Drug-coated balloons for the treatment of coronary artery bypass graft failure

Patients with coronary artery bypass graft (CABG) failure may present with de novo graft lesions or in-graft in-stent restenosis (ISR). Percutaneous coronary intervention (PCI) is preferred over redo-surgery; however, graft PCI remains challenging because of diffuse, friable atherosclerosis, which predisposes patients to distal embolisation and periprocedural complications1. Outcomes remain inferior to native vessel PCI, with target lesion revascularisation rates of approximately 12% with drug-eluting stents2. Drug-coated balloons (DCB) may offer a promising alternative by delivering antiproliferative therapy without additional metallic layers3. This study aimed to evaluate the feasibility and clinical outcomes of DCB angioplasty for de novo and ISR lesions in bypass grafts.

This retrospective, multicentre registry included consecutive patients with prior CABG who underwent DCB treatment for graft failure between 2009 and 2023 at three tertiary university hospitals. The study was approved by institutional ethics committees, and written informed consent was obtained from all patients.

Quantitative coronary angiography measurements were performed offline at an independent core laboratory using validated CAAS software (Pie Medical Imaging). Reference vessel diameter, percentage diameter stenosis, and lesion length were obtained from optimal angiographic...