Comparison of Ultrathin-Strut Sirolimus-Eluting Stents Versus Drug-Coated Balloons in Small Coronary Vessels: Real-World Data

Objective: Drug-coated balloons (DCBs) and ultrathin-strut sirolimus-eluting stents (SES) are both treatment options for small-vessel coronary artery disease. However, comparative real-world data between these strategies are limited.

Method: In this single-center retrospective study, 178 consecutive patients with stable angina who underwent percutaneous coronary intervention with either a DCB (n = 89) or an ultrathin-strut SES (n = 89) between January 2017 and May 2025 were analyzed. Baseline demographics, angiographic and procedural features, and clinical outcomes were assessed. The primary outcome of this study was major adverse cardiac events (MACE), defined as a composite of target-lesion revascularization (TLR), long-term all-cause mortality, stroke, and myocardial infarction.

Results: Baseline characteristics were generally comparable, although SES-treated patients were older and had higher SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) scores. During a median follow-up of 293 days, MACE occurred in 2.2% of the DCB group and 5.6% of the SES group (P = 0.441). Rates of TLR, myocardial infarction, bleeding, and all-cause mortality were not significantly different. Kaplan–Meier analysis likewise demonstrated no significant difference in cumulative MACE between the two groups (log-rank P = 0.068).

Conclusion: In this real-world study, DCB treatment demonstrated similar safety and efficacy compared to ultrathin-strut SES for small-vessel coronary artery disease. DCB therapy may represent a viable alternative to DES in selected patients, supporting the “leave nothing behind” strategy.

Keywords: Drug-coated balloon, drug-eluting stent, sirolimus-eluting stent, small-vessel disease, ultrathin-strut