CONTENT
Despite advances in Drug-Eluting Stent (DES) technology, at 10-year follow-up there has been no significant difference between DES and Bare-Metal Stent (BMS) in terms of target-lesion revascularization or stent thrombosis (
The European Bifurcation Club’s Keep it Simple, Swift, and Safe (KISS) principle guides the main treatment approach. Although stenting the main branch with provisional side-branch stenting remains the basic strategy, carinal shift and significant side-branch ostial narrowing sometimes make this impossible.
In the current issue’s publication on DCB use in bifurcation lesions,2 the author’s meta-analyses did not demonstrate the superiority of DCB in bifurcation lesions.2 However, these studies exhibit a high degree of heterogeneity. In the DEBUIT trial,3 the main determinant of DCB’s inferiority to DES was use of a matrix-free DCB. In addition to the drug, the presence of a carrier matrix both accelerates transfer into the vessel wall and enhances efficacy. Moreover, both the DEBUIT4 and BABILON trials4 included concomitant use of a BMS alongside DES; the higher restenosis rate with BMS further increases heterogeneity of results.
Jiang and Liu5 examined DCB use in bifurcation lesions through meta-analysis and showed that side-branch DCB application significantly reduced MACE; this finding held for both randomized and non-randomized studies.5 Ikuta et al6 demonstrated that 71% of cases treated with side-branch DCB exhibited late lumen gain (LLG) rather than late lumen loss (LLL).
In the DCB-BIF trial, Gao et al compared main-branch stenting with side-branch treatment using either DCB or a non-compliant balloon (NCB).7 They found that the primary endpoint was significantly lower in the DCB group (7.2% vs. 12.5%,
Her et al8 divided de novo bifurcation lesions into three groups—main-branch DCB, DES, or medical therapy alone—and reported LLL at the side-branch ostium of –0.16 ± 0.45 mm in the DCB group, 0.08 ± 0.38 mm in the medical group, and 0.50 ± 0.52 mm in the DES group (
In the REC-CAGEFREE I Trial, Gao et al9 showed that in non-complex lesions, DCB was inferior to DES (
Which DCB should we use in bifurcation lesions?
In the SPACIOUS study,10 sirolimus- and paclitaxel-coated balloons were compared. While there was no significant difference in LLL between groups (
As a result, Recent data suggest that at least in small vessels and bifurcation lesions (in the absence of dissection beyond type C in the side branch and with residual stenosis under 30%), DCB offers efficacy at least equivalent to DES or NCB.
References
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- Özbay MB, Değirmen S, Güllü A, Nnaemeka Nriagu BN, Özen Y, Yayla Ç. Drug-coated balloons vs. plain balloon angioplasty for side branch management in coronary bifurcation lesions: A systematic review and meta-analysis. Anatol J Cardiol. 2025;29(6):272-279. https://doi.org/10.14744/AnatolJCardiol.2025.5296
- Stella PR, Belkacemi A, Dubous C. A multicenter randomized comparison of drug-eluting balloon plus bare-metal stent versus bare-metal stent versus drug-eluting stent in bifurcation lesions treated with a single-stenting technique: six-month angiographic and 12-month clinical results of the drug-eluting balloon in bifurcations trial. Catheter Cardiovasc Interv. 2012;80(7)():1138-1146. https://doi.org/10.14744/AnatolJCardiol.2025.5296
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- Jiang AM, Liu L. Drug-Coated versus Uncoated Balloon for Side Branch Protection in Coronary Bifurcation Lesions Treated with Provisional Stenting Using Drug-Eluting Stents: A Meta-analysis. Int J Clin Pract. 2022;2022():5892589-. https://doi.org/10.1016/j.carrev.2021.12.020
- Ikuta A, Kubo S, Ohya M. Impact of Late Lumen Loss on Clinical Outcomes of Side-Branch Bifurcation Lesions Treated by Drug-Coated Balloon Angioplasty With Main-Branch Stenting. Cardiovasc Revasc Med. 2022;41():92-98. https://doi.org/10.1016/j.carrev.2021.12.020
- Gao X, Tian N, Kan J. Drug-Coated Balloon angioplasty of the Side Branch during Provisional stenting:the Multicenter Randomized DCB-BIF trial. J Am Coll Cardiol. 2025;85(1):1-15. https://doi.org/10.1016/j.jacc.2024.08.067
- Her AY, Kim B, Kim S, Kim YH, Scheller B, Shin ES. Comparison of Angiographic Change in Side-Branch ostium after Drug- Coated Balloon vs. Drug-Eluting Stent vs. medication for the Treatment of de Novo coronary Bifurcation lesions. Eur J Med Res. 2024;29(1):280-. https://doi.org/10.1186/s40001-024-01877-6
- Gao C, He X, Ouyang F. Drug-coated balloon angioplasty with rescue stenting versus intended stenting for the treatment of patients with de novo coronary artery lesions (REC-CAGEFREE I): an open-label, randomised, non-inferiority trial. Lancet. 2024;404(10457)():1040-1050. https://doi.org/10.1186/s40001-024-01877-6
- Zhou Y, Hu Y, Zhao X. Sirolimus-coated versus paclitaxel-coated balloons for bifurcated coronary lesions in the side branch: the SPACIOUS TRİAL. EuroIntervention. 2025;21(6):e307-e317. https://doi.org/10.4244/EIJ-D-24-00742