Aims. We aimed to evaluate the efficacy of stentless strategy by drug-coated balloon (DCB) angioplasty following directional coronary atherectomy (DCA) for left main (LM) bifurcation lesions. Methods. A total of 38 patients who underwent DCB angioplasty following DCA for LM bifurcation lesions were retrospectively enrolled. The primary endpoint was target vessel failure (TVF) at 12 months. Secondary endpoints included procedure-related major events during the hospitalization, major adverse cardiac events at 12 months, ischemia-driven target lesion revascularization (TLR) at 12 months, and bleeding complications defined as the Bleeding Academic Research Consortium criteria ≥2 at 12 months. Results. Among these 38 lesions, 31 lesions were de novo LM bifurcation lesions and 7 lesions were stent edge restenosis at the left anterior descending (LAD) ostium. The mean % plaque area (%PA) after DCA was 44.0 ± 7.4%. TVF at 12 months occurred in 1 lesion (3.2%) of de novo LM bifurcation lesion and in 3 lesions (42.9%) of stent edge restenosis at the LAD ostium. All events of TVF were ischemia-driven TLR by percutaneous coronary intervention. Among 4 TLR cases, %PA after DCA was high (55.9%) in the de novo LM bifurcation lesions; on the other hand, %PA after DCA was low (42.4%, 38.7%, and 25.7% in the 3 cases) in stent edge restenosis at the LAD ostium. No procedure-related major events were observed during hospitalization. There was no cardiac death, no myocardial infarction, no coronary artery bypass grafting, and no bleeding complications at 12 months. Conclusions. Stentless strategy by DCB angioplasty following DCA for de novo LM bifurcation lesions resulted in acceptable outcomes. On the other hand, its efficacy was limited for stent edge restenosis at the LAD ostium even after aggressive debulking by DCA.

中文翻译：

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左主干分叉病变定向冠状动脉粥样硬化斑块切除术后药物涂层球囊血管成形术的无支架策略

目标。我们旨在评估药物涂层球囊 (DCB) 血管成形术在定向冠状动脉粥样硬化斑块切除术 (DCA) 后对左主干 (LM) 分叉病变的疗效。方法。回顾性纳入了 38 名在 DCA 后接受 DCB 血管成形术治疗 LM 分叉病变的患者。主要终点是 12 个月时的目标血管衰竭 (TVF)。次要终点包括住院期间与手术相关的主要事件、12 个月时的主要不良心脏事件、12 个月时缺血驱动的靶病变血运重建 (TLR) 以及定义为 12 个月时出血学术研究联盟标准≥2 的出血并发症。结果. 在这38个病灶中，31个病灶为新发LM分叉病灶，7个病灶为左前降支（LAD）口支架边缘再狭窄。DCA 后平均 % 斑块面积 (%PA) 为 44.0 ± 7.4%。12 个月时的 TVF 发生在 1 个病变（3.2%）的新生 LM 分叉病变和 3 个病变（42.9%）的 LAD 口支架边缘再狭窄。TVF的所有事件都是经皮冠状动脉介入治疗缺血驱动的TLR。在 4 例 TLR 病例中，新发 LM 分叉病变中 DCA 后的 %PA 较高（55.9%）；另一方面，在 LAD 口的支架边缘再狭窄中，DCA 后 %PA 较低（3 例分别为 42.4%、38.7% 和 25.7%）。住院期间未观察到与手术相关的重大事件。没有心源性死亡，没有心肌梗塞，没有冠状动脉旁路移植术，结论。DCB 血管成形术对新生 LM 分叉病变的 DCB 血管成形术的无支架策略产生了可接受的结果。另一方面，即使在通过 DCA 积极减瘤后，其对 LAD 开口处支架边缘再狭窄的疗效也有限。