PCI for Chronic Total Occlusions with Distal Diffuse Disease: Stent Alone vs. Stent plus Drug Balloon
Background: Chronic total occlusion (CTO) of coronary arteries is a significant challenge in percutaneous coronary intervention (PCI). Despite successful revascularization, patients often develop diffuse coronary lesions, increasing the risk of restenosis and necessitating complex stent strategies....
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Elsevier
2025-10-01
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| Series: | International Journal of Cardiology: Heart & Vasculature |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352906725001654 |
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| author | Xinyi Yan Xinchen Gao Yingying Hu Jianlei Cao Wei Zhang Yi Lu Jia Zhou Qingqing Wu Xiaorong Hu |
| author_facet | Xinyi Yan Xinchen Gao Yingying Hu Jianlei Cao Wei Zhang Yi Lu Jia Zhou Qingqing Wu Xiaorong Hu |
| author_sort | Xinyi Yan |
| collection | DOAJ |
| description | Background: Chronic total occlusion (CTO) of coronary arteries is a significant challenge in percutaneous coronary intervention (PCI). Despite successful revascularization, patients often develop diffuse coronary lesions, increasing the risk of restenosis and necessitating complex stent strategies. Objective: This study aimed to compare the clinical outcomes of drug-eluting stents (DES) combined with drug-coated balloon (DCB) angioplasty versus DES-only treatment in patients with revascularized CTO and diffuse coronary artery disease. Methods: Patients with successfully revascularized CTO and diffuse lesions were divided into DES-only (n = 191) and DES plus DCB (n = 100) groups. The primary endpoint was major adverse cardiovascular events (MACE), including all-cause death, cardiac death, stroke, and revascularization. The secondary endpoint was the rate of cardiovascular-related hospitalization. Symptom improvement was evaluated using the Canadian Cardiovascular Society (CCS) classification. Results: At 24-month follow-up, the DES plus DCB group had significantly lower MACE incidence (26.00 % vs. 41.36 %, P = 0.008) and cardiovascular-related hospitalization (20.00 % vs. 36.65 %, P = 0.005) compared to the DES-only group. CCS classification improved more significantly in the DES plus DCB group (P < 0.001). Multivariate Cox regression identified DES plus DCB as an independent protective factor against MACE (HR, 0.57; 95 % CI, 0.33–0.99; P = 0.046). Conclusion: In patients with revascularized CTO and diffuse coronary artery disease, the combined DES plus DCB strategy was associated with a lower incidence of MACE and reduced cardiovascular-related hospitalization compared to DES-only treatment. This approach may represent a superior therapeutic option for managing complex coronary lesions. |
| format | Article |
| id | doaj-art-29fc461d01034df99e8e7160f41c29f1 |
| institution | Kabale University |
| issn | 2352-9067 |
| language | English |
| publishDate | 2025-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology: Heart & Vasculature |
| spelling | doaj-art-29fc461d01034df99e8e7160f41c29f12025-08-20T03:42:10ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672025-10-016010176210.1016/j.ijcha.2025.101762PCI for Chronic Total Occlusions with Distal Diffuse Disease: Stent Alone vs. Stent plus Drug BalloonXinyi Yan0Xinchen Gao1Yingying Hu2Jianlei Cao3Wei Zhang4Yi Lu5Jia Zhou6Qingqing Wu7Xiaorong Hu8Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan 430062, China; Institute of Myocardial Injury and Repair, Wuhan University, Wuhan 430062, ChinaDepartment of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan 430062, China; Institute of Myocardial Injury and Repair, Wuhan University, Wuhan 430062, ChinaDepartment of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan 430062, China; Institute of Myocardial Injury and Repair, Wuhan University, Wuhan 430062, ChinaDepartment of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan 430062, China; Institute of Myocardial Injury and Repair, Wuhan University, Wuhan 430062, ChinaDepartment of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan 430062, China; Institute of Myocardial Injury and Repair, Wuhan University, Wuhan 430062, ChinaDepartment of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan 430062, China; Institute of Myocardial Injury and Repair, Wuhan University, Wuhan 430062, ChinaDepartment of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan 430062, China; Institute of Myocardial Injury and Repair, Wuhan University, Wuhan 430062, ChinaDepartment of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan 430062, China; Institute of Myocardial Injury and Repair, Wuhan University, Wuhan 430062, China; Corresponding authors at: Department of Cardiology, Zhongnan Hospital of Wuhan University, Institute of Myocardial Injury and Repair, Wuhan University, Donghu Road 169, Wuhan 430062, China.Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan 430062, China; Institute of Myocardial Injury and Repair, Wuhan University, Wuhan 430062, China; Corresponding authors at: Department of Cardiology, Zhongnan Hospital of Wuhan University, Institute of Myocardial Injury and Repair, Wuhan University, Donghu Road 169, Wuhan 430062, China.Background: Chronic total occlusion (CTO) of coronary arteries is a significant challenge in percutaneous coronary intervention (PCI). Despite successful revascularization, patients often develop diffuse coronary lesions, increasing the risk of restenosis and necessitating complex stent strategies. Objective: This study aimed to compare the clinical outcomes of drug-eluting stents (DES) combined with drug-coated balloon (DCB) angioplasty versus DES-only treatment in patients with revascularized CTO and diffuse coronary artery disease. Methods: Patients with successfully revascularized CTO and diffuse lesions were divided into DES-only (n = 191) and DES plus DCB (n = 100) groups. The primary endpoint was major adverse cardiovascular events (MACE), including all-cause death, cardiac death, stroke, and revascularization. The secondary endpoint was the rate of cardiovascular-related hospitalization. Symptom improvement was evaluated using the Canadian Cardiovascular Society (CCS) classification. Results: At 24-month follow-up, the DES plus DCB group had significantly lower MACE incidence (26.00 % vs. 41.36 %, P = 0.008) and cardiovascular-related hospitalization (20.00 % vs. 36.65 %, P = 0.005) compared to the DES-only group. CCS classification improved more significantly in the DES plus DCB group (P < 0.001). Multivariate Cox regression identified DES plus DCB as an independent protective factor against MACE (HR, 0.57; 95 % CI, 0.33–0.99; P = 0.046). Conclusion: In patients with revascularized CTO and diffuse coronary artery disease, the combined DES plus DCB strategy was associated with a lower incidence of MACE and reduced cardiovascular-related hospitalization compared to DES-only treatment. This approach may represent a superior therapeutic option for managing complex coronary lesions.http://www.sciencedirect.com/science/article/pii/S2352906725001654CTODESDCBRevascularizationMACE |
| spellingShingle | Xinyi Yan Xinchen Gao Yingying Hu Jianlei Cao Wei Zhang Yi Lu Jia Zhou Qingqing Wu Xiaorong Hu PCI for Chronic Total Occlusions with Distal Diffuse Disease: Stent Alone vs. Stent plus Drug Balloon International Journal of Cardiology: Heart & Vasculature CTO DES DCB Revascularization MACE |
| title | PCI for Chronic Total Occlusions with Distal Diffuse Disease: Stent Alone vs. Stent plus Drug Balloon |
| title_full | PCI for Chronic Total Occlusions with Distal Diffuse Disease: Stent Alone vs. Stent plus Drug Balloon |
| title_fullStr | PCI for Chronic Total Occlusions with Distal Diffuse Disease: Stent Alone vs. Stent plus Drug Balloon |
| title_full_unstemmed | PCI for Chronic Total Occlusions with Distal Diffuse Disease: Stent Alone vs. Stent plus Drug Balloon |
| title_short | PCI for Chronic Total Occlusions with Distal Diffuse Disease: Stent Alone vs. Stent plus Drug Balloon |
| title_sort | pci for chronic total occlusions with distal diffuse disease stent alone vs stent plus drug balloon |
| topic | CTO DES DCB Revascularization MACE |
| url | http://www.sciencedirect.com/science/article/pii/S2352906725001654 |
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