Key result
Stentless DCB-based strategy maintains 6-month vessel patency in complex ostial LCX lesion.
Case Report (n=1)
A stentless strategy using plaque modification and a drug-coated balloon is a feasible approach for complex thrombotic bifurcation lesions in ACS, potentially avoiding the risks of permanent metallic stents.
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Supports feasibility of stentless strategies in select ACS lesions; hypothesis-generating and requires prospective validation before practice change.
We present the case of a 56-year-old male with non-ST elevation myocardial infarction (NSTEMI) and a complex thrombotic lesion at the ostial left circumflex artery (LCX), extending into bifurcating marginal branches. Due to the high risk of side branch occlusion, a stentless strategy using thrombus aspiration, the reverse wire technique, and sequential plaque modification with a cutting balloon (Rodin-CUT technique) was employed. Following optimal lesion preparation, a drug-coated balloon (DCB) was deployed, achieving excellent angiographic and intravascular ultrasound (IVUS) results, with sustained vessel patency at 6-month follow-up. This case highlights the efficacy of a free-metal strategy in managing challenging bifurcation lesions while preserving side branches and avoiding the risks associated with permanent metallic implants.
Gherasie et al. (2026) conducted a case report in NSTEMI with complex thrombotic ostial LCX lesion (n=1). Stentless strategy (thrombus aspiration, cutting balloon, drug-coated balloon) was evaluated on Vessel patency and angiographic/IVUS results at 6-month follow-up. A stentless strategy using thrombus aspiration, cutting balloon, and drug-coated balloon successfully treated a complex ostial LCX lesion with sustained vessel patency at 6 months.
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