In patients with de novo lesions in small coronary vessels, the Elutax 3 paclitaxel drug-coated balloon (DCB) showed good physiological performance through 6 months post-procedure, according to a new trial sub-analysis. Bernardo Cortese, MD, of Fondazione Ricerca e Innovazione Cardiovascolare, Milan, presented these results during a Late-Breaking Clinical Science presentation Saturday at Cardiovascular Research Technologies (CRT) 2024 in Washington, D.C. Several clinical trials have evaluated DCBs used to treat lesions in small coronary vessels. These trials have shown good results in terms of angiographic and clinical performance. However, acute and long-term physiological performance of DCBs is not known. PICCOLETO II µFR is a sub-analysis of the academic, multicenter, investigator-driven PICCOLETO II randomized clinical trial. The PICCOLETO II trial showed the superiority of the Elutax SV/Emperor (AR Baltic Medical) to the Xience everolimus-eluting stent (EES; Abbott) in terms of in-lesion late lumen loss (LLL; 0.04 vs. 0.17 mm; p = 0.001 for noninferiority; p = 0.03 for superiority) at a median 189 days of follow-up. The subanalysis aimed to compare the acute and late angiographic and physiological of paclitaxel DCB and in patients with lesions in native coronary vessels <2.75 mm. The primary endpoint was the change in angiographic µFR between the final result at index procedure and follow-up. Secondary endpoints included LLL, percent diameter stenosis and binary restenosis. Data were available for 59 patients from two centers (DES=29, DCB=30). The baseline clinical and procedural characteristics were similar between the groups. The average lesion length was 18.8 ± 10.4 mm. Before PCI, µFR was 0.58 ± 0.31 in the EES group and 0.65 ± 0.31 in the DCB arm (p=0.20). Immediately after PCI, µFR was 0.89 in the EES arm and 0.86 in the DCB group (p=0.074). After a median follow-up of 192 days (interquartile range: 165-201 days), LLL was 0.29 mm in the EES arm and -0.03 mm in the DCB arm (p=0.027), and net lumen game was 0.86 mm in the EES arm and 0.85 mm in the DCB arm (p=0.93). µFR did not significantly differ between groups (0.84 in both, p=0930). The change in µFR was 0.06 in the EES group and -0.01 in the DCB group (p=0.51). Photo Credit: Bailey Salimes/CRTonline.org Photo Caption: Bernardo Cortese, MD, presents findings from a PICCOLETO II substudy Saturday at CRT 2024 in Washington, D.C.