Drug-Coated Balloon Performance in a Calcified Coronary Bifurcation Complicated by Cardiogenic Shock

Q: What are the key findings of this study?

In a frail patient with complex calcified coronary disease, a hybrid strategy using intravascular lithotripsy and drug-coated balloons successfully restored flow and maintained 1-year vessel patency with positive remodeling.

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: NSTEMI with complex calcified multivessel coronary artery disease complicated by cardiogenic shock (n=1). Intervention: Hybrid scaffold-minimizing strategy (intravascular lithotripsy and drug-coated balloons). Primary outcome: Procedural success (coronary flow restoration) and angiographic patency at follow-up.

Q: What does this research mean for the field?

A hybrid scaffold-minimizing strategy combining intravascular lithotripsy and drug-coated balloons can successfully restore flow in acute side-branch occlusion and maintain 1-year vessel patency with positive remodeling in complex calcified bifurcation lesions. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Florin-Leontin Lazăr; Shirin Khasha; Paula Anderco; Teodor Paul Kacso; Horea‐Laurentiu Onea

doi:10.1016/j.jaccas.2026.109445

July 24, 2026JACC Case ReportsOpen Access

Drug-Coated Balloon Performance in a Calcified Coronary Bifurcation Complicated by Cardiogenic Shock

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Key result

Hybrid IVL and DCB strategy restores flow and maintains 1-year patency in complex calcified CAD.

n=1

Figures

Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY-NC-ND

Why the study?

Complex coronary disease in frail patients with severe calcification requires balancing procedural efficacy, safety, and minimizing permanent metallic implantation, but optimal strategies remain challenging.

Does a hybrid strategy using intravascular lithotripsy and drug-coated balloons improve revascularization outcomes and minimize stent burden in frail patients with complex calcified coronary disease?

Key Points

Evaluate the feasibility of a scaffold-minimizing hybrid revascularization strategy using drug-coated balloons for severe calcified coronary bifurcation lesions complicated by acute vessel closure.
Treated a 76-year-old frail woman presenting with non-ST-segment elevation acute coronary syndrome and triple-vessel disease.
Conducted extensive bifurcation preparation using noncompliant balloons, cutting balloons, and intravascular lithotripsy (8 cycles of 10 pulses).
Managed intraprocedural diagonal occlusion with drug-coated balloon angioplasty in both branches, followed by staged recanalization of a right coronary artery chronic total occlusion using drug-coated balloons and focal stenting.
Drug-coated balloon angioplasty successfully restored coronary flow and hemodynamic stability without requiring complex bailout bifurcation stenting.
Angiography at 1-year follow-up confirmed sustained patency in all treated vessels and late luminal enlargement indicating positive remodeling at the bifurcation.
Left ventricular ejection fraction improved from 30% to 35% at baseline to 40% to 45% at 1 year, with no major adverse cardiovascular events.

Study Design

Type

Case Report (n=1)

Structured PICO

Does a hybrid strategy using intravascular lithotripsy and drug-coated balloons improve revascularization outcomes and minimize stent burden in frail patients with complex calcified coronary disease?

P

Population

A 76-year-old frail woman presenting with NSTEMI, triple-vessel disease, and severe calcification who underwent complex hybrid revascularization.

I

Intervention

Hybrid scaffold-minimizing strategy using intravascular lithotripsy (IVL) followed by drug-coated balloons (DCBs) for acute flow compromise in bifurcation, and a staged DCB plus focal stent strategy for chronic total occlusion.

O

Outcome

Procedural success (TIMI 3 flow, <30% residual stenosis) and angiographic patency at 1-year follow-upsurrogate

This case illustrates that a hybrid strategy utilizing intravascular lithotripsy and drug-coated balloons can effectively rescue acute flow compromise and achieve long-term vessel patency without excessive metallic scaffolding in complex, severely calcified disease.

Limitations

Absence of intravascular imaging due to procedural complexity and hemodynamic instability
Findings are based on a single-patient report
Single-patient report limits generalization

Implication

May offer a stent-minimizing option for frail patients with complex calcified disease; leaves open prospective validation before broader adoption.

Abstract

BACKGROUND: Complex coronary disease in frail patients requires balancing procedural efficacy, safety, and permanent metallic implantation. CASE SUMMARY: A 76-year-old frail woman presented with non-ST-segment elevation acute coronary syndrome and triple-vessel disease, including a calcified left anterior descending artery-diagonal bifurcation, circumflex culprit lesion, and right coronary artery chronic total occlusion. After circumflex stenting, the bifurcation lesion underwent extensive preparation with balloons and intravascular lithotripsy. The procedure was complicated by acute diagonal occlusion with hemodynamic instability. Flow was restored using drug-coated balloons (DCBs) in both branches, avoiding complex stenting. At a staged procedure, the right coronary artery chronic total occlusion was recanalized with a hybrid DCB and focal stent strategy. Repeat angiography demonstrated positive remodeling. DISCUSSION: This case illustrates a scaffold-minimizing hybrid strategy for complex calcified coronary disease. TAKE-HOME MESSAGES: DCBs may be effective in selected high-risk patients. In selected cases, acute flow compromise during complex percutaneous coronary intervention can be managed with DCB angioplasty without resorting to bailout stenting.

Discussion

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Cite This Study

Lazăr et al. (2026) conducted a case report in NSTEMI with complex calcified multivessel coronary artery disease complicated by cardiogenic shock (n=1). Hybrid scaffold-minimizing strategy (intravascular lithotripsy and drug-coated balloons) was evaluated on Procedural success (coronary flow restoration) and angiographic patency at follow-up. In a frail patient with complex calcified coronary disease, a hybrid strategy using intravascular lithotripsy and drug-coated balloons successfully restored flow and maintained 1-year vessel patency with positive remodeling.

synapsesocial.com/papers/6ad0fc2515427f6a8403ff40 https://doi.org/10.1016/j.jaccas.2026.109445

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Drug-Coated Balloon Performance in a Calcified Coronary Bifurcation Complicated by Cardiogenic Shock

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Drug-Coated Balloon Performance in a Calcified Coronary Bifurcation Complicated by Cardiogenic Shock

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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