title: Effect of Drug-Coated Balloons in Native Coronary Artery Disease Left With a Dissection.
abstract: OBJECTIVE
  The authors sought to understand the clinical and angiographic outcomes of dissections left after drug-coated balloon (DCB) angioplasty.
  
  
  BACKGROUND
  Second-generation DCB may be an alternative to stents in selected populations for the treatment of native coronary lesions. However, the use of these devices may be hampered by a certain risk of acute vessel recoil or residual coronary dissection. Moreover, stenting after DCB has shown limited efficacy. Little is known about when a non-flow-limiting dissection is left after DCB angioplasty.
  
  
  METHODS
  This was a prospective observational study whose aim was to investigate the outcome of a consecutive series of patients with native coronary artery disease treated with second-generation DCB and residual coronary dissection at 2 Italian centers. We evaluated patient clinical conditions at 1 and 9 months, and angiographic follow up was undertaken at 6 months.
  
  
  RESULTS
  Between July 2012 and July 2014, 156 patients were treated with DCB for native coronary artery disease. Fifty-two patients had a final dissection, 4 of which underwent prosthesis implantation and 48 were left untreated and underwent angiographic follow-up after 201 days (interquartile range: 161 to 250 days). The dissections were all type A to C, and none determined an impaired distal flow. Complete vessel healing at angiography was observed in 45 patients (93.8%), whereas 3 patients had persistent but uncomplicated dissections, and 3 had binary restenosis (6.2%). Late lumen loss was 0.14 mm (-0.14 to 0.42). Major adverse cardiovascular events occurred in 11 patients in the entire cohort and in 4 of the dissection cohort (7.2% vs. 8.1%; p = 0.48). We observed 8 and 3 target lesion revascularizations, respectively (5.3% vs. 6.2%; p = 0.37).
  
  
  CONCLUSIONS
  In this cohort of consecutive patients treated with new-generation DCB and left with a final dissection, this strategy of revascularization seemed associated with the sealing of most of dissections and without significant neointimal hyperplasia.
authors.affiliation: Cardiac Department, A.O. Fatebenefratelli, Milano, Italy. Electronic address: bcortese@gmail.com.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Cortese
authors.affiliation: Cardiac Department, A.O. Fatebenefratelli, Milano, Italy.
authors.forename: Pedro
authors.initials: P
authors.lastname: Silva Orrego
authors.affiliation: Cardiac Department, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Agostoni
authors.affiliation: Cardiac Department, A.O. Fatebenefratelli, Milano, Italy; Cardiac Department, A.O.U.P. Paolo Giaccone, Palermo, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Buccheri
authors.affiliation: Cardiac Department, A.O. Fatebenefratelli, Milano, Italy; Cardiac Department, A.O.U.P. Paolo Giaccone, Palermo, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Piraino
authors.affiliation: Cardiac Department, A.O.U.P. Paolo Giaccone, Palermo, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Andolina
authors.affiliation: Cardiac Department, A.O. Fatebenefratelli, Milano, Italy.
authors.forename: Romano Giuseppe
authors.initials: RG
authors.lastname: Seregni
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D062906:Cardiac Catheters; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D020099:Coated Materials, Biocompatible; D003323:Coronary Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D023903:Coronary Restenosis / Q000209:etiology; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D020099:Coated Materials, Biocompatible
keywords: angiographic follow-up; coronary dissection; dissection healing; drug-coated balloon