Three‐Year Outcome of Drug Coated Balloon Angioplasty Following Atherectomy for Severely Calcified Coronary Lesions

We aimed to compare the long-term efficacy and safety of drug-coated balloon (DCB) and drug-eluting stent (DES) following atherectomy for coronary arteries with severely calcified lesions. Of the 258 consecutive patients and 422 de novo lesions treated with DCB at Kanazawa Medical University Hospital, we retrospectively enrolled highly calcified de novo lesions treated with atherectomy, rotablator, and/or orbital atherectomy system (OAS), followed by the use of either DCB (94 cases, 191 lesions) or DES (159 cases, 216 lesions) were retrospectively examined. The primary endpoint was target lesion revascularization (TLR), and the secondary endpoint was major adverse cardiac event (MACE) during 3 years of follow-up. Regarding patient background, there was a significant difference in age (All DCB vs. DES: 69.5 ± 11.4 vs. 73.2 ± 8.6; p < 0.001), and the DCB group included more dialysis cases (28.3% vs. 15.3%; p < 0.01). No significant difference was observed in the lesion background. The balloon size of the DCB was 2.56 ± 0.40 mm. Acute closure was not observed after DCB. Late lumen loss (LLL) was -0.07 ± 0.34 mm (DCB) versus 0.46 ± 0.65 mm (DES). Late lumen engagement (LLE) was observed in 56 lesions (56/129 [43.4%]) in the DCB group. As adjunctive treatment after atherectomy for calcified lesions, no significant difference was observed in TLR (16.2% vs. 13.4%; log-rank, p = 0.08) and MACE (18.3% vs. 16.2%; log-rank, p = 0.13). For highly calcified coronary lesions, relative to DES, treatment with DCB after atherectomy could provide clinically acceptable favorable results in terms of TLR and MACE at 3 years.