Duration of dual antiplatelet therapy in elective drug‐coated balloon angioplasty

Abstract

Objectives We sought to answer whether 1‐month duration of dual antiplatelet therapy (DAPT) is safe after elective drug‐coated balloon only (DCB) angioplasty. Background The duration of DAPT after elective DCB was called into question after the ESC Focused DAPT Update of 2017. Until then, a 1‐month duration of DAPT was considered safe by national consensus groups (German, Italian, and Chinese) supported by data from prospective worldwide registries. The ESC Guidelines recommended a 6‐month duration of DAPT based on evidence from in‐stent restenosis randomized controlled trials only. Methods Retrospective, real‐world population, single‐center analysis conducted from January 1, 2012 to March 31, 2017 in a high‐volume, tertiary PCI center. Consecutive patients receiving 1‐month duration of DAPT after elective DCB angioplasty were included. We identified a primary composite outcome of cardiac death, myocardial infarction and target lesion revascularization at 6‐months. Results A total of 303 patients (78.5% male) with mean age of 67 ± 12.5 were included. This incorporated 86.1% de novo lesions and 56.5% nonsmall (≥3 mm diameter) coronary arteries treated. There were no reported outcomes of lesion thrombosis, target vessel MI, target lesion revascularization or cardiac death at 6‐months. There were two (0.6%) nontarget vessel MIs and one (0.3%) noncardiac death. Conclusion One‐month duration of DAPT appears safe after elective DCB‐only angioplasty, highlighting this strategy for patients at high‐risk of bleeding. These results also show favorable clinical outcomes for de novo coronary artery disease and nonsmall coronary arteries treated with DCB‐only angioplasty. A 1‐month duration of DAPT appears a safe and attractive option.

Efficacy of drug‐coated balloon angioplasty after directional coronary atherectomy for coronary bifurcation lesions (DCA/DCB registry)

“…As shown previously, the latest DES could shorten the duration of the dual antiplatelet therapy (DAPT) 29 ; however, the ideal duration of DAPT after LMT stenting is unknown. DCB provides advantages, such as the potential for favorable vascular remodeling after angioplasty without a stent, no risk of stent thrombosis, and decreased DAPT duration to only 4 weeks 30 . Furthermore, DCB angioplasty was less likely to cause carina shift than stenting.…”

Drug-coated Balloons or Drug-eluting Stents – Determining an Optimum Strategy for Patients with High Bleeding Risk

“…Of course, these MACE rates cannot be directly compared; however, it certainly adds strength to the concept that DCB is a very appealing strategy for patients at high risk of bleeding. This is backed up by our registry data with 0% MACE rates at 6 months in patients who received 1 month of DAPT 30.…”

“…13 A retrospective database analysis of all patients receiving 1 month of DAPT, showing no occurrence of MACE at 6 months, further strengthens the safety argument for the use of DCBs in those at high risk of bleeding. 30 While the current ESC guidelines recommend DCBs only for in-stent restenosis, 42 there is randomised controlled trial evidence supporting their use in small vessels (<3 mm). 13 With some observational data supporting the use of DCBs in large vessels, including left main stem lesions, 23,31,43,44 and upcoming randomised controlled trials being considered to further investigate the use of DCBs in large vessels, their role in patients with high bleeding risk is thought to increase.…”

Endothelial Dysfunction and Coronary Vasoreactivity - A Review of the History, Physiology, Diagnostic Techniques, and Clinical Relevance

“…These have been associated with late scaffold thrombosis and other complications that have led to it being licensed for research purposes only (109,110). Drug Coated Balloon Angioplasty is a method currently widely used to treat ISR that has been proposed as a technique that does not carry the same level of risk of ST or prolonged, mandated anti platelet therapy given its absence of scaffold structure (104,(111)(112)(113).…”