IMR Press / RCM / Volume 23 / Issue 1 / DOI: 10.31083/j.rcm2301013
Open Access Review
DCBs as an adjuvant tool to DES for very complex coronary lesions
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1 Cardiology Department, Lebanese University, 00961 Beirut, Lebanon
2 Cardiology Department, Al-Zahraa University Hospital, 00961 Beirut, Lebanon
3 Clinica Polispecialistica San Carlo, Paderno Dugnano, 20037 Milano, Italy
4 Fondazione Ricerca e Innovazione Cardiovascolare, 20121 Milano, Italy
*Correspondence: (Bernardo Cortese)
Academic Editor: Jerome L. Fleg
Rev. Cardiovasc. Med. 2022, 23(1), 13;
Submitted: 20 October 2021 | Revised: 30 November 2021 | Accepted: 1 December 2021 | Published: 14 January 2022
(This article belongs to the Special Issue Drug-Coated balloons-The “leave nothing behind” strategy)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Drug eluting stents (DES) have revolutionised interventional cardiology and currently represent the standard for percutaneous coronary interventions (PCI). However, due to several limitations, new strategies are required, especially in very complex lesions. Drug-coated balloons (DCB) offer an attractive therapeutic alternative, and have already obtained a Class I recommendation for the treatment of in stent restenosis (ISR) with Level A of evidence. Moreover, the role of DCB has been tested in several other settings, such as de novo large vessel disease, multivessel disease or very complex lesions, with promising results regarding safety and effectiveness. In this context, a hybrid strategy consisting in the use of a DES and DCB with the aim of reducing the amount of metal implanted and minimising the risk of ISR and stent thrombosis could become the solution for very complex lesions. Several important studies already demonstrated very good angiographic results in terms of late lumen loss and restenosis for this approach in bifurcation lesions. Moreover, for long diffuse coronary disease similar rates of MACE, TVR, and TLR at 2-year follow-up in comparison to a DES-alone strategy were found. What is more, the use of this strategy in high-bleeding risk patients could safely permit the practitioners to reduce the DAPT duration, as data is suggesting. As our daily practice already strongly incorporated this strategy and with more data expected from important trials, it is our strong believe that the hybrid approach can become a standard treatment choice in the near future.

Complex coronary lesions
Fig. 1.
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