Drug-Eluting Balloon Usage in Contemporary Real-world Percutaneous Coronary Intervention: A Retrospective Analysis from South India

Abstract

Background: Drug-eluting balloons (DCBs) have emerged as an important alternative to stent-based strategies in percutaneous coronary intervention (PCI), particularly in clinical scenarios where permanent metallic implantation may be undesirable. While randomized trials have demonstrated efficacy in selected lesion subsets, contemporary real-world data on DCB utilization and outcomes from India remain limited. Aims: To evaluate indications, utilization patterns, procedural characteristics, and short-term clinical outcomes associated with DCB use in routine PCI practice in South India. Study Design: Retrospective observational study. Place and Duration of Study: Department of Cardiology, Apollo Speciality Hospitals, Vanagaram, Chennai, India; January 2024 to June 2025. Methodology: This retrospective, observational, single-centre study included all consecutive adult patients who underwent PCI involving at least one DCB between January 2024 and June 2025. Clinical, angiographic, and procedural data were collected and analyzed. The primary outcome was procedural success, defined as achievement of TIMI grade 3 flow without bailout stenting. Secondary outcomes included procedural complications and short-term (1-month) major adverse cardiac events (MACE). Results: A total of 46 patients were included (mean age 60.4 ± 8.8 years; 82.6% male). DCBs were used in de novo lesions (67.4%) and in-stent restenosis (32.6%), with a high prevalence of small-vessel disease (<2.5 mm, 60.9%) and complex lesions (73.9% ACC/AHA type B2/C). Procedural success was achieved in 87.0%, with bailout stenting required in 6.5%. No major in-hospital complications were observed. At 1-month follow-up, no MACE, including death, myocardial infarction, or target lesion or vessel revascularization, was recorded. Conclusion: In this real-world South Indian cohort, DCB-based PCI demonstrated high procedural success and excellent short-term safety, including in complex lesion subsets such as small-vessel disease and in-stent restenosis. These findings support the feasibility of DCB strategies in routine clinical practice, although larger prospective studies with longer follow-up are needed to establish long-term outcomes.