Efficacy and safety of drug-coated balloon angioplasty in proximal LAD stenosis with distal myocardial bridge: a 12-month comparative study with drug-eluting stents.

INTRODUCTION

Myocardial bridge (MB), particularly involving the distal left anterior descending artery (LAD), presents unique challenges in percutaneous coronary intervention (PCI) when coexisting with proximal LAD stenosis. Drug-coated balloon (DCB) represents a "leave nothing behind" strategy that may offer advantages over drug-eluting stents (DES) in these anatomically complex lesions.

METHODS

In this retrospective single-center study, 231 patients with proximal LAD stenosis and distal MB underwent PCI using either DCB ( = 83) or DES ( = 148). Intravascular ultrasound (IVUS)-guided lesion preparation and quantitative coronary angiography (QCA) were used. Clinical and angiographic outcomes were assessed at 12-month follow-up.

RESULTS

Baseline characteristics were comparable between groups. DES achieved greater acute lumen gain (1.94 ± 0.26 mm vs. 1.58 ± 0.36 mm;  < 0.001), while DCB resulted in significantly lower late lumen loss (-0.04 ± 0.04 mm vs. 0.18 ± 0.05 mm; < 0.001). The incidence of major adverse cardiovascular events (MACE) was lower in the DCB group (9.6% vs. 21.6%;  = 0.033), as was target lesion revascularization (7.2% vs. 18.2%;  = 0.035).

CONCLUSION

DCB angioplasty is a safe and effective alternative to DES in proximal LAD lesions complicated by distal MB. Despite reduced acute lumen gain, DCBs yielded comparable angiographic results, reduced restenosis and MACE, and enabled shorter dual antiplatelet therapy duration.