When Less is More: Drug-coated Balloon–only Treatment of Acute Anterior STEMI with High Thrombus Burden
Mohamed Sarsari *
Mohammed V University, Rabat, Morocco and Cardiology B Department, Ibn Sina University Hospital, Rabat, Morocco.
Oualid Kerrouani
Mohammed V University, Rabat, Morocco and Cardiology B Department, Ibn Sina University Hospital, Rabat, Morocco.
Soukaina Cherkaoui
Mohammed V University, Rabat, Morocco and Cardiology B Department, Ibn Sina University Hospital, Rabat, Morocco.
Jamila Zarzur
Mohammed V University, Rabat, Morocco and Cardiology B Department, Ibn Sina University Hospital, Rabat, Morocco.
Mohamed Cherti
Mohammed V University, Rabat, Morocco and Cardiology B Department, Ibn Sina University Hospital, Rabat, Morocco.
*Author to whom correspondence should be addressed.
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.
Keywords: Drug-coated balloon, st-elevation myocardial infarction, de novo coronary lesion, thrombus aspiration, primary percutaneous coronary intervention.