A Comparison of a Drug Coated Balloon With Drug Eluting Stent Strategy for Treating Coronary Bifurcation Lesions

Sep 30, 2026

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Background: Coronary bifurcation lesions remain complex and linked to higher rates of long-term adverse cardiovascular events due to anatomical and procedural challenges. Aims: Compare procedural outcomes between a drug coated balloon (DCB) only approach and a 2nd generation drug eluting stent (DES) strategy for treating de novo coronary bifurcation lesions. Methods: Retrospective cohort (2015–2019) with propensity score matching and a bifurcation-oriented composite endpoint. Results: 2113 patients; event rates were higher with DES (14.0% vs 9.9%), driven mainly by target bifurcation revascularization and target bifurcation myocardial infarction. Conclusions: DCB-only appears a safe alternative within retrospective single-center limits; an RCT is required.

LanguageEnglish

CategoryHealthcare

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Pages12

Reading Time30 min

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Abstract

Background

Aims

Methods

Results

Conclusions

Background

Coronary bifurcation lesions and outcomes

Provisional strategy and evidence for DCB

Catheterization and Cardiovascular Interventions ORIGINAL ARTICLE ‐ CLINICAL SCIENCE A Comparison of a Drug Coated Balloon With Drug Eluting Stent Strategy for Treating Coronary Bifurcation Lesions Natasha Corballis1,2 | Ioannis Merinopoulos1,2 | U. Bhalraam2 | Tharusha Gunawardena1,2 | Vasiliki Tsampasian1,2 | Rajkumar Natarajan2 | Upul Wickramarachchi2 | Mohamed Mohamed3,4 | Allan Clark1 | Mamas A. Mamas4 | Vassilios S. Vassiliou1,2 | Simon Eccleshall2 | SPARTAN‐Norfolk Consortium 1Department of Medicine, University of East Anglia, Norwich, UK | 2Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK | 3Institute of Health Informatics, University College London, London, UK | 4Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, UK Correspondence: Natasha Corballis ([n.corballis@uea.ac.uk](n.corballis@uea.ac.uk)) | Simon Eccleshall ([simon.eccleshall@nnuh.nhs.uk](simon.eccleshall@nnuh.nhs.uk)) Received: 24 June 2025 | Revised: 30 September 2025 | Accepted: 13 October 2025 Keywords: complex PCI | coronary bifurcation lesions | drug coated balloons | PCI ABSTRACT Background: The treatment of coronary bifurcation lesions (CBL) remains complex and associated with a higher rate of long‐ term adverse cardiovascular events due to anatomical and procedural complexity. Aims: We compared procedural outcomes between a drug coated balloon (DCB) only approach and a 2nd generation drug eluting stent (DES) for treating de novo CBLs. Methods: We retrospectively identified all patients with CBL treated with either a DCB only or DES only strategy, including all coronary bifurcations and compared a bifurcation‐oriented composite endpoint (BOCE) of cardiovascular death, target bifurcation‐related myocardial infarction (TB‐MI), and clinically driven target bifurcation revascularization (TBR) using nationally obtained clinical outcome measures from 2015 to 2019 . A propensity score matched analysis was undertaken. Results: Of 2113 patients, 1030 patients were treated with a DCB and 1083 with a DES. There was higher lesion complexity in the DCB group, and propensity score‐matched analysis was utilized. This included a total of 2052 patients (1026 in each arm) . The median age was 68 (59−75), and all clinical presentations were included. The median follow‐up time was 3.6 (2.5−4.8) years with 501 (48.8%) patients having follow‐up available at 5 years. Propensity matched analysis showed a significant increase in events (14.0% vs. 9.9% respectively) (HR: 1.39 [1.08−1.79], p = 0.01) when using DES compared to DCB, driven predominantly by an increase in TBR (8.9% vs. 5.0%) (HR: 1.79 [1.27−2.50], p ≤ 0.001) and TB‐MI (3.0% vs. 1.6%) (HR: 1.92 [1.05−3.57], p 0.03) . Conclusions: The use of DCB‐only in a coronary bifurcation is a safe alternative in treating CBL, within the limitations of a retrospective single center analysis. An appropriately designed RCT is now required. | Abbreviations: BOCE, bifurcation oriented composite endpoint; CBL, coronary bifurcation lesion; DCB, drug coated balloon; DES, drug eluting stent; TLR, target lesion revascularization; TL‐MI, target lesion myocardial infarction.
Vassilios S. Vassiliou and Simon Eccleshall contributed equally to this study.
For a complete list of the SPARTAN‐Norfolk Consortium, see on page 10 . | | --- | | This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
© 2025 The Author(s) . Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC. | Catheterization and Cardiovascular Interventions, 2026; 107:3–14 3 [https://doi.org/10.1002/ccd.70273](https://doi.org/10.1002/ccd.70273) 1 | Background Coronary bifurcation lesions (CBL) account for at least one in five angioplasties u

FAQs

What was the primary comparison in the study?

The study compared a drug coated balloon (DCB) only approach versus a 2nd generation drug eluting stent (DES) strategy for treating de novo coronary bifurcation lesions.

How were patients and endpoints evaluated?

Patients treated with either DCB-only or DES-only strategies from 2015 to 2019 were identified and analyzed using propensity score matching. Outcomes used a bifurcation-oriented composite endpoint including cardiovascular death, target bifurcation-related myocardial infarction, and clinically driven target bifurcation revascularization.

What were the main findings on event rates?

Propensity matched analysis showed significantly higher events with DES compared with DCB (14.0% vs 9.9%). The increase was predominantly driven by higher rates of target bifurcation revascularization and target bifurcation-related myocardial infarction.

Sep 30, 2026

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