Drug Coated Balloon as a preferred treatment strategy in very young patients with ST-elevation myocardial infarction

A 25-year-old man was urgently admitted to our Cath-lab following relevant ST-elevation in inferior ECG-leads accompanied with chest pain (STEMI). Patient presented in hemodynamic stable condition with typical risk factors like cigarette smoking, arterial hypertension and elevated LDL-cholesterol. A coronary angiogram revealed occlusion of the proximal right coronary artery (RCA) (Figure 1A) as culprit lesion and signs of atherosclerosis but no relevant coronary disease in the left coronary system. After wiring the culprit lesion a true intracoronary lumen position was confirmed by contrast media injection through the wire lumen of an over the wire balloon. This was followed by lesion preparation using a non-compliant balloon. Primary result showed a prominent lumen gain with remained small degree stenosis (20%) accompanied with type-B dissection (Figure 1B). However, a prompt TIMI III flow could be detected. A further plaque-modification using a scoring-balloon was performed. After final treatment of the culprit lesion with a paclitaxel coated balloon a more acute lumen gain (almost no stenosis left) of the vessel and regression of a dissection (to type-A) was detected with prompt TIMI III flow (Figure 1C). Patient recovered completely and was discharged one week after admission. A control coronary computed tomography angiography one month upon discharge is scheduled.

Percutaneous coronary intervention with drug coated balloon after comprehensive lesion preparation may be considered as a preferred treatment strategy in young patients with STEMI in order to avoid acute but especially chronic complications associated with implantation of drug eluting stents (DES).

Figure 1. (A) Culprit lesion, occluded proximal RCA; (B) lesion preparation with NC and scoring balloon resulting with more lumen gain and no flow limiting dissection type-B; (C) very good result (TIMI Flow III, sign of type-A dissection) after final treatment with drug coated balloon.