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

Abstract

Objectives To evaluate the efficacy and safety of additional drug‐coated balloon (DCB) angioplasty after directional coronary atherectomy (DCA) for coronary bifurcation lesions. Background The optimal therapy for bifurcation lesions has not been established, even in the drug‐eluting stent era. DCA possibly prevents plaque and carina shift in bifurcation lesions by plaque debulking; however, the efficacy of combined DCA and DCB (DCA/DCB) for bifurcation lesions remains unclear. Methods This multicenter registry retrospectively recruited patients with bifurcation lesions who underwent DCA/DCB and follow‐up angiogram at 6–15 months. The primary endpoint was the 12‐month target vessel failure (TVF) rate. The secondary endpoints were procedure‐related major complications, major cardiovascular events at 12 months, restenosis at 12 months, target lesion revascularization (TLR) at 12 months, and target vessel revascularization (TVR) at 12 months. Results We enrolled 129 patients from 16 Japanese centers. One hundred and four lesions (80.6%) were located around the left main trunk bifurcations. No side branch compromise was found intraoperatively. Restenosis was observed in three patients (2.3%) at 12 months. TLR occurred in four patients (3.1%): 3 (2.3%) in the main vessel and 1 (0.8%) in the ostium of the side branch at 12 months. TVF incidence at 12 months was slightly higher in 14 patients (10.9%), and only two patients (1.6%) had symptomatic TVR. One patient (0.8%) had non‐target vessel‐related myocardial infarction. Conclusions Our data suggested that DCA/DCB provided good clinical outcomes and minimal side branch damage and could be an optimal non‐stent percutaneous coronary intervention strategy for bifurcation lesions.

Stentless Strategy by Drug-Coated Balloon Angioplasty following Directional Coronary Atherectomy for Left Main Bifurcation Lesion

“…We consider that DCB angioplasty played an important role in inhibiting neointimal hyperplasia. On the other hand, a recent multicenter registry (DCA/DCB registry) demonstrated the low incidence of TLR at 12 months (3.6%) after DCA following DCB angioplasty for coronary bifurcation lesions even though the mean %PA after DCA was higher than our study (56.3% versus 44.0%) [6]. Based on these results, aggressive debulking of DCA to achieve a %PA less than 50% may not be necessary, if DCA was followed by DCB angioplasty.…”

“…Similarly, for LM bifurcation lesions, an improved novel directional coronary atherectomy (DCA) catheter (ATHEROCUT®, Nipro Corporation, Osaka, Japan) has been commercially available in Japan since 2015 and the possibility of stentless strategy using DCA followed by the DCB angioplasty has been investigated. A recent multicenter registry which was conducted in Japan (DCA/DCB registry) reported the efficacy of the DCB angioplasty following DCA for coronary bifurcation lesions [ 6 ]. We investigated the efficacy of stentless strategy by DCB angioplasty following DCA for LM bifurcation lesions.…”

A Case Report: Directional coronary atherectomy supported with optical coherence tomography is useful for the slit lesion

“…DCA is now available again since 2014 in Japan and DCB after DCA has become popular to avoid stent implantation [1][2][3] . Since the effect of plaque reduction is more conclusive in DCA…”

Novel strategy for ostial left anterior descending artery acute myocardial infarction: Combined treatment with directional coronary atherectomy followed by drug‐coated balloon angioplasty

“…Recently, an improved novel DCA catheter (Atherocut™, NIPRO) has been developed in Japan and was commercialized since 2015. A multicenter retrospective study showed that combination therapy with DCA and DCB could provide an option for stent‐less management of LMT bifurcated lesions in patients with stable coronary artery disease 7 . However, the efficacy of the combination therapy with DCA and DCB in AMI remains unclear.…”