{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T05:45:08Z","timestamp":1785908708536,"version":"3.56.0"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Evidence regarding an \u201conly drug-coated balloon (DCB)\u201d strategy in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) remains limited, particularly in complex all-comer populations. We aimed to evaluate the feasibility, safety, and mid-term outcomes of an only DCB strategy in consecutive patients undergoing contemporary CTO PCI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicenter observational study included consecutive CTO PCI procedures performed between January 2024 and April 2026 at three high-volume CTO centers. All procedures were initially attempted using an intention-to-treat \u201conly DCB\u201d strategy. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), defined as cardiac death, target lesion revascularization (TLR), target vessel myocardial infarction, or stroke.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 457 CTO PCI procedures were evaluated. After excluding unsuccessful guidewire crossing procedures, 423 lesions underwent lesion preparation using the only DCB protocol. Final treatment with an \u201conly DCB\u201d strategy was achieved in 248 lesions, corresponding to a feasibility rate of 58.62%. Mean J-CTO score was 1.97\u2009\u00b1\u20091.04. Antegrade wiring was used in 95.2% of procedures, whereas retrograde wiring was used in 16.9%. Mean follow-up duration was 231.1\u2009\u00b1\u2009130.3 days. MACCE occurred in 28 patients (13.9%), and target vessel failure in 27 (13.4%). Follow-up mortality occurred in one patient (0.5%), and no patient had a stroke. Patients with angiographic restenosis \u226570% had smaller final minimum lumen diameter (1.69\u2009\u00b1\u20090.64\u2005mm vs. 2.23\u2009\u00b1\u20090.80\u2005mm;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001). Among patients with angiographic follow-up, late lumen gain was observed in 55.5% of lesions, whereas lumen gain&amp;gt;0.2\u2005mm was observed in 45.4%, supporting positive vessel remodeling after DCB treatment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In an all-comer CTO PCI population, an only DCB strategy appears feasible in more than half of patients, with acceptable mid-term clinical and angiographic outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1889893","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T04:53:32Z","timestamp":1785905612000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Feasibility and safety of only DCB approach in consecutive patients undergoing contemporary CTO PCI; the all-comers DCB study"],"prefix":"10.3389","volume":"13","author":[{"given":"Sevket","family":"Gorgulu","sequence":"first","affiliation":[{"name":"Cardiology Department, Biruni University Medical School","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sefa","family":"Sural","sequence":"additional","affiliation":[{"name":"Cardiology Department, Toros University","place":["Mersin, Turkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmut","family":"Uluganyan","sequence":"additional","affiliation":[{"name":"Cardiology Department, Bezmialem Vakif University","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hasim","family":"Tuner","sequence":"additional","affiliation":[{"name":"Cardiology Department, Memorial Bahcelievler Hospital","place":["Istanbul, 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T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omer","family":"Dogan","sequence":"additional","affiliation":[{"name":"Cardiology Department, Istanbul University, Cerrahpasa Institute of Cardiology , Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Turgut","family":"Uygun","sequence":"additional","affiliation":[{"name":"Cardiology Department, Konya City Hospital","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cuneyt","family":"Kocas","sequence":"additional","affiliation":[{"name":"Cardiology Department, Biruni University Medical School","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanouil S.","family":"Brilakis","sequence":"additional","affiliation":[{"name":"Cardiology Department, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital","place":["Minneapolis, MN, 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