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Predictors of Bailout Stent Implantation After Drug-Eluting Balloon Angioplasty: A Lesion-Level Analysis in Contemporary Real-World PCI
Session:
Sessão de Posters 06 - Balões revestidos na ICP contemporânea
Speaker:
Lucas Hamann
Congress:
CPC 2026
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.2 Coronary Intervention
Session Type:
Posters Eletrónicos
FP Number:
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Authors:
Lucas Hamann; D. Faria; J. Guerreiro Pereira; S. Andraz; J. Moura Guedes; J. Bispo; H. Costa; P. De Azevedo; J. Mimoso; H. Vinhas
Abstract
<p>Background:</p> <p>Drug-eluting balloon (DEB) angioplasty is increasingly used across a wide spectrum of coronary lesions, but unplanned rescue stenting remains a clinically relevant failure mode that may indicate insufficient lesion preparation, balloon oversizing, or vessel trauma. Despite its procedural importance, predictors of rescue DES implantation in real-world DEB practice remain insufficiently characterized.</p> <p>Methods:</p> <p>We conducted a retrospective single-centre analysis of 398 consecutive patients, from 2023-2024 (mean age 67.1±12.6 years, 83.2% male) treated with DEB, yielding 518 DEB-treated lesions, with one year follow-up. Rescue stenting was defined as unplanned DES implantation following DEB inflation due to acute vessel compromise. Candidate predictors included hybrid treatment strategy, bifurcation anatomy, lesion subtype (AHA class), vessel segment, DEB diameter and length, lesion preparation (NC/scoring/cutting balloons), and procedural complications (dissection, no-reflow). Univariate and multivariable penalized logistic regression models were applied.</p> <p>Results:</p> <p>Rescue stenting occurred in 35 lesions (6.8%). On univariate analysis, procedural complications were the strongest correlates: any dissection (55.6% rescue rate; OR≈57.9) and no-reflow (60.0%; OR≈22.5) demonstrated the highest risk, whereas bifurcation anatomy and hybrid strategy showed no significant effect. A detailed classification of dissection severity showed a stepwise rise in risk: Type A (40.7%; OR 31.8), Type B (90.0%; OR 416.7), and Type C (62.5%; OR 77.2) compared with no dissection, confirming a powerful gradient of risk linked to deeper vessel injury. Beyond complications, DCB diameter emerged as a significant independent predictor: each 1-mm increase was associated with 4.22-fold higher odds of requiring rescue DES (95%CI 1.63–10.93, p=0.003). Conversely, DEB length, lesion type, restenosis, vessel segment, and hybrid approaches were not independent predictors. A predefined cutoff analysis showed that DCB >2.5 mm did not significantly increase rescue risk (8.6% vs 5.9%; OR 1.49, p=0.26).</p> <p>Conclusion:</p> <p>In contemporary DEB practice, rescue stenting is uncommon (6.8%) but overwhelmingly driven by intraprocedural complications, especially flow-limiting dissections and no-reflow, with a strong graded effect across dissection types. Importantly, larger DCB diameter independently predicts a significantly higher risk of bailout DES, suggesting that subtle oversizing may predispose to vessel trauma, recoil, or propagation of dissection. These findings emphasize the need for precise vessel sizing, meticulous lesion preparation, and cautious inflation strategy, particularly when using larger DCBs or in lesions predisposed to dissection.</p>
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