Work

DCB vs. DES in aorto-ostial lesions- clinical outcomes and QCA insights from SPARTAN registry

Year: 2026

Type: article

Abstract: Background Aorto-ostial de novo coronary lesions (AOL) represent a technically challenging subset of coronary artery disease with historically high restenosis rates, even with contemporary drug-eluting stent (DES) platforms. Drug-coated balloons (DCB) offer a stent-less alternative strategy; however, data on their use in AOL are limited. We aimed to compare long-term clinical outcomes of DCB vs. DES in de novo AOL. Methods We identified all patients undergoing percutaneous coronary intervention (PCI) with either DCB or DES for de novo AOL as their first procedure between January 2015 and November 2019. The primary endpoint was target lesion failure (TLF), defined as a composite of target lesion revascularisation (TLR), target lesion myocardial infarction (TLMI), and cardiovascular death. Secondary endpoints included the individual components of TLF, target vessel revascularisation and all-cause mortality. Exploratory quantitative coronary angiography (QCA) analysis was performed on any follow up angiograms obtained that were technically feasible. Clinical outcomes were obtained using national outcome datasets. Results A total of 197 patients with aorto-ostial lesions were included (DES n = 140; DCB n = 57). Over a median follow-up of 3.7 years, TLF occurred in 17.1% of DES-treated lesions and 14.0% of DCB-treated lesions (HR: 0.79, 95% CI: 0.35–1.76; p = 0.563). Rates of TLR, TVR, TLMI, cardiovascular mortality, and all-cause mortality were similar between groups. Severe calcification and creatinine independently predicted TLF. Follow-up QCA was available in 59 lesions over varying time intervals and demonstrated lower late lumen loss (LLL) following DCB treatment, compared with DES-treated lesions. Conclusion In this real-world cohort with aorto-ostial coronary lesions, a DCB-only strategy was feasible and associated with similar long-term outcomes to DES. Exploratory angiographic analyses demonstrated significant late lumen gain following DCB treatment. These findings are hypothesis-generating and support further prospective evaluation of a DCB approach in aorto-ostial coronary disease.

Source: Frontiers in Cardiovascular Medicine

DOI: 10.3389/fcvm.2026.1953073