Possible mechanism of late lumen enlargement after treatment for de novo coronary lesions with drug-coated balloon

Abstract

Background: Drug-coated balloon (DCB) treatment for de novo coronary artery disease has demonstrated late lumen enlargement (LLE) in mid-term follow-up and it was considered as clinical benefit; however, its mechanism and the predictive factor remains unclear. Methods: This study enrolled 46 consecutive patients (54 lesions) treated with DCB, using intravascular ultrasound (IVUS) at the index procedure and at the 9-month follow-up. We measured IVUS parameters at 1-mm intervals and calculated the mean volume of the external elastic membrane (EEM), lumen, and plaque. We calculated the dissection index (DI) defined as summation of the following points, 2: dissection over EEM, 1: intra-EEM dissection, 0: no dissection at every 1-mm interval, and divided by lesion length. Results: IVUS showed that there was no flow limiting dissection just after DCB treatment, the mean EEM and lumen volume (LV) had significantly increased while mean plaque volume had significantly decreased at 9 months, and 74.1% lesions exhibited LLE. We divided the patients into three groups according to delta mean LV. Mean EEM volume significantly increased and mean plaque volume significantly decreased in the larger and smaller LLE groups, but not in the non-LLE group. The DI was higher in a descending order in the three groups. The multiple regression analysis demonstrated that the DI was the strongest predictor of the change in mean LV. Conclusions: LLE after DCB treatment may be caused by vessel enlargement and plaque regression. The non-flow limiting larger dissection just after DCB treatment may strongly associate with the intending LLE.

Drug-Coated Balloon vs. Stent for de novo Non-small Coronary Artery Disease: A Systematic Review and Meta-Analysis

“…LLL was introduced to assess the real changes for the lesions. For LLL, it could be regarded as a mark of unfavorable remodeling, and the mechanism might be inferred as an increase in the plaque area (28). The results showed no significant difference between DCB and stents with significant heterogeneity in RCT.…”

Favorable Vasomotor Function after Drug-Coated Balloon-Only Angioplasty of De Novo Native Coronary Artery Lesions

“…Consequently, although stent design iterations have improved acute clinical results, a persistent annualized event rate of 2-3% without a plateau effect is observed after coronary stenting regardless of the stent type, including contemporary DESs [19]. DCB angioplasty is expected to help rid patients of adverse events related to permanent coronary implants, which is based on the assumption that the absence of metallic caging would facilitate restoration of vasomotion and ultimately induce luminal enlargement and reduction of plaque burden [7,8]. This study for the first time demonstrated that the DCB strategy, completely devoid of vessel-caging material, could allow restoration of the coronary vasomotor function as early as 6 months after angioplasty, achieving levels comparable to those of angiographically healthier, untreated segments.…”

“…Further, the absence of potential inflammatory sources, such as polymer or vessel-caging metallic material, reduces the risk of maladaptive healing responsible for restenosis and thrombosis and allows the vessels to freely constrict and dilate [4][5][6]. As positive consequences, recent studies reported that successful DCB angioplasty could induce positive vessel remodeling and even plaque regression [7,8].…”

Drug-Coated Balloon Treatment for Possible Sequelae of Kawasaki Disease Evaluated by Multi-Modalities

“…Additionally, intravascular imaging could contribute to determining the reference artery diameter and lesion length to decide the pretreatment strategy and suitable device size. During DCB treatment, Yamamoto, et al 11) and Sogabe, et al 12) reported that both intravascular ultrasound and OCT could identify appropriate dissection that facilitates the uptake of anti-proliferation drugs to enter into the vessel wall without acute complications, which could lead to favorable long-term prognosis. In the present case, OCT-guided serial pretreatment and intimal dissection without intramural hematoma may partly explain the excellent outcome at the 1-year follow-up.…”