Drug eluting balloons in complex coronary lesions — case report

Cardiologia CROATICA Introduction: Drug eluting balloons (DEB) are mostly used for treatment of BMS restenosis, but the indications are broadening (DES restenosis, de novo lesions, small vessel disease and bifurcations). They are usualy combined with BMS. The usage of DEB without stent implantation is a promissing new tool in PCI. Case report: In 2010 a 72-year-old women was transferred to our department, after successful fibrinolysis of an acute inferior STEMI. Coronary angiography revealed ostial D1 stenosis, occlusion of mid LAD and multiple stenoses of RCA. After RCA stenting with 2 BMS “no reflow” occurred. TIMI 3 flow was restored with eptifibatide and implantation of 2 additional BMS. Evaluation was suggested regarding elective PCI LAD but the patient didn’t return. She was readmitted in February 2012 because of unstable angina. Coronary angiography revealed a patent RCA, TIMI 1 flow in D1 and occlusion of mid LAD. PCI of LAD-D1 bifurcation lesion was attempted. After successful wire crossing, PTCA of LAD and D1 was performed. DEB were used in both vessels with an optimal result and TIMI 3 flow. The patient was discharged with DAPT recommendation for 12 months. Angiographic follow up in February 2013 showed a patent LAD and D1 without significant recoil. Discussion: Bifurcations and small vessel are still a challenge. Even with the usage of DES there is still a high percentage of restenosis and periprocedural complications. DEB only in small vessel disease showed good results in randomized trials and registries. In bifurcation trials DEB were used with BMS in the main branch and alone in the side branch, but trials with DEB only are started. Our patient had a complex bifurcation lesion and DEB only proved a good treatment option. Conclusion: We can assume that DEB only is an optional method in some patients with complex coronary lesions. They can be used for small vessels and bifurcation lesions with optimal results. Further research must be done to confirm this hypothesis.