Hybrid strategy for percutaneous coronary intervention in diffuse left coronary artery disease: single-center one-year outcomes

Abstract

The treatment of diffuse coronary artery disease remains technically demanding due to long lesions, distal vessel tapering, and side branches, and may require extensive metal implantation. A segment-oriented hybrid PCI approach combines the predictable mechanical support of a drug-eluting stent in the proximal vessel segment with local antiproliferative drug delivery using a drug-coated balloon in the smaller distal segment.Aim. To evaluate the immediate angiographic and 1-year clinical outcomes of a hybrid PCI strategy using a proximal drug-eluting stent and a distal drug-coated balloon in the left anterior descending coronary artery in patients with chronic coronary syndrome.Materials and methods. This single-centre descriptive study included 16 patients with chronic coronary syndrome and diffuse de novo disease of the left anterior descending coronary artery. Eleven patients were men (68.75%), and five were women (31.25%). Drug-eluting stent diameters ranged from 3.0 to 4.0 mm, whereas drug-coated balloon diameters ranged from 2.0 to 2.75 mm. Technical success, final TIMI flow, periprocedural complications, and clinical events during 12 months of follow-up were assessed.Results. Final TIMI 3 flow was achieved in all 16 patients, and no periprocedural complications were recorded. No cardiovascular death, non-fatal myocardial infarction, or stroke occurred during 1 year of follow-up. One woman experienced target lesion failure due to clinically driven repeat revascularization of the drug-coated-balloon-treated segment, corresponding to an event rate of 6.25%.No target-lesion-related events occurred in the proximal stented segment.Conclusions. In this small single-centre cohort, a proximal drug-eluting stent combined with a distal drug-coated balloon achieved 100% immediate angiographic success without periprocedural complications. During the 1-year follow-up, one clinically driven repeat revascularization of the distal drug-coated-balloon-treated segment was recorded. The findings support the technical feasibility of the segment-oriented approach, but larger prospective studies are required.