The association between the extent of dissection observed by intravascular ultrasound and long-term progression of vessel lesions after drug-coated balloon angioplasty in patients with de novo coronary artery disease

Abstract Objective: This study aimed to investigate the correlation between the extent of dissection and long-term progression of vessel lesions (LPVL) after drug-coated balloon (DCB) angioplasty in patients with de novo coronary disease. Methods: Patients who underwent DCB angioplasty and intravascular ultrasound (IVUS) assessment for de novo coronary lesions were retrospectively observed. The dissections were reclassified based on IVUS images, while the angiogram, post-DCB angioplasty and follow-up angiogram were analyzed using qualitative coronary angiography (QCA). The primary endpoint was the median 12-month follow-up angiographic result of target vessel stenosis. Results：The present study involved 115 patients who were divided into two groups based on LPVL<5%: the progression group (n=51) and the non-progression group (n=64). The median follow-up period was 12 months (IQR 6-13 months). At baseline, the result of dissection type (p=0.003) and non-small vessel disease (NSVD) status (p=0.044) were significantly different between the two groups. Univariate logistic regression analysis of LPVL revealed that dissection type (odds ratio 1.70; 95% CI: 1.27-2.29; p<0.0001) and NSVD (odds ratio: 0.39; 95% CI: 0.17-0.91; p=0.029) were predictors of LPVL. However, according to multiple logistic regression, only dissection type (odds ratio: 1.73; 95% CI: 1.13-2.66; p=0.0124) was identified as an independent predictor of LVPL. Conclusion： The severity of dissection type after DCB angioplasty was significantly associated with LPVL. Although there was a significant difference between small vessel disease and non-small vessel disease treated with a DCB, it was not an independent predictor of LPVL. It is recommended to assess de novo coronary lesions by IVUS after DCB angioplasty.