Evaluating Drug-Eluting Balloons Versus Stenting for Provisional Bifurcation Lesions: Short-Term Outcomes and Future Directions

Background This prospective cohort study aimed to evaluate the short-term clinical outcomes of drug-eluting balloons (DEBs) versus stenting in provisional bifurcation lesions, focusing on procedural success, safety, and major adverse cardiac events (MACE). The study specifically assessed key adverse outcomes, including restenosis, target lesion revascularization (TLR), myocardial infarction (MI), stent thrombosis, and mortality. Bifurcation lesions present significant challenges in interventional cardiology due to their complex anatomy, which contributes to a higher risk of restenosis, side-branch occlusion, and thrombotic events. This study compared the efficacy, safety, and procedural complexity of DEBs and stenting. Methodology Fifty patients with bifurcation lesions were enrolled and divided into two equal groups: 25 (50%) treated with DEBs and 25 (50%) treated with provisional stenting. The primary outcome measure was the incidence of MACE, including TLR, MI, stent thrombosis, and death. The study was conducted over one year, with follow-up assessments at one- and three months post-intervention. After the intervention, all patients were put on dual antiplatelet therapy (DAPT) comprising aspirin, clopidogrel, and high-intensity statins. Additionally, other medications were prescribed based on patient-specific needs. Results The DEB group exhibited an overall MACE rate of 2 (8%) compared with 3 (12%) in the stenting group (p = 0.58). Restenosis occurred in 1 (4%) of the DEB group and in 2 (8%) of the stenting group, whereas TLR was required in 1 (4%) and 2 (8%) of the patients, respectively. The incidence of MI was low in both groups 1 (4%), with no reported cases of stent thrombosis or death. No significant differences were observed between the groups in any of the clinical outcome measures (p > 0.05). The DEB group achieved treatment success without necessitating side-branch stenting or additional kissing balloon inflation, whereas the stenting group demonstrated comparable success, but increased procedural complexity. Conclusion DEBs and stenting showed comparable short-term efficacy and safety for provisional bifurcation lesions, offering the potential advantage of procedural simplicity. This study supports the viability of DEBs as an effective treatment option for selected bifurcation lesions, avoiding the additional complexities associated with stenting. However, larger studies with extended follow-up are necessary to validate these findings and inform clinical decision-making.