Stentless but not harmless: coronary aneurysm formation after drug-coated balloon intervention in chronic total coronary occlusions

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Chronic total coronary occlusion (CTO) (n=2). Intervention: Paclitaxel-coated drug-coated balloon (DCB) angioplasty. Primary outcome: Focal coronary artery aneurysm (CAA) formation.

Bharat Khialani; Ang Anshing; Sandeep Basavarajaiah; George Touma; and Bernard Wong; Dharmaraj Kartikhesan

doi:10.24875/recice.m26000622

October 13, 2026REC interventional cardiology (English Edition)Open Access

Stentless but not harmless: coronary aneurysm formation after drug-coated balloon intervention in chronic total coronary occlusions

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Key result

Paclitaxel-coated balloons for chronic total occlusions can induce late focal coronary artery aneurysms.

n=2

Key Points

Describe focal coronary artery aneurysm formation following paclitaxel-coated balloon angioplasty in chronic total coronary occlusions and review potential mechanisms linking vessel injury with antiproliferative drug delivery.
Evaluated two patients undergoing percutaneous coronary intervention for chronic total occlusions treated with a drug-coated balloon-only strategy without permanent stenting.
Assessed arterial injury, subintimal tracking, and dissections using intravascular ultrasound alongside follow-up coronary angiography at 7 and 9 months.
Both patients developed focal coronary artery aneurysms at 7 and 9 months post-procedure, localized precisely to segments of previous subintimal tracking or medial dissection.
In the first case, invasive physiological assessment demonstrated an absence of hemodynamic significance with a fractional flow reserve of 0.96.
Both patients were managed conservatively with medical therapy and surveillance imaging, remaining asymptomatic throughout follow-up.

Study Design

Type

Case Report (n=2)

Multicenter

No

Structured PICO

P

Population

2 male patients (aged 55 and 59 years) with chronic total coronary occlusions treated with paclitaxel-coated balloon angioplasty and followed for 7 to 9 months.

I

Intervention

Paclitaxel-coated drug-coated balloon (DCB) angioplasty using a DCB-only strategy (Case 1: 2 sequential paclitaxel-coated DCBs [3.5 mm × 25 mm and 3.0 mm × 25 mm] at 6 atm for 60 seconds, followed by aspirin indefinitely and clopidogrel 75 mg daily for 6 months; Case 2: 3 overlapping paclitaxel-coated DCBs [3.5 mm × 30 mm, 3.0 mm × 30 mm, and 2.5 mm × 30 mm] at 12 atm for 60 seconds, followed by aspirin indefinitely and ticagrelor 90 mg twice daily for 12 months).

O

Outcome

Focal coronary artery aneurysm (CAA) formation on follow-up coronary angiography at 7 months (Case 1) and 9 months (Case 2).safety

Paclitaxel-coated balloon angioplasty in chronic total coronary occlusions with subintimal tracking or medial dissection can trigger focal coronary artery aneurysm formation at the site of vessel wall injury, warranting careful lesion assessment and imaging surveillance.

Limitations

Repeat intravascular imaging was not performed at follow-up angiography, limiting direct characterization of aneurysm morphology.
Coronary computed tomography angiography (CCTA) was not obtained during initial surveillance.
Small sample size and limited number of DCB-treated CTO procedures at the institution preclude estimation of true incidence.
CCTA was not obtained during initial surveillance.
The limited number of DCB-treated CTO procedures performed at the institution precludes estimation of the true incidence of this complication.

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Implication

Alerts to possible aneurysm risk after paclitaxel-coated balloon use in CTOs; leaves open true incidence and clinical relevance.

Abstract

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Cite This Study

Khialani et al. (2026) conducted a case report in Chronic total coronary occlusion (CTO) (n=2). Paclitaxel-coated drug-coated balloon (DCB) angioplasty was evaluated on Focal coronary artery aneurysm (CAA) formation. Paclitaxel-coated balloon angioplasty for chronic total coronary occlusions resulted in asymptomatic focal coronary artery aneurysms at sites of vessel wall injury in 2 patients at 7-9 months.

synapsesocial.com/papers/6aee6c1f71a7594806220dab https://doi.org/10.24875/recice.m26000622

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Stentless but not harmless: coronary aneurysm formation after drug-coated balloon intervention in chronic total coronary occlusions

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Stentless but not harmless: coronary aneurysm formation after drug-coated balloon intervention in chronic total coronary occlusions

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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