Restenosis patterns after percutaneous coronary intervention with drug-coated balloon for de novo coronary lesions as assessed by optical coherence tomography

Abstract Backgrounds Drug-coated balloons (DCBs) are currently used to treat de novo coronary artery lesions. Although controversial, previous studies have suggested the possibility that DCB for de novo coronary artery disease is non-inferior to drug-eluting stent implantation, including small vessel disease. However, the morphological changes in lesions with target lesion revascularization (TLR) following DCB treatment have not been fully clarified. Purpose The purpose of this study it to compare TLR lesions initially treated with DCB on serial optical coherence tomography (OCT) imaging. Methods This is aretrospective observational study. Between April 2018 and April 2024, 408 patients with de novo coronary lesions were subjected to OCT-guided PCI using paclitaxel-coated balloons. Among them, 26 TLR lesions in 24 patients with serial OCT examinations (pre-and post-PCI at the index PCI and TLR) were enrolled. All TLR were ischemia or clinically driven (presence of chest symptom or the evidence of ischemia)and OCT images at pre-and post-PCI and TLR were assessed. Suboptimal lumen expansion (SE) is defined as lesions with both post-PCI minimum lumen area (MLA) 3.00 mm² and expansion ratio, defined as MLA/mean reference lumen area 0.50 at the index PCI. Layered plaque (LP) was defined as a different optical intensity with clear demarcation from the underlying plaque. Calcified nodule protrusion (CNP) was defined as a calcified nodule (CN), which is the accumulation of small calcium deposits underlying the calcified plate which includes either a pathological eruptive CN or nodular calcification protruding into the lumen. Results The median period between the index PCI and TLR was 309 days (IQR; 239–462) days. Based on the OCT findings at TLR, LP was the most frequent (76.9%), followed by CNP (38.5%) and erosion (3.8%). These OCT findings were not significantly different in lesions with early (1 year from index PCI) or late TLR (≥1 year). All post-PCI coronary dissections at the index PCI disappeared at TLR. When the pre- and post-PCI OCT findings were retrospectively assessed at the index PCI compared to those at TLR, the absence of post-PCI medial dissection (50.0%), post-PCI SE (23.1%), and pre-PCI CN (26.9%) was mainly observed in the future TLR segment. After excluding one lesion with erosion, 25 TLR lesions were divided into three groups based on the main restenosis types; LP: 53.8% (n=14), SE: 23.1% (n=6), and CNP: 19.2% (n=5). The largest lipid arc was found in lesions with LP (median lipid arc; LP: 159°, SE: 76°, CNP: 0°, P=0.004), whereas the most severely calcified plaque in lesions with CNP (median calcium thickness; LP: 730 µm, SE: 1130 µm, CNP: 1180 µm, P=0.014) at the index PCI. Conclusions After treatment with DCBs for de novo coronary lesions, unique underlying morphological findings were observed in lesions treated with TLR.Study flow chart Central Illustration