Drug coated balloons for coronary artery bifurcation lesions: A systematic review and focused meta-analysis.

Natasha H Corballis,Ioannis Merinopoulos,Tharusha Gunawardena,Simon C Eccleshall,Sophie Paddock,Vassilios S Vassiliou,Katriina Aalto-Setala

doi:10.1371/journal.pone.0251986

Natasha H Corballis, Ioannis Merinopoulos + Show 5 more

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https://doi.org/10.1371/journal.pone.0251986

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Abstract

ObjectivesWe sought to systematically review the evidence supporting the role of drug coated balloons (DCBs) in the treatment of coronary bifurcation lesions.BackgroundDCBs are emerging as an attractive alternative treatment strategy for treating coronary bifurcations due to simplifying the approach and reducing rates of stent related complications. We systematically reviewed the evidence for DCB use in coronary bifurcations and conducted a focused meta-analysis on late lumen loss in the side branch comparing DCB and plain old balloon angioplasty (POBA).MethodsThis study was conducted in line with the PRISMA statement. All studies (including both RCTs and observational studies, excluding case reports) using DCB as part of a bifurcation strategy were included in this review. A literature search identified a total of ten studies for inclusion. A focused meta-analysis was undertaken for the use of DCB in side-branch compared with POBA. Mean late lumen loss was used with a random effects model due to heterogeneity.ResultsDCB was found to be superior to POBA for side branch treatment in bifurcations (p = 0.01). There are four studies that investigated the use of DCB for main branch treatment in a bifurcation, with evidence supporting its safety in main branches of bifurcation lesions, while prospective observational studies have demonstrated favourable target lesion revascularisation rates.ConclusionAlthough there is a lack of robust RCTs comparing DCBs with current generation DES, DCBs appear safe in main branch bifurcation lesions with improved side branch late lumen loss when compared with DES or POBA.

Highlights

A coronary bifurcation lesion is defined as a lesion occurring at, or adjacent to, a significant division of a major epicardial vessel [1]
We systematically reviewed the evidence for drug coated balloons (DCBs) use in coronary bifurcations and conducted a focused meta-analysis on late lumen loss in the side branch comparing DCB and plain old balloon angioplasty (POBA)
DCB was found to be superior to POBA for side branch treatment in bifurcations (p = 0.01)

Summary

Introduction

A coronary bifurcation lesion is defined as a lesion occurring at, or adjacent to, a significant division of a major epicardial vessel [1]. Bifurcation lesions account for 1 in 5 of all cases requiring percutaneous coronary intervention (PCI) [1] and are associated with worse outcomes than non-bifurcation PCI [2]. Treatment strategies for these lesions are complex and there remains a lack of consensus on the best approach. We systematically reviewed the evidence supporting the use of drug coated balloons (DCBs) as an alternative to complex stenting. DCBs are emerging as an attractive alternative treatment strategy for treating coronary bifurcations due to simplifying the approach and reducing rates of stent related complications. We systematically reviewed the evidence for DCB use in coronary bifurcations and conducted a focused meta-analysis on late lumen loss in the side branch comparing DCB and plain old balloon angioplasty (POBA).

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