s00392-012-0532-3 PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Bonaventura K, Leber AW, Sohns C, Roser M, Boldt LH, Kleber FX, Haverkamp W, Dorenkamp M (2012) Cost-effectiveness of paclitaxel-coated balloon angioplasty and paclitaxel-eluting stent implantation for treatment of coronary in-stent restenosis in patients with stable coronary artery disease. Clin Res Cardiol 101(7):573–584. doi: 10.1007/s00392-012-0428-2 PubMedCrossRefGoogle Scholar
  23. 23.
    Cremers B, Toner JL, Schwartz LB, von Oepen R, Speck U, Kaufels N, Clever YP, Mahnkopf D, Böhm M, Scheller B (2012) Inhibition of neointimal hyperplasia with a novel zotarolimus coated balloon catheter. Clin Res Cardiol 101(6):469–476. doi: 10.1007/s00392-012-0415-7 PubMedCrossRefGoogle Scholar
  24. 24.
    Cremers B, Kelsch B, Clever YP, Hattangadi N, Mahnkopf D, Speck U, Taupitz M, Scheller B (2012) Inhibition of neointimal proliferation after bare metal stent implantation with low-pressure drug delivery using a paclitaxel-coated balloon in porcine coronary arteries. Clin Res Cardiol 101(5):385–391. doi: 10.1007/s00392-011-0408-y PubMedCrossRefGoogle Scholar
  25. 25.
    Scheller B, Fischer D, Clever YP, Kleber FX, Speck U, Böhm M, Cremers B (2013) Treatment of a coronary bifurcation lesion with drug-coated balloons: lumen enlargement and plaque modification after 6 months. Clin Res Cardiol 102(6):469–472. doi: 10.1007/s00392-013-0556-3 PubMedCrossRefGoogle Scholar
  26. 26.
    Biondi-Zoccai G, Sheiban I, Romagnoli E, De Servi S, Tamburino C, Colombo A, Burzotta F, Presbitero P, Bolognese L, Paloscia L, Rubino P, Sardella G, Briguori C, Niccoli L, Franco G, Di Girolamo D, Piatti L, Greco C, Capodanno D, Sangiorgi G (2011) Is intravascular ultrasound beneficial for percutaneous coronary intervention of bifurcation lesions? Evidence from a 4,314-patient registry. Clin Res Cardiol 100(11):1021–1028. doi: 10.1007/s00392-011-0336-x PubMedCrossRefGoogle Scholar
  27. 27.
    Biondi-Zoccai G, Sheiban I, Moretti C, Palmerini T, Marzocchi A, Capodanno D, Tamburino C, Margheri M, Vecchi G, Sangiorgi G, Santarelli A, Bartorelli AL, Briguori C, Vignali L, Pede FD, Ramondo A, Medda M, de Carlo M, Falsini G, Benassi A, Palmieri C, Filippone V, Sangiorgi D, Barlocco F, de Servi S (2011) Appraising the impact of left ventricular ejection fraction on outcomes of percutaneous drug-eluting stenting for unprotected left main disease: insights from a multicenter registry of 975 patients. Clin Res Cardiol 100(5):403–411. doi: 10.1007/s00392-010-0258-z PubMedCrossRefGoogle Scholar
  28. 28.
    Rittger H, Rieber J, Kögler K, Sinha A, Schmidt M, Breithardt OA, Biggar P, Einsle F, Diegeler A, Brachmann J (2011) Clinical outcome and quality of life after interventional treatment of left main disease with drug-eluting-stents in comparison to CABG in elderly and younger patients. Clin Res Cardiol 100(5):439–446. doi: 10.1007/s00392-010-0262-3 PubMedCrossRefGoogle Scholar
  29. 29.
    Bondesson P, Lagerqvist B, James SK, Olivecrona GK, Venetsanos D, Harnek J (2012) Comparison of two drug-eluting balloons: a report from the SCAAR registry. EuroIntervention 8:444–449PubMedCrossRefGoogle Scholar
  30. 30.
    Colombo A, Bramucci E, Saccà S, Violini R, Lettieri C, Zanini R, Sheiban I, Paloscia L, Grube E, Schofer J, Bolognese L, Orlandi M, Niccoli G, Latib A, Airoldi F (2009) Randomized study of the crush technique versus provisional side-branch stenting in true coronary bifurcations: the CACTUS (Coronary Bifurcations: application of the Crushing Technique Using Sirolimus-Eluting Stents) Study. Circulation 119:71–78PubMedCrossRefGoogle Scholar
  31. 31.
    Steigen TK, Maeng M, Wiseth R, Erglis A, Kumsars I, Narbute I, Gunnes P, Mannsverk J, Meyerdierks O, Rotevatn S, Niemelä M, Kervinen K, Jensen JS, Galløe A, Nikus K, Vikman S, Ravkilde J, James S, Aarøe J, Ylitalo A, Helqvist S, Sjögren I, Thayssen P, Virtanen K, Puhakka M, Airaksinen J, Lassen JF, Thuesen L (2006) Nordic PCI Study Group Randomized study on simple versus complex stenting of coronary artery bifurcation lesions: the Nordic bifurcation study. Circulation 114:1955–1961PubMedCrossRefGoogle Scholar
  32. 32.
    Niemelä M, Kervinen K, Erglis A, Holm NR, Maeng M, Christiansen EH, Kumsars I, Jegere S, Dombrovskis A, Gunnes P, Stavnes S, Steigen TK, Trovik T, Eskola M, Vikman S, Romppanen H, Mäkikallio T, Hansen KN, Thayssen P, Aberge L, Jensen LO, Hervold A, Airaksinen J, Pietilä M, Frobert O, Kellerth T, Ravkilde J, Aarøe J, Jensen JS, Helqvist S, Sjögren I, James S, Miettinen H, Lassen JF, Thuesen L (2011) Nordic–Baltic PCI Study Group Randomized comparison of final kissing balloon dilatation versus no final kissing balloon dilatation in patients with coronary bifurcation lesions treated with main vessel stenting: the Nordic–Baltic Bifurcation Study III. Circulation 123:79–86PubMedCrossRefGoogle Scholar
  33. 33.
    Hildick-Smith D, de Belder AJ, Cooter N, Curzen NP, Clayton TC, Oldroyd KG, Bennett L, Holmberg S, Cotton JM, Glennon PE, Thomas MR, Maccarthy PA, Baumbach A, Mulvihill NT, Henderson RA, Redwood SR, Starkey IR, Stables RH (2010) Randomized trial of simple versus complex drug-eluting stenting for bifurcation lesions: the British Bifurcation Coronary Study: old, new, and evolving strategies. Circulation 121:1235–1243PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Antonia Schulz
    • 1
  • Telse Hauschild
    • 1
    • 2
  • Franz X. Kleber
    • 1
    • 3
  1. 1.Charité Universitätsmedizin BerlinBerlinGermany
  2. 2.Ernst von Bergmann Klinikum PotsdamPotsdamGermany
  3. 3.Cardio Centrum BerlinBerlinGermany

Personalised recommendations