The Eurocto registry analysis covering 43,153 patients from 2016 to 2023 shows a significant increase in the use of drug-eluting balloons (DEBs), primarily for treating distal non-occlusive disease and bifurcations. The study found that DEB use leads to reduced stent lengths and contrast use, while improving technical success rates, although the long-term benefits compared to traditional stenting remain uncertain. The findings suggest DEBs are effective in specific CTO cases, particularly where avoiding over-stenting is desired.

1. DCB Usage in the EuroCTO Registry
Carlo Di Mario, Niccolo’ Ciardetti, Alessio
Mattesini on behalf of the EuroCTO Registry
Investigators

6. DEB Use in the EuroCTO Registry: Introduction
• Data on the use of DEB in native coronary artery are less robust and mainly based
on registry rarely addressing CTO where the gold standard is full coverage with
stents of the occluded segment to prevent reocclusion

7. EuroCTO experience (2016-2023)
Total patients: 43153
12,2%
13,3%
12,4%
13,6%
11,7% 11,8%
13%
12%
3,3% 3,3%
3,7%
4,4%
5,9%
6,1%
8,3%
14,3%
0,0%
2,0%
4,0%
6,0%
8,0%
10,0%
12,0%
14,0%
16,0%
2016 2017 2018 2019 2020 2021 2022 2023
CTO-PCI DCB use
p<0.001*
*Pearson Chi-square and Mantel–Haenszel tests
CTO-PCI with DCB temporal trend
DCB alone
23,8%
DCB+DES
76,2%
2631 (6.1%) treated with DCB

8. Type of DCB and indications
ISR 26,7%
diffuse distal
disease 59,4%
SB in
bifurcation
14,0%
0,0%
5,0%
10,0%
15,0%
20,0%
25,0%
30,0%
35,0%
In-stent CTO
31,8%
7,6%
DCB yes DCB no

9. Antegrade wire escalation
(Corsair Pro XS, Fielder XTR,
Gaia I, Gaia II)
PL wiring with bilumen
catheter Sasuke
Long CTO Dominant RCA
with severe proximal/Distal
disease

10. Everolimus eluting stents implantation 3.0x33 mm & 3.5x28 mm in overap – post dilated
with NC 4.0 mm up to 22 atm

11. Kissing balloon PDA-PL with Prevail
Paclitaxel eluting balloons 2.5 x 20 mm
DEB Prevail 3.0 x 25 mm (PLB) with
Guideliner support

12. IVUS final assessment
Good result after
DEB in PL
Bifurcation
PDA-PL
Distal stent
malapposition
Dissection at PDA
ostium, non flow
limiting
Proximal stent
malapposition

13. Final result after post-dilation with NC 4.0 (distally) & NC 4.5 mm (proximally) balloons

14. RCA 53,7%
LM 0,4%
LAD 26,0%
LCx 15,7%
SB 2,5%
Graft 0,2% Unknown
1,4%
CTO characteristics
paclitaxel
91,7%
sirolimus
8,2%
DCB drug

15. 0
10,8%
1
20,1%
2
27,6%
3
25,3%
4
13,5%
5
2,7%
J-CTO
score
CTO complexity
J-CTO ≥2 CASTLE ≥4
69,1%
13,6%
69,2%
13,2%
DCB no DCB yes
p=0.91
p=0.61

16. DCB use and reduction of number of stent
24,0%
14,6%
25,4%
21,0%
25,1%
30,0%
16,8%
22,7%
5,7%
8,9%
2,3%
2,2%
0,5%
0,5%
0,2%
0,1%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
DCB yes
DCB no
0 1 2 3 4 5 6 7
p <0.001

17. DCB use and stent length reduction
57.2 (95%CI: 56.8 - 57.5) mm
43.9 (95%CI: 42.5 - 45.3) mm
p <0.001

18. DCB use and procedural time
97.7 (95%CI: 97.1 – 98.3) min
95.7 (95%CI: 93.7 – 97.7) min
p =0.12

19. DCB use and dye injection
p =0.02
226 (95%CI: 224.6 – 227.4) ml
202.9 (95%CI: 198.6 – 207.1) ml

20. 82,0%
84,0%
86,0%
88,0%
90,0%
92,0%
94,0%
96,0%
98,0%
100,0%
Technical success
98,9%
88,1%
DCB yes DCB no
DCB use and technical success
p<0.001
0,0%
10,0%
20,0%
30,0%
40,0%
50,0%
60,0%
70,0%
80,0%
90,0%
100,0%
TIMI flow 0/1 TIMI flow 2 TIMI flow 3
DCB no DCB yes
9.5%
0.2% 0.7% 0.4%
89.8%
99.4%
p<0.001

21. Independent factors associated with technical success at multivariate analysis

22. Complications
0,0%
0,5%
1,0%
1,5%
2,0%
2,5%
3,0%
3,5%
4,0%
4,5%
5,0%
DCB no DCB yes
NS NS
NS
NS NS
NS
p=0.002
p=0.002

23. DCB use and coronary perforations
CORONARY PERFORATIONS PERICARDIAL TAMPONADE
4,6%
0,6%
3,2%
0,1%
DCB no DCB yes
p=0.002
p=0.002

24. DEB Use in the EuroCTO Registry: Conclusions
• The use of DEB has been rapidly growing in the last 2-3 years
• They are used mainly to treat distal non occlusive disease or bifurcations along the
occlusion segment and avoid the “full metal jacket” approach
• When used across the occluded segment, this often involves in-stent reocclusion
• Their use does not prolong the procedure, reduces contrast use and
perforations/pericardial tamponade
• In the absence of f-up data their advantage over a full stenting or stent/normal POBA
strategy remains speculative