Key result
Drug-coated balloon for de novo ostial LCx stenosis yields no residual stenosis and sustained symptom relief.
Why the study?
Ostial left circumflex disease remains one of the most challenging lesion subsets in PCI, with drug-eluting stent implantation often complicated by in-stent restenosis.
Case Report (n=1)
No
This case report demonstrates the feasibility and 12-month clinical success of a drug-coated balloon-only strategy following optimal lesion preparation for de novo ostial left circumflex coronary artery disease.
Supports feasibility of DCB-only strategy for ostial LCx stenosis; hypothesis-generating and requires prospective validation before practice change.
Ostial left circumflex (LCx) disease remains one of the most challenging lesion subsets in percutaneous coronary intervention (PCI), with drug-eluting stent (DES) implantation often complicated by in-stent restenosis. In this case, we describe a 65-year-old male smoker who presented with one week of unstable angina. Coronary angiography demonstrated severe mid-left anterior descending (LAD) disease and severe large-caliber ostial LCx stenosis. The LAD was treated with two overlapping DESs. The ostial LCx underwent lesion preparation with a non-compliant balloon and cutting balloon, followed by treatment with a 4.0 × 20 mm drug-coated balloon (DCB). Final angiography showed no residual stenosis and no significant dissection. The patient remained symptom-free at 12 months clinic follow-up. This case highlights the feasibility of a DCB-only strategy for de novo ostial LCx disease. Optimal lesion preparation is essential, while calcium modification may be required in calcified lesions. Bailout DES implantation remains necessary for flow-limiting dissections.
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Naqvi et al. (2026) conducted a case report in De novo ostial left circumflex stenosis and severe mid-LAD disease with unstable angina (n=1). Drug-coated balloon (DCB) angioplasty after non-compliant and cutting balloon preparation was evaluated on Angiographic success and symptom-free status at 12 months. Drug-coated balloon angioplasty (4.0x20 mm) for de novo ostial LCx stenosis resulted in no residual stenosis and left the patient symptom-free at 12 months.
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