Primjena balona s otpuštanjem lijekau postraničnu granu bifurkacijekoronarnih arterija [Use of drug-eluting balloons in side branch of bifurcation lesions on coronary arteries]

Despite the progress and development of interventional cardiology, treatment of bifurcation lesions is still nonoptimal and presents one of the most demanded interventions with a higher proportion of complications, short-term and long-term unwanted events. The aim of this study was to compare the angiographic results of drug-eluting balloon (DEB) in the side branch of coronary artery bifurcations to the angiographic results using the drug-eluting stent (DES) or provisional stenting, primarily by comparing the degree of in-stent restenosis and late luminal loss, at least six months after the intervention. The study was defined as a prospective single-center study involving patients with true bifurcation lesions that affect both the main and side branch. 60 patients were divided into three groups: DES-DEB, DESDES, and DES with provisional stenting. Overall, the median age was 67 years (47-84), with 76.6% male patients. The coronary angiography indication was stable angina pectoris in 77% of patients and unstable angina in 23% of patients. There were no statistically significant differences in clinical and demographic characteristics, nor cardiovascular risk factors among groups. No patient has experienced a major adverse event, counted by the death of a cardiovascular cause or a myocardial infarction. Target lesion revascularization with the repeated intervention was recorded in two patients in the second, and two in the third group due to unstable angina while not observed in the first group. A statistically significant increase in diameter of the side branch was recorded in the first group from the period of the procedure to the control coronary angiography (0.90 mm), while in the second and third group there was a lumen loss (0.10 mm and 0.20 mm). Differences in initial values of the narrowest lumen diameter of the side branch stenosis between the groups did not exist. After the intervention, the narrowest lumen diameter was higher in the second and third group compared to the first group, with the loss of difference observed on follow-up between the first and the second group (2.25 vs. 2.22 mm; p = 0.607). Also, the narrowest lumen diameter in the first group on follow-up was significantly higher concerning the third group (2.25 vs. 1.74 mm; p = 0.0003). The data obtained show the superior six-month angiographic results of using DEB in the side branch segment to the provisional technique and the non-inferiority to DES use.