DEBS-025 | Systematic Review of Drug-Coated Balloon Substances in Coronary Interventions

insufficient to assess its adequacy.This study evaluated long-term outcomes of DCB angioplasty guided by invasive pressure gradient.Methods: In this retrospective, dual center cohort study, 106 patients (126 lesions) underwent DCB angioplasty between February 2020 and June 2024.After lesion preparation, a pressure wire was used to assess the ratio between distal coronary pressure (Pd) an aortic pressure (Pa); a Pd/Pa 0.90 indicated an optimal result suitable for DCB-only treatment.DES was implanted in cases with Pd/Pa <0.90 or type B dissections.Results: Patients were mostly male (90%), aged 72 ( 10) years, with 95% presenting chronic coronary syndrome.Lesions were complex (83% B2/C) and predominantly involved the left anterior descending artery (65%).The mean Pd/Pa significantly increased from 0.78 at baseline to 0.94 at the end of lesion preparation (p < 0.001).DCBonly treatment was successful in 76% of lesions, with 12% requiring bailout DES, despite angiographically visible dissections in 60%.At a median follow-up of 951 days [IQR 377-1172], target lesion failure occurred in 11.7% of patients, target lesion revascularization in 8.4%, target vessel myocardial infarction in 1.7%, and cardiovascular death in 3.3%.Conclusions: In conclusion, Pd/Pa-guided DCB angioplasty ensured favorable long-term outcomes in complex de novo lesions, allowing safe DES deferral and supporting physiological guidance to optimize vessel healing.