title: Results From the International Drug Coated Balloon Registry for the Treatment of Bifurcations. Can a Bifurcation Be Treated Without Stents?
abstract: OBJECTIVE
  This observational study assessed the 9-month clinical outcomes in patients with coronary bifurcation lesions suitable for drug-coated balloon (DCB) angioplasty. It was the intention to use DCB's without additional stenting (DCB-only strategy) in selected patients for this chosen strategy. Bail-out main branch (MB) and/or side branch (SB) stenting, however, were permissible when flow limiting dissections or excessive recoil occurred.
  
  
  BACKGROUND
  A multitude of interventional strategies have been studied to treat bifurcation lesions. With the availability of DCB angioplasty, investigators have been using this interventional tool with the optional implantation of bare metal stents (BMS).
  
  
  METHODS
  This study is an international, prospective, multicenter registry enrolling patients with coronary bifurcation lesions including a side branch ≥2 mm in diameter. Patients with stable angina and documented ischemia or selected forms of unstable angina due to a culprit bifurcation lesion of any Medina classification type were recruited. The primary endpoint was clinically driven target-lesion revascularization (TLR) at 9 months. Secondary endpoints included 9-month major adverse cardiac events (death, myocardial infarction, or TLR), technical success, in-hospital outcomes and vessel thrombosis rates.
  
  
  RESULTS
  A total 127 patients 66.1 ± 10.1 years of age were enrolled. Demographic characteristics were 80.3% (102/127) male gender, 31.5% (40/127) diabetes, 91.3% (116/127) hypertension, 7.1% (9/127) ST-elevation myocardial infarction (STEMI), and 9.4% (12/127) non ST-elevation myocardial infarction (NSTEMI). The 130 lesions were treated with 184 DCB's and 64 BMS. In 53.8% (70/130) of all lesions the DCB-only strategy could be used while 34.6% (45/130) of lesions had at least 1 stent (BMS) in the main branch, 8.5% (11/130) had at least 1 stent in the side branch and 3.1% (4/130) needed at least 1 stent in the main and side branch. 94.5% patients (121/127) were available for follow-up after 9.8 ± 2.0 months. The TLR rate was 4.6% in the absence of any thrombotic events in the treated vessels whereas the 9-month MACE rate was 6.2%.
  
  
  CONCLUSIONS
  This observational study suggests that the DCB-only strategy is safe and effective to treat selected bifurcations while benefiting from a shortened dual antiplatelet therapy (DAPT).
authors.affiliation: Unfallkrankenhaus Berlin, Berlin, Germany.
authors.forename: Leonhard
authors.initials: L
authors.lastname: Bruch
authors.affiliation: Klinikum Karlsburg der Klinikgruppe Dr. Guth GmbH and Co. KG, Karlsburg, Germany.
authors.forename: Mariusz
authors.initials: M
authors.lastname: Zadura
authors.affiliation: Medical Scientific Affairs B.Braun Vascular Systems, Berlin, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Waliszewski
authors.affiliation: Clinical Hospital Center Rijeka, Rijeka, Croatia.
authors.forename: Zeljko
authors.initials: Z
authors.lastname: Platonic
authors.affiliation: Pohjois-Karjalan Keskussairaala 1, Kokkola, Finland.
authors.forename: Jaako
authors.initials: J
authors.lastname: Eränen
authors.affiliation: Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
authors.forename: Bruno
authors.initials: B
authors.lastname: Scheller
authors.affiliation: Christliches Krankenhaus Quakenbrück gGmbH, Quakenbrück, Germany.
authors.forename: Bettina
authors.initials: B
authors.lastname: Götting
authors.affiliation: Medical Scientific Affairs B.Braun Vascular Systems, Berlin, Germany.
authors.forename: Denny
authors.initials: D
authors.lastname: Herberger
authors.affiliation: Ospedale del Cuore G. Pasquinucci, Massa, Italy.
authors.forename: Cataldo
authors.initials: C
authors.lastname: Palmieri
authors.affiliation: Policlinico Le Scotte Siena, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sinicròpi
authors.affiliation: Klinikum Karlsburg der Klinikgruppe Dr. Guth GmbH and Co. KG, Karlsburg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Motz
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology; D054855:Drug-Eluting Stents / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D012042:Registries; D013997:Time Factors; D016896:Treatment Outcome