Drug-Coated Balloon DCB in Coronary Bifurcation Lesions; a strategy less utilized

Abstract

Background: The case involved a challenging coronary bifurcation lesion with a Medina classification of 0,1,1 involving the left main, left circumflex, and high obtuse marginal (OM) arteries. The left circumflex artery had a barely visible stump, with the high OM branch originating from the same root. Initially, the treatment plan was a provisional percutaneous coronary intervention (PCI) to the left circumflex artery (LCX) with planned crossover of the high OM branch. However, the complex anatomy presented challenges, leading to a decision to switch to a drug-coated balloon (DCB) only strategy for both the LCX and high OM due to unsuitability for conventional stenting.

Case Presentation: A 37-year-old male, with no history of diabetes or hypertension but with a smoking habit, presented with non-ST-segment elevation myocardial infarction (NSTEMI) in June 2022. Elevated troponin levels indicated myocardial damage, while 2-D echocardiography demonstrated preserved left ventricular (LV) function.

Management and Results: Given the patient's clinical presentation and coronary anatomy, PCI was performed using DCB on the LCX and high OM branches. The DCB approach facilitated angioplasty without the need for complex stenting, thereby minimizing the risk of branch compromise. Post-angioplasty angiography revealed satisfactory results, with restoration of coronary flow and no significant complications. Furthermore, the patient experienced improved clinical outcomes following the intervention.

Conclusion: In cases of coronary bifurcation lesions where conventional stenting is not feasible due to anatomical constraints, the use of DCB represents a pragmatic approach. By avoiding complex stenting and potential branch compromise, this strategy optimizes patient care and enhances clinical outcomes.