Drug-Eluting Balloons Versus Conventional Balloons in Treatment of Coronary Bifurcation Lesions in Small Vessels

BACKGROUND Coronary bifurcation lesions in small vessels are challenging due to complex anatomy and high restenosis risk. Conventional balloons (CBs) yield suboptimal outcomes, whereas drug-eluting balloons (DEBs), which deliver antiproliferative drugs without stenting, may offer a superior alternative. This study compares the efficacy and safety of DEBs versus CBs for treating coronary bifurcation lesions in small vessels. MATERIAL AND METHODS This retrospective study analyzed patients with de novo coronary bifurcation lesions in small vessels (≤2.5 mm in diameter) treated between April 2022 and May 2024, assigned to either the CB group (n=56) or the DEB group (n=62) based on the type of balloon used. Procedural success was defined by angiographic criteria and TIMI grade 3 flow. Primary and secondary outcomes included major adverse cardiovascular events (MACE), restenosis rates, minimum lumen diameter (MLD), and late lumen loss. RESULTS Baseline characteristics were similar between groups (p>0.05). The DEB group had significantly lower restenosis rates (4.8% vs 26.8%, p<0.001), higher post-procedural MLD (2.48±0.23 mm vs 2.11±0.21 mm, p<0.001), and reduced late lumen loss (0.07±0.02 mm vs 0.10±0.03 mm, p<0.001). Rates of perioperative complications and 1-year MACE were low and comparable (p=0.621 and p=0.259, respectively). CONCLUSIONS DEBs appear safe and effective for small-vessel coronary bifurcation lesions, offering superior efficacy over CBs in reducing restenosis and improving luminal outcomes. These results support their use as a preferred treatment option.