Clin Res Cardiol (2021). 10.1007/s00392-021-01933-9

Drug Eluting Balloon vs. Stent in the Main Vessel for the Treatment of Bifurcation Lesions - Results from the DEBIFU registry
P. Swojanowsky1, H. U. Hink2, T. Gori3, B. Hügl4, B. Buchter4, R. Zotz5, E. Friedrich6, H. von Korn1, für die Studiengruppe: DEBIFU
1Medizinische Klinik I, Marienhaus Klinikum Hetzelstift, Neustadt a. d. Weinstraße; 2Klinik für Innere Medizin 1 - Kardiologie, Klinikum Frankfurt Höchst GmbH, Frankfurt am Main; 3Zentrum für Kardiologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz; 4Klinik für Kardiologie/Rhythmologie, Marienhaus Klinikum St. Elisabeth Neuwied, Neuwied; 5Marienhaus Klinikum Eifel-Bitburg, Bitburg; 6Praxis für Kardiologie und Angiologie, St. Wendel;
Objectives:
Treating the main vessel with drug eluting balloon only is safe and feasible in bifurcation lesions and may reduce the rate of stent usage.

Background:
Bifurcation lesions are the most common complex lesion in everyday practice in the cath lab. Several strategies exist to handle these lesions, and there is still debate about optimal treatment. Stent implantation is accompanied by the risk of stent thrombosis, which correlates with stent length.

Methods:
DEBIFU registry consists of 98 patients with coronary bifurcation lesions. We further selected a total of 64 patients that were either treatet with a plain balloon and stent (n=48) or solely with a DEB in the MV (n=16pts.) 

Results:
Regarding baseline characteristics, DEB patients were significantly older (71,4±11,1 vs. 64,6±11,6; p=0,02) and had numerically more advanced CAD with 50 vs. 35% of three vessel disease. Stenting was mostly performed in the LAD/Diagonalis bifurcation where DEB was most used in RCX/OM (p=0,003 respective p<0,001). Comparing lumen gain, the results favored the stent group with significantly more acute lumen gain in the proximal MV (p<0,001) and significantly more lumen diameter and acute lumen gain in the distal MV (p=0,02 respective p=0,04). Overall MACE rates were low, with no MACE in the DEB group. In the stent group, one death occurred and there were 2 TLR, one due to stent thrombosis.

Conclusion:
Treating the MV with a DEB only seems to be safe and feasible. MACE rates and outcome showed no difference between strategies with numerically lower TLR and stent thrombosis rates in the DEB group. Even with regard to the lower lumen gain with DEB. Therefore, DEB only may be a viable option in selected patients with bifurcation lesions to prevent stent implantation. In our opinion, patient selection is key to this strategy and it has to be evaluated further which patients will benefit the most.

https://dgk.org/kongress_programme/ht2021/P756.htm