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Paclitaxel-coated balloon versus drug-eluting stent during PCI of small coronary vessels, a prospective randomised clinical trial. The PICCOLETO Study
  1. Bernardo Cortese1,
  2. Andrea Micheli1,
  3. Andrea Picchi1,
  4. Amelia Coppolaro1,
  5. Loria Bandinelli1,
  6. Silva Severi2,
  7. Ugo Limbruno1
  1. 1Interventional Cardiology Unit, Cardiovascular Department, Ospedale della Misericordia, Grosseto, Italy
  2. 2Cardiology Unit, Cardiovascular Department, Ospedale della Misericordia, Grosseto, Italy
  1. Correspondence to Bernardo Cortese, Interventional Cardiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Sforza, 20122 Milano, Italy; bcortese{at}


Background Percutaneous coronary intervention (PCI) of small vessels is limited by an increased risk of restenosis and adverse outcome, even when drug-eluting stents (DES) are employed. In recent years, the paclitaxel-coated balloon (PCB) has been shown to reduce neointimal proliferation and the need for target lesion revascularization (TLR) in an in-stent restenosis setting. The impact of a PCB during PCI of small coronary vessels was evaluated and compared to one of the most widely used DES.

Methods In the PICCOLETO randomised clinical trial, patients with stable or unstable angina undergoing PCI of small coronary vessels (≤2.75 mm) were randomised to Dior PCB (28 patients) or Taxus DES (29 patients). The primary study end point was per cent diameter stenosis at 6-month angiographic follow-up (non-inferiority), secondary end points were angiographic binary restenosis and occurrence of major adverse cardiac events (MACE: death, Q-wave myocardial infarction, TLR) at 9 month follow-up.

Results The two groups were not dissimilar regarding clinical and angiographic characteristics. Study was interrupted after enrolment of two-thirds of patients due to a clear superiority of one study group. The primary end point was not met, because the PCB group showed higher per cent diameter stenosis (43.6% vs 24.3%, p=0.029); angiographic restenosis was higher as well (32.1 vs 10.3%, p=0.043), whereas MACE were 35.7% in the PCB group and 13.8% in the DES group (p=0.054).

Conclusions Dior PCB failed to show equivalence to Taxus DES regarding angiographic end points during PCI of small coronary arteries.

Clinical Trial Registration Number (EudraCT code) 2009-012268-15.

  • Coronary angioplasty (PCI)

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  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Ethics Committee, Ospedale della Misericordia, Groseto, Italy, 5 July 2007.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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