Mid-term results of stent-less coronary intervention using rotational atherectomy and drug-coated balloon for De Novo lesions in hemodialysis patients

Although drug-coated balloon (DCB) -based stent-less percutaneous coronary intervention (PCI) for de novo lesions has attracted more attention, outcomes of the DCB procedure for hemodialysis (HD) patients are reported to be inferior to those for non-HD patients, similarly to drug-eluting stent (DES). Recent several reports have shown that rotational atherectomy (RA) followed by DCB treatment (RA/DCB) could be an option of revascularization strategy particularly for calcified de novo lesions even in the new-generation DES era; however, efficacy of the RA/DCB procedure for HD patients remains unclear.A total of 47 consecutive cases (53 lesions) undergoing RA/DCB for de novo lesions were enrolled. According to the presence/absence of HD at baseline, the 47 cases were divided into the HD cases (n=16) and the non-HD cases (n=31), and the 53 lesions were divided into the HD lesions (n=20) and the non-HD lesions (n=33).The HD cases had a significantly lower prevalence of dyslipidemia and smoking than the non-HD cases. Final RA burr size, DCB diameter used, and angiographic success rate of PCI did not significantly differ between the 2 groups. Pre-procedural, post-procedural, and follow-up QCA parameters were also similar between the 2 groups. Twelve-month clinical outcomes were comparable between the 2 groups.Mid-term outcomes of stent-less PCI using RA/DCB for de novo lesions in HD patients might be comparable to those in non-HD patients, suggesting efficacy of pre-treatment of RA prior to DCB treatment in HD patients.