One-year outcomes after hybrid DES-DCB and two-stent strategies for true distal left main bifurcation lesions: A single-center registry.

Background

True distal left main (LM) bifurcation percutaneous coronary intervention (PCI) is technically challenging. A hybrid strategy using a drug-eluting stent (DES) in the main branch and a drug-coated balloon (DCB) in the side branch may reduce permanent metal at the bifurcation, but LM-specific data remain limited.

Objectives

To describe 1-year clinical outcomes after completed hybrid DES-DCB and two-stent strategies for true distal LM bifurcation lesions and to provide an exploratory unadjusted comparison between groups.

Methods

This single-center retrospective cohort registry included consecutive adults undergoing PCI for true distal LM bifurcation disease between April 2020 and December 2024. Patients were classified according to the completed index strategy: hybrid DES-DCB or two-stent PCI. The primary clinical endpoint was the 1-year composite of cardiac death or clinically driven target lesion revascularization (CD-TLR). Between-strategy comparisons were exploratory and hypothesis-generating.

Results

Among 83 patients, 52 underwent hybrid DES-DCB and 31 underwent two-stent PCI; intravascular imaging was used in 77 procedures (92.8%). The primary clinical endpoint occurred in 3 of 52 hybrid patients (5.8%; 95% CI, 1.2%-15.9%) and 2 of 31 two-stent patients (6.5%; 95% CI, 0.8%-21.4%; exploratory p = 1.000). Both deaths were sudden cardiac deaths.

Conclusions

This selected single-center cohort provides descriptive 1-year outcomes after completed hybrid DES-DCB and two-stent procedures. Larger prospective LM-specific studies are needed.