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Drug-Eluting Balloon Angioplasty in Complex vs. Non-Complex Coronary Lesions: A Real-World Lesion-Based Outcome Study
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; S. Andraz; J. Guerreiro Pereira; H. Costa; P. De Azevedo; H. Palmeiro; J. Bispo; J. Moura Guedes; J. Mimoso; H. Vinhas
Abstract
<p>Background: Drug-eluting balloons (DEB) are established therapy for coronary in-stent restenosis and are increasingly used in small-vessel disease, where they showed non-inferiority to DES in randomized trials such as BASKET-SMALL 2. Current ESC and international consensus documents primarily frame DCB as a strategy for ISR and de novo small vessels (<2.75–3.0 mm), with much less evidence in complex coronary lesions. However, the safety profile of DEB-based strategies across escalating levels of anatomical complexity remains insufficiently characterized.</p> <p>Purpose: To evaluate whether lesion complexity adversely affects clinical and procedural outcomes after DEB angioplasty, using an expanded composite endpoint that includes both follow-up events and intraprocedural rescue stenting.</p> <p>Methods: 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 520 DEB-treated lesions, with a 1 year follow-up. Complex anatomy was defined by ≥1 of the following criteria: AHA type C calcification, bifurcation, chronic total occlusion, left main involvement, in-stent restenosis, or long lesion segment (≥30 mm). Outcomes included target lesion failure (TLF), target lesion revascularization (TLR), cardiovascular death, all-cause death, rescue stenting, and a composite of all. Univariate comparisons were followed by penalized multivariable logistic regression.</p> <p>Results: A total of 385 lesions (74.0%) were classified as complex. Although numerically higher event rates were observed in complex lesions, none of the comparisons reached statistical significance. The composite endpoint occurred in 16 non-complex lesions (11.9%) vs 48 complex lesions (12.5%; OR 1.07, p=1.000). Similarly, TLF showed a non-significant directional increase (3.1% vs 1.5%). All secondary endpoints, including cardiovascular death, all-cause death and rescue stenting, were not statistically different between groups.</p> <p>Conclusions: In this real-world DEB cohort, anatomical complexity did not significantly worsen lesion-level clinical or procedural outcomes, although numerically higher rates were observed. These findings suggest that DEB angioplasty may remain a viable strategy even in complex coronary anatomy when meticulous lesion preparation and bailout DES readiness are ensured. Larger prospective studies are needed to determine whether specific complexity components carry incremental risk.</p>
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