ArticleFrontiers in cardiovascular medicine2026
Feasibility and safety of only DCB approach in consecutive patients undergoing contemporary CTO PCI; the all-comers DCB study.
Article in Frontiers in cardiovascular medicine, 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
Background: Evidence regarding an "only drug-coated balloon (DCB)" strategy in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) remains limited, particularly in complex all-comer populations. We aimed to evaluate the feasibility, safety, and mid-term outcomes of an only DCB strategy in consecutive patients undergoing contemporary CTO PCI. Methods: This multicenter observational study included consecutive CTO PCI procedures performed between January 2024 and April 2026 at three high-volume CTO centers. All procedures were initially attempted using an intention-to-treat "only DCB" strategy. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), defined as cardiac death, target lesion revascularization (TLR), target vessel myocardial infarction, or stroke. Results: A total of 457 CTO PCI procedures were evaluated. After excluding unsuccessful guidewire crossing procedures, 423 lesions underwent lesion preparation using the only DCB protocol. Final treatment with an "only DCB" strategy was achieved in 248 lesions, corresponding to a feasibility rate of 58.62%. Mean J-CTO score was 1.97 ± 1.04. Antegrade wiring was used in 95.2% of procedures, whereas retrograde wiring was used in 16.9%. Mean follow-up duration was 231.1 ± 130.3 days. MACCE occurred in 28 patients (13.9%), and target vessel failure in 27 (13.4%). Follow-up mortality occurred in one patient (0.5%), and no patient had a stroke. Patients with angiographic restenosis ≥70% had smaller final minimum lumen diameter (1.69 ± 0.64 mm vs. 2.23 ± 0.80 mm; Conclusions: In an all-comer CTO PCI population, an only DCB strategy appears feasible in more than half of patients, with acceptable mid-term clinical and angiographic outcomes.
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