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Onea et al. Vessel Plus 2023;7:13 https://dx.doi.org/10.20517/2574-1209.2023.11 Page 7 of 12

length was 34.4 mm, while 70% of the de-novo lesions were located in vessels ≤ 2.5 mm in diameter. At a
median follow-up of 14.6 months, there were no cardiac deaths in the de-novo cohort, with an acceptable
frequency of the other clinical parameters- target vessel MI (1.3%), TLR (17.7%), target-vessel
[32]
revascularization (TVR) (16.5%) and MACE (16.5%) . The Magic Touch sirolimus-DCB (Concept
Medical, India) was also assessed in a cohort of 373 primarily de-novo (68%), small and diffuse (60%)
lesions with even more promising results at 1 year. There was no documented acute vessel closure, and
while hard clinical endpoints showed low rates (cardiac death- 1.7%, MI- 3.4%), TLR and MACE were also
[33]
adequate (12 and 10%, respectively) .
Costopoulos et al. included patients with long coronary lesions (cutoff of 25 mm, 45.2% with DM) and
compared a DCB vs. a DES strategy in this context. What is more, in the DCB group, 36.6% of lesions were
treated with a blended DCB/DES approach in cases of very-long lesions (mean length = 67.7 mm).
Paclitaxel-DCB used were IN.Pact Falcon in the majority of cases and Pantera Lux (Biotronik SE,
Germany). The end of the 26-month follow-up shows a similar frequency of MACE (a composite of
all-cause death, MI and TVR) (20.8% vs. 22.7%; P = 0.74) and TVR (14.8% vs. 11.5%; P = 0.44) between the
DCB ± DES and DES-only groups. Similar results were reported in cases of TLR rates (9.6% vs. 9.3%; P =
0.84), with more events arising in the DCB/ DES compared to the DCB-only subgroup .
[3]

A hybrid strategy using a bioresorbable vascular scaffold (BRS) and a DCB was attempted by Ielasi et al. on
a relatively small number of patients, 88% of them with diffuse lesions. DCB were used exclusively to treat
small vessels (< 2.75 mm). One year follow-up showed an excellent safety profile with no cardiac death and
target-vessel MI, as well as no BRS/DCB thrombosis being reported. Although angiographic follow-up is
available only in half of the patients, ischemia-driven TLR occurred in 4.7% of cases, related to the BRS-
[34]
treated segment .

SPARTAN DCB was a prospective cohort study offering a head-to-head comparison between paclitaxel-
DCB-only and second-generation DES in native stable CAD. The mean lesion length in the DCB arm was
26 mm. Over 1,500 patients were included and follow-up was available for up to 5 years. There was a signal
towards better survival in the DCB group sustained after propensity score-matching (no. at risk 30 vs. 468,
[35]
P = 0.083; no. at risk 30 vs. 162, P = 0.018) . DCB show encouraging results even in a population of young
(< 45 years) patients with ACS. At a mean follow-up period of 3.1 years as opposed to the DES group,
patients treated with DCB (mean device length = 26 mm) had a trend towards a lower incidence of the
composite endpoint (cardiac death, MI and TLR) driven mainly by TLR (3.0% vs. 11.0%, P = 0.12; 3.0% vs.
9.1%, P = 0.19). There was no difference between the groups with respect to the incidence of heart failure or
major bleeding (0.0% vs. 1.9%, P = 0.39; 1.5% vs. 4.8%, P = 0.30) .
[36]
DCB have been used as a single tool in treating chronic total occlusions (CTO) associated with diffuse
disease [37-39] . Jun et al. retrospectively included 93 CTO lesions with a mean length of 42.4 mm revascularized
with a DCB-only strategy (SeQuent Please). Two-year follow-up shows a low incidence of hard clinical
endpoints: cardiac death- 2.4%, MI- 3.6%, no vessel thrombosis and a negligible LLL of 0.03 ± 0.53 mm. The
MACE rate was 16.7%, mainly driven by TVR (13.1%) .
[39]

With DM being a known risk factor for stent failure, Pan et al. conducted a propensity score analysis
comparing the outcomes of 1,156 patients with and without DM treated with DCB (SeQuent Please). The
mean DCB length was 25 mm, while over 80% of lesions were de-novo. At 1 year of follow-up, DCB show
similar results in both the DM and non-DM groups in terms of MACE (OR: 1.580, 95%CI: 0.912 - 2.735),
cardiac death (OR: 1.608, 95%CI: 0.523 - 4.946) or any revascularization (OR: 1.534, 95%CI: 0.983 - 2.393;