Cage-Free Chronic Occlusion PCI: Multivessel Total and Subtotal Occlusion Treatment With Drug Coated Balloon Angioplasty.

Drug-coated balloon (DCB) catheters offer an alternative to drug-eluting stents (DES) by delivering anti-proliferative drugs directly to vessel walls, avoiding implantation of a permanent metallic structure. While DCBs have shown efficacy for in-stent restenosis, evidence for their application in de novo coronary disease and chronic total occlusion (CTO) PCI is growing. We present a case of a 49-year-old male with multivessel chronic total and subtotal occlusions who had complete percutaneous revascularisation using a DCB only strategy. Each lesion had unique characteristics involving its length and location, bifurcation anatomy, and vessel diameter for which this stent-free approach was favored. DCB use in CTO PCI may be promising in select cases and lesions, and further studies are warranted to ascertain long-term efficacy in this setting.
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