title: The role of drug-eluting balloons alone or in combination with drug-eluting stents in the treatment of de novo diffuse coronary disease.
abstract: OBJECTIVE
  This study sought to investigate the role of drug-eluting balloons (DEB) alone or in combination with drug-eluting stents (DES) in the treatment of diffuse de novo coronary artery disease (CAD) (>25 mm).
  
  
  BACKGROUND
  The use of DEB in diffuse CAD, either alone or in combination with DES, offers an alternative to stenting alone. Data regarding DEB in this context are limited.
  
  
  METHODS
  We retrospectively evaluated all patients treated with DEB for diffuse CAD between June 2009 and October 2012. Endpoints analyzed were major adverse cardiac events, defined as all-cause death, myocardial infarction, and target vessel revascularization (TVR), as well as TVR and target lesion revascularization separately. Results were compared with those obtained from a cohort of patients with similar characteristics treated with DES alone.
  
  
  RESULTS
  A total of 69 patients (93 lesions) were treated with DEB ± DES, and 93 patients with DES alone (93 lesions). A high proportion of patients were diabetic (46.4% vs. 44.1%, p = 0.77). Of the DEB-treated lesions, 56.0% were treated with DEB alone, 7.4% with DEB and DES as bail out, and 36.6% with DES and DEB as part of a hybrid approach for very long disease. Outcome rates with DEB ± DES were comparable to those with DES alone at 2-year follow-up (major adverse cardiac events = 20.8% vs. 22.7%, p = 0.74; TVR = 14.8% vs. 11.5%, p = 0.44; target lesion revascularization = 9.6% vs. 9.3%, p = 0.84).
  
  
  CONCLUSIONS
  DEB may have a role in the treatment of diffuse de novo CAD, either alone in smaller vessels or in combination with DES in very long disease.
authors.affiliation: Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Imperial College London, London, United Kingdom.
authors.forename: Charis
authors.initials: C
authors.lastname: Costopoulos
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
authors.forename: Toru
authors.initials: T
authors.lastname: Naganuma
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sticchi
authors.forename: Filippo
authors.initials: F
authors.lastname: Figini
authors.forename: Sandeep
authors.initials: S
authors.lastname: Basavarajaiah
authors.forename: Mauro
authors.initials: M
authors.lastname: Carlino
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.forename: Matteo
authors.initials: M
authors.lastname: Montorfano
authors.forename: Charbel
authors.initials: C
authors.lastname: Naim
authors.forename: Masanori
authors.initials: M
authors.lastname: Kawaguchi
authors.forename: Francesco
authors.initials: F
authors.lastname: Giannini
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D062906:Cardiac Catheters; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D020099:Coated Materials, Biocompatible; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D023903:Coronary Restenosis / Q000209:etiology; D054855:Drug-Eluting Stents; D005260:Female; D061847:Hospitals, High-Volume; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D020099:Coated Materials, Biocompatible
keywords: CABG; DAPT; DEB; DES; EES; MACE; MI; PCI; ST; TLR; TVR; coronary artery bypass graft; diffuse coronary artery disease; drug-eluting balloon; drug-eluting stent(s); drug-eluting balloon(s); dual antiplatelet therapy; everolimus-eluting stent(s); major adverse cardiac event(s); myocardial infarction; percutaneous coronary intervention; stent thrombosis; target lesion revascularization; target vessel revascularization