Stents Versus PAclitaxel Coated Balloons for Revascularization of CompleX and Small Coronary Vessels (SPARX) Trial

Clinical inclusion criteria:

1. Age≥18 years
2. Patient with NSTE-ACS or CCS with either symptoms and/or ischemia on non-invasive or invasive testing (i.e. FFR/iFR, CMR, SPECT, PET-CT or stress-echo)
3. The patient must be able to understand and provide written informed consent and comply with all study procedures
4. Life expectancy of > 2 years Angiographic inclusion criteria:
5. One or more trial target vessel (LAD, CX or RCA, or of their branches) with:
6. Stenosis of ≥70% or
7. Stenosis ≥50% and <70% (visually assessed) with evidence of ischemia by positive stress test, or FFR ≤0.80, or iFR <0.90 or IVUS minimum lumen area ≤4.0 mm2
8. The target vessel/target lesion matches at least one of the following criteria
9. Small vessel: vessel reference diameter is ≤ 3 mm
10. Long lesions: length ≥ 25 mm
11. Calcified lesion: grade 3 by angiography or confirmed on intravascular imaging
12. Chronic total occlusion (CTO)
13. Bifurcation lesions, including ostial LAD and ostial CX
14. Lesions in diabetic coronary artery disease
15. In-Stent Restenosis (ISR)
16. Lesion preparation must be according to the 3rd DCB consensus, with lesions that have:
17. ≤ 30% residual stenosis
18. TIMI (Thrombolysis in Myocardial Infarction) flow grade 3.
19. The absence of flow-limiting dissection (Type A-C allowed only)

Clinical exclusion criteria:

1. STEMI or cardiogenic shock related to an acute MI within 2 days prior to the index PCI
2. Pregnancy or nursing declarations (As per country specific guideline) (a negative pregnancy test is required of women with child-bearing potential within 7 days prior to enrollment)
3. LVEF<30%
4. Known contraindication or hypersensitivity to any limus family drugs, paclitaxel, or to medications such as heparin, aspirin, clopidogrel, ticlopidine, prasugrel and ticagrelor or any component of the devices.
5. Allergy to imaging contrast media which cannot be adequately pre-medicated
6. Stroke/TIA during the last 6 months, or any prior intracranial hemorrhage
7. Active peptic ulcer or upper gastrointestinal bleeding within last 6 months
8. Known renal insufficiency with an eGFR<30 ml/min1.73m2, or subject on dialysis, or acute renal failure (as per physician judgment)
9. Planned surgery within 6 months with the necessity to stop DAPT
10. History of bleeding diathesis or coagulopathy
11. Platelet count<100.000 cells/mm3 or >400.000 cells/mm3, a WBC of <3000 cells/mm3, documented or suspected liver disease (including laboratory evidence of hepatitis)
12. Patient is a recipient of a heart transplant
13. Participation in another investigation with an investigational drug or another MD within the 30 days preceding and during the present investigation Angiographic exclusion criteria:
14. Target lesion is in the left main coronary artery
15. Target lesion is in a coronary artery bypass graft
16. Flow limiting target vessel thrombus
17. Evidence of aneurysm in target vessel within 10 mm of the target lesion
18. Aorto-ostial target lesion (within 3 mm of the aorta junction)