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Background Chronic total occlusions remain one of the biggest challenges for interventional cardiologists and the high risk of restenosis and stent thrombosis is still a major problem. Drug-coated balloons showed favorable results for the treatment of in-stent restenosis and other lesion types. The aim of this study was to evaluate the feasibility and outcome of a drug-coated balloon only approach for chronic total occlusion. Methods We included 34 patients with a native chronic total occlusion treated only by drug-coated balloons. A visual residual stenosis of 30% or less without major dissection was considered a satisfactory percutaneous intervention result according to the German Consensus Group recommendations for drug-coated balloon use. We collected clinical and procedural data. Angiograms were conducted during the procedure and at follow-up. Quantitative coronary analysis was performed and mean and minimal lumen diameter and late luminal changes were assessed. Results The recanalization was considered satisfactory in 79.4% (n=27). Restenosis occurred in 11.8% (n=4) and reocclusion in 5.9% (n=2). Out of the 27 patients with a satisfactory initial result, 3.7% (n=1) had reocclusion and 3.7% (n=1) had restenosis. In the subgroup without satisfactory result (n=7), restenosis occurred in 3 patients (42.9%) and reocclusion in 1 patient (14.3%). A luminal increase was found in 67.6% (n=23) and mean late luminal gain was 0.11±0.49mm. Angina class improved significantly (p Conclusions Drug-coated balloon angioplasty without stenting is a feasible and well-tolerated treatment method for chronic total occlusions if the predilatation result is good.

Background Despite several negative prospective randomized trials on the efficacy of patent foramen ovale (PFO) occlusion, the discussion on indications is ongoing. Because the incidence of paradoxical coronary embolism through a PFO is unknown, we investigated the risk of paradoxical embolic myocardial infarction over a period of 13 years.Methods and Results:We conducted a retrospective and a prospective study. In the former, we searched the hospital database of a tertiary referral center for cases of acute myocardial infarction (AMI) during the past 10 years and screened them for possible paradoxical MIs. On this basis we started a prospective evaluation over 39 months in another tertiary referral center. All patients with AMI and normal coronary arteries were screened for PFO and if no other reason for the AMI could be found, the case was judged as presumed paradoxical embolism. In the retrospective analysis we found 22 cases (0.45%) of presumed paradoxical coronary artery embolism under 4,848 AMI. In the prospective study there were 11 presumed paradoxical coronary artery embolisms among 1,654 patients with AMI, representing an incidence of 0.67%. Conclusions Our findings demonstrated that well below 1% of AMIs are caused by paradoxical embolism via an interatrial communication. Although this percentage appears low, it is not a negligible number of patients based on the huge number of MIs occurring in the industrialized world.

This study investigated p aclitaxel-induced luminal changes following drug-coated balloon (DCB) angioplasty to treat coronary de novo lesions without additional stenting. DCB-mediated local drug delivery reduces late lumen loss in de novo coronary artery lesions. We performed a retrospective clinical assessment based on a pre-specified quantitative coronary angiography (QCA) protocol. QCA was performed for each centre to assess the primary endpoint late lumen changes, i.e. the difference between in-lesion minimal lumen diameter (MLD) at the routine angiographic follow-up as compared to post-procedural in-lesion MLDs. These MLD changes were compared to corresponding reference vessel diameter changes as an intra-patient control. We evaluated 58 consecutive native coronary artery lesions directly after DCB angioplasty and at a routine target follow-up angiography of 4 months by QCA. Target lesion MLD increased significantly within the 4.1 ± 2.1 month observation period (1.75 ± 0.55 vs. 1.91 ± 0.55 mm, p

This observational study investigated the value of drug-coated balloons (DCB) only strategy in bifurcation lesions in a consecutive series of all comer percutaneous coronary intervention. Local application of paclitaxcel by DCB has clinical benefits in various settings including coronary bifurcations. While so far most bifurcation studies investigated sequential application of DCBs to the main (MB) and side branch (SB) with stenting of the MB, we report first results after DCB intervention without additional stenting of the MB or SB. We performed 39 consecutive DCB only interventions in de novo bifurcation lesions with SB ≥2 mm and scheduled follow-up angiography after 4 months. Patients refusing angiography had telephone follow-up. Follow-up angiograms were obtained in 30 out of 39 DCB only interventions. 33.3 % were located in the left main (LM) bifurcation, 28.2 % in left anterior descending (LAD), 20.5 % in left circumflex (LCX) and 17.9 % in the right coronary artery. Four months after index procedure no patient had died, experienced myocardial infarction or stroke. Follow-up angiograms showed restenosis in 3 out of 30 interventions (10 %), 2 developing in the distal main (6.7 %) and 1 in the SB (3.3 %). All three patients had been treated for LM/LAD/LCX bifurcations and suffered from most severe coronary artery disease, but had not been eligible for CABG for various reasons. Target lesion revascularization was performed in 3 out of 39 patients consistent with a MACE rate of 7.7 %. Treatment of de novo bifurcation lesions with DCB only intervention without additional stenting is a safe therapy with low rates of restenosis and TLR.

Despite several negative prospective randomized trials on the efficacy of patent foramen ovale (PFO) occlusions the discussion on the validity of these studies and on new indications is ongoing. We investigated the risk of paradoxical embolic myocardial infarction over a time period of more than 13

Local paclitaxel delivery to coronary arteries by application of a drug-coated balloon (DCB) has been shown to reduce in-stent restenosis (ISR) and late lumen loss in de novo lesions of small coronary arteries in comparison to other forms of PCI. While inherent healing processes after plane PTCA