Skip to main content
SpringerLink
Log in

Treatment of coronary de novo bifurcation lesions with DCB only strategy

  • Original Paper
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

Abstract

Objectives

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.

Background

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.

Methods

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.

Results

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 %.

Conclusion

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

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  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 53:10–14

    Article  CAS  PubMed  Google Scholar 

  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 94:115–118

    Article  CAS  PubMed  Google Scholar 

  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 109:1244–1249

    Article  PubMed  Google Scholar 

  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 47:1949–1958

    Article  PubMed  Google Scholar 

  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 119:2986–2994

    Article  CAS  PubMed  Google Scholar 

  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 4:149–154

    Article  PubMed  Google Scholar 

  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 1377–1382

  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 99:327–333

    Article  PubMed  Google Scholar 

  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 5:323–330

    Article  PubMed  Google Scholar 

  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 381:461–467

    Article  CAS  PubMed  Google Scholar 

  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 11:123

    Article  PubMed Central  PubMed  Google Scholar 

  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–K69

    Article  PubMed  Google Scholar 

  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 60:2473–2480

    Article  CAS  PubMed  Google Scholar 

  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 99:165–174

    Article  CAS  PubMed  Google Scholar 

  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–K65

    Article  PubMed  Google Scholar 

  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–K128

    Article  PubMed  Google Scholar 

  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 102:785–797

    Article  CAS  PubMed  Google Scholar 

  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 68:467–471

    Article  CAS  PubMed  Google Scholar 

  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–81C

    Article  PubMed  Google Scholar 

  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):21–27

    Google Scholar 

  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

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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 8:444–449

    Article  PubMed  Google Scholar 

  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 119:71–78

    Article  PubMed  Google Scholar 

  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 114:1955–1961

    Article  PubMed  Google Scholar 

  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 123:79–86

    Article  PubMed  Google Scholar 

  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 121:1235–1243

    Article  CAS  PubMed  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. Charité Universitätsmedizin Berlin, Berlin, Germany

    Antonia Schulz, Telse Hauschild & Franz X. Kleber

  2. Ernst von Bergmann Klinikum Potsdam, Potsdam, Germany

    Telse Hauschild

  3. Cardio Centrum Berlin, Berlin, Germany

    Franz X. Kleber

Authors
  1. Antonia Schulz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Telse Hauschild
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Franz X. Kleber
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Franz X. Kleber.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schulz, A., Hauschild, T. & Kleber, F.X. Treatment of coronary de novo bifurcation lesions with DCB only strategy. Clin Res Cardiol 103, 451–456 (2014). https://doi.org/10.1007/s00392-014-0671-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-014-0671-9

Keywords

Search

Navigation