Impact of Dissection after Drug-Coated Balloon Treatment of De Novo Coronary Lesions: Angiographic and Clinical Outcomes

Abstract

Purpose: Dissection after plain balloon angioplasty is required to achieve adequate luminal area; however, it is associated with a high risk of vascular events. This study aimed to examine the relationship between non-flow limiting coronary dissections and subsequent lumen loss and long-term clinical outcomes following successful drug-coated balloon (DCB) treatment of de novo coronary lesions. Materials and Methods: A total of 227 patients with good distal flow (Thrombolysis in Myocardial Infarction flow grade 3) following DCB treatment were retrospectively enrolled and stratified according to the presence or absence of a non-flow limiting dissection. The primary endpoint was late lumen loss (LLL) at 6-month angiography, and the secondary endpoint was target vessel failure (TVF, a composite of cardiac death, target vessel myocardial infarction, target vessel revascularization, and target vessel thrombosis). Results: The cohort consisted of 95 patients with and 132 patients without a dissection. There were no between-group differences in LLL (90.8%) returning for angiography at 6 months (0.05±0.19 mm in non-dissection and 0.05±0.30 mm in dissection group, p= 0.886) or in TVF (6.8% in non-dissection and 8.4% in dissection group, p=0.799) at a median follow-up of 3.4 years. In a multivariate analysis, the presence of dissection and its severity were not associated with LLL or TVF. Almost dissections (93.9%) were completely healed, and there was no newly developed dissection at 6-month angiography. Conclusion: The presence of a dissection following successful DCB treatment of a de novo coronary lesion may not be associated with an increased risk of LLL or TVF (Impact of Drug-coated Balloon Treatment in de Novo Coronary Lesion; NCT04619277).

The fate of coronary dissections left after sirolimus‐coated balloon angioplasty: A prespecified subanalysis of the EASTBOURNE study

“…4 Another study published in 2020 conducted by Hui et al studied the impact of dissection after DCB treatment of de novo coronary lesions in 227 patients with coronary artery disease and showed that the presence of dissection post DCB treatment was not associated with increased risk of LLL and target vessel revascularization at 6 months follow up confirming the safety and efficacy of DCB. 11 Additionally, the DCB group had a lower rate of TLR and a higher rate of clinical improvement compared with the POBA group. The safety profile of DCB was also favorable, with no significant difference in the incidence of adverse events between the two groups.…”

Comparisons of Drug-Eluting Balloon versus Drug-Eluting Stent in the Treatment of Young Patients with Acute Myocardial Infarction

“…These findings indicated that the occurrence of coronary dissections and acute vessel closure might be the major concern of DEB use instead of implanting DESs in young AMI patients. Lin et al demonstrated that the independent predictors of dissection after DEB treatment for patients with native coronary artery disease were women, higher DEB-to-reference vessel ratio, and longer lesion length [ 30 ]. Cortese et al showed that patients had more severe–moderate calcification, a larger diameter of the predilation balloon, and DEBs in the dissection group than in the nondissection group [ 31 ].…”

Research progress of drug eluting balloon in arterial circulatory system

“…Invasive and non-invasive methods are usually available, and the commonly used invasive methods include coronary angiography and optical coherence tomography. Coronary angiography can be used to compare the changes in vessel patency and stenosis before and after treatment, and can be used for localized treatment ( 132 , 133 ). Optical coherence tomography is a new type of catheter-based invasive imaging modality, which uses infrared light rather than ultrasound, and can clearly reflect arterial plaques and blood clots ( 134 ).…”