ArticleCardiology journal2026
Invest-to-treat drug-coated balloon strategy in chronic total occlusion percutaneous intervention for high-risk stent failure patients.
Article in Cardiology journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundLong-term patency in complex chronic total occlusion percutaneous intervention (CTO-PCI) is often hindered by a high-risk of stent-failure (HR-SF), impacting prognosis. Drug-coated balloon (DCB) angioplasty may offer an alternative after successful crossing. We evaluated an invest-to-treat DCB strategy, determined by plaque modification results.
methodsPatients with CTO wire-crossing and suboptimal lesion profile for stenting were enrolled at Campus Bio-Medico University Hospital of Rome (April-July 2024). After plaque preparation, results were classified as good, suboptimal, or poor based on residual stenosis and thrombolysis in myocardial infarction (TIMI) flow. Poor results received conventional stenting [drug-eluting stent (DES)]. Good results underwent a nine-month follow-up; suboptimal results underwent a three-month angiography. A "redo-DCB" approach was used for persistent suboptimal results within the invest-to-treat strategy.
resultsOf 32 CTO-PCIs performed, 29 completed the nine-month follow-up. 11 patients (38%) had poor outflow and required DES (DES-group). The other 18 patients (62%) were managed with DCB alone: six patients (21%) achieved good immediate results (DCB-group), and 12 (41%) were treated as "DCB-investment" due to suboptimal plaque modification (DCB-investment group). At the three-month follow-up, four patients (14%) showed improved angiographic results, while six (21%) had suboptimal outcomes and received redo-DCB after plaque modification; two (7%) of these required DES. At nine-months, 14 patients (48%) were successfully treated with a DCB-only approach.
conclusionsThis prospective study demonstrates that a DCB strategy for CTO patients with HR-SF is feasible and safe. A DCB-only approach resulted in favorable early outcomes for most patients. In the case of suboptimal initial results, the redo-DCB strategy emerged as a promising alternative to extensive stenting.
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