When Less is More: Drug-coated Balloon–only Treatment of Acute Anterior STEMI with High Thrombus Burden

Abstract

Drug-coated balloons (DCBs) have emerged as an established alternative to drug-eluting stents (DES) in selected coronary settings, particularly for in-stent restenosis and small vessel disease. Their role in de novo coronary lesions during the acute phase of ST-elevation myocardial infarction (STEMI) remains less clearly defined. We report the case of a 56-year-old woman with type 2 diabetes mellitus who presented with acute anterior STEMI. Emergency coronary angiography revealed a thrombotic occlusion of the proximal left anterior descending artery. Following pharmacological optimization and thrombus aspiration, antegrade flow was restored with no significant residual stenosis. A drug-coated balloon was subsequently used with excellent angiographic and clinical outcomes. At six-month follow-up, angiographic and echocardiographic reassessments demonstrated sustained vessel patency and complete functional recovery. This case highlights the potential role of DCB-only angioplasty in carefully selected de novo coronary lesions in the acute thrombotic setting. We discuss current indications, advantages and limitations of DCBs compared with DES, and review emerging evidence supporting their use in acute coronary syndromes.