The leave-nothing-behind strategy in coronary intervention took a meaningful step forward this year. SELUTION DeNovo, a large multicentre, open-label, randomised all-comers trial (3,341 patients across 62 sites in 12 countries, first presented at TCT 2025, with 12-month and ACS-subgroup analyses featured through SCAI 2026), tested a sirolimus-eluting balloon (SEB) with provisional stenting against a routine drug-eluting stent (DES) strategy for de novo lesions in vessels roughly 2 to 5 mm in diameter. Notably, about 80% of balloon-arm patients were treated without any stent.
At 12 months the primary endpoint, target vessel failure (a composite of cardiac death, target-vessel MI, and clinically driven target-vessel revascularisation), was 5.3% in the SEB arm versus 4.4% in the DES arm, meeting the pre-specified non-inferiority margin. The individual components were low and broadly comparable, with procedural safety maintained. A separately reported ACS substudy at SCAI 2026 suggested the sirolimus-eluting balloon performed comparably to stents in acute coronary syndrome patients, an area where operators have historically been cautious about a stent-free approach.
Why this matters for practice. A validated DCB-only (or DCB-first with bailout stenting) option for selected de novo lesions is attractive wherever leaving less permanent metal is desirable: smaller vessels, patients at higher bleeding risk, younger patients in whom future revascularisation options should be preserved, and settings where a shorter dual-antiplatelet duration is a genuine consideration. It does not displace DES as the default, but it strengthens the evidence base for a tailored, lesion-by-lesion strategy.
Relevance for central Gujarat patients. In a busy semi-urban catchment like Anand and Kheda, a proportion of patients live with diabetes, small-vessel disease, or bleeding concerns, and many face cost and follow-up constraints. An evidence-backed strategy that can, in appropriate lesions, avoid a permanent implant and potentially shorten antiplatelet exposure is worth watching closely as guidelines evolve, always within careful case selection.