# Drug-Coated Balloon After Intravascular Lithotripsy: Procedural and Clinical Outcome of the “Crack and Drug” Strategy

## TL;DR

This study compares drug-coated balloons and drug-eluting stents after intravascular lithotripsy for treating calcified coronary lesions, finding both approaches effective and safe.

## Contribution

The study provides new evidence on the efficacy and safety of drug-coated balloons after intravascular lithotripsy in calcified coronary lesions.

## Key findings

- Procedural success rates were comparable between IVL + DCB and IVL + DES strategies.
- In-hospital MACE rates were low and not significantly different between the two treatment strategies.

## Abstract

Drug-eluting stents (DESs) after intravascular lithotripsy (IVL) have proven effective in calcified coronary lesions. However, evidence supporting drug-coated balloons (DCBs) after IVL remains limited.

We aimed to compare the technical success and 1-year clinical outcomes of IVL + DES vs IVL + DCB strategies for the treatment of balloon-crossable calcified coronary lesions.

Patients undergoing percutaneous coronary intervention with IVL from the prospective BENELUX-IVL registry were included. Participants were stratified into DCB or DES groups based on post-IVL treatment strategy. The primary endpoint was procedural success, a composite endpoint defined as successful IVL catheter crossing with residual stenosis <30%, final TIMI flow grade 3, and no in-hospital major adverse cardiac events (MACE). The primary safety endpoint was in-hospital MACE, including cardiac death, nonfatal myocardial infarction, or target vessel revascularization.

Among 579 patients, 45 (7.8%) were treated with DCB after IVL. Baseline characteristics, clinical presentation, and SYNTAX scores were comparable between groups. Chronic total occlusions (17.8% vs 6.8%; P < 0.01) and in-stent restenosis lesions (60.0% vs 29.6%; P < 0.01) were more common in the DCB group. Intraprocedural complications were low, with no significant difference (8.9% vs 5.8%; P = 0.41) between DES or DCB strategies. No bailout DES implantation was required in the DCB arm. Procedural success (89.4% vs 91.7%; P = 0.55) and in-hospital MACE rates (0% vs 2.1%; P = 0.33) were comparable among the 2 strategies.

In calcified coronary lesions, DCB after IVL demonstrates excellent efficacy and safety, achieving high technical success with low device-dependent adverse event rates.