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Jones J, Mouyis K, Tyrlis A, Rathod KS, Guttmann O, Wragg A, O'Mahony C, Mathur A, Baumbach A, Jones DA. An observational study assessing the use of Sirolimus-eluting balloons for side-branch treatment in the provisional stenting of coronary bifurcations. Am Heart J Plus 2023; 30:100301. [PMID: 38510922 PMCID: PMC10945945 DOI: 10.1016/j.ahjo.2023.100301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 03/22/2024]
Abstract
Background Drug eluting balloons (DEB) are a feasible method of rapid delivery of drug to a coronary vessel wall. Their efficacy has been established for the treatment of in-stent restenosis and small vessel disease but there is limited data for their use in bifurcation lesions. Objective The aim of this study was to assess the effectiveness of provisional upfront side-branch DEB use in bifurcation lesions compared to a simple balloon (POBA) or upfront 2 stent bifurcation strategy. Methods We conducted an observational study of 625 patients undergoing PCI to bifurcation lesions. All the patients had a DES deployed in the main vessel (MV). Decision on revascularization option for the side branch (SB) was made by the operator. The primary endpoint was target vessel failure. Secondary endpoints were target vessel myocardial infarction and all-cause mortality. Results 311 patients had upfront DEB to the SB whilst the remaining were treated with either DES (188) or POBA (126). Baseline characteristics were similar aside from history of previous MI, which were higher in patients treated with DES or POBA, p = 0.009 whereas patients with previous CABG were likely to undergo DEB treatment (p = 0.004). TVF was more likely to occur in the POBA group (7.5 %) compared to the DEB (3.3 %) and DES (3.3 %) groups (p = 0.0019). There was no significant difference in TV-MI (p = 0.62) or death (p = 0.98) between the groups. Conclusion This study suggests that provisional bifurcation stenting with upfront Sirolimus DEB use in the SB is an effective treatment for non-LMS bifurcation PCI.
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Affiliation(s)
- Johanna Jones
- Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Kyriacos Mouyis
- Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Angelos Tyrlis
- Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Krishnaraj S. Rathod
- Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK
| | - Oliver Guttmann
- Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK
| | - Andrew Wragg
- Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK
| | - Constantinos O'Mahony
- Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Anthony Mathur
- Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK
| | - Andreas Baumbach
- Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Daniel A. Jones
- Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK
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