Sanna Uskela and colleagues at North Karelia Central Hospital Heart Center in Finland conducted a retrospective, single-center registry study focused on the use of a drug-coated balloon (DCB)-only strategy in the treatment of de novo left main coronary artery disease. . This study is important because it addresses a treatment approach that has not previously been extensively studied, particularly in the setting of high bleeding risk (HBR) patients.

This study included all consecutive patients who underwent percutaneous coronary intervention (PCI) for new left main artery lesions using a DCB-only strategy between August 2011 and December 2018. became a target. The primary endpoint was major cardiovascular events including cardiac death (MACE). , nonfatal myocardial infarction, and target lesion revascularization (TLR). This cohort was divided into two groups based on whether lesion preparation was performed according to international consensus group guidelines.

Key findings from this study include: (1) The study included 66 patients with a mean age of 75±8.6 years, and 72% were male. Acute coronary syndrome was present in her 52% of patients. (2) No procedural mortality or acute closure of the treated left main occurred. (3) At 12 months, MACE and TLR occurred in 24% and 6% of the entire cohort, respectively. MACE and TLR rates were significantly lower at 21.2% and 1.9% when the lesions were prepared according to the guidelines. (4) This study concludes that left main PCI with a DCB-only strategy is safe and leads to acceptable MACE and low TLR rates after 1 year if lesion preparation is performed according to guidelines.

This study highlights the importance of appropriate lesion preparation in a DCB-only strategy for de novo left main artery disease. DCB-only strategies also allow for a shorter duration of dual antiplatelet therapy (DAPT) or no DAPT at all, reducing the risk of bleeding complications, especially in patients with HBR. We also highlight the potential benefits of this approach.

Limitations of this study include its retrospective nature, relatively small number of patients, and overrepresentation of patients with HBR, older age, and calcified complex left-sided main lesions. Despite these limitations, this study provides valuable insight into her DCB-only strategy for left main coronary artery disease and demonstrates that with appropriate lesion preparation, this approach is feasible for her HBR patients. This suggests that it could be a viable option.

This paper makes a significant contribution to the field of interventional cardiology, especially for clinicians and researchers interested in PCI strategies and management of HBR patients for left main coronary artery disease. To confirm these results and further explore the potential benefits and limitations of a DCB-only strategy, a prospective randomized study comparing DCB angioplasty and stenting with drug-eluting stents (DES) An exam is required.