Vascular responses to drug-coated balloon angioplasty in lipid-rich vs non-lipid-rich coronary lesions

BACKGROUND Lipid-rich plaques are strongly associated with adverse cardiac events. However, the vascular response of lipid-rich lesions to drug-coated balloon (DCB) angioplasty has not been fully elucidated. This study aimed to compare vascular responses following DCB angioplasty between lipid-rich and non-lipid-rich coronary lesions. METHODS This study included patients scheduled for DCB angioplasty for de novo small vessel lesions between February 2021 and April 2024. All patients underwent pre- and post-procedural near-infrared spectroscopy combined with intravascular ultrasound (NIRS-IVUS), along with follow-up coronary angiography and NIRS-IVUS at 8 months. Lesions were categorized as lipid-rich or non-lipid-rich based on the pre-procedural maximum lipid core burden index over 4mm (maxLCBI 4 mm). Changes in plaque volume and maxLCBI 4 mm from post-procedure to the 8-month follow-up, as well as the incidence of late lumen enlargement (LLE), were compared between the two groups. RESULTS Forty-six patients were included in the final analysis: 15 in the lipid-rich group and 31 in the non-lipid-rich group. LLE occurred in 27% of the lipid-rich group and 39% of the non-lipid-rich group (P = 0.52). Percent plaque volume showed minimal change in the lipid-rich group (+0.3%), while a significant reduction was observed in the non-lipid-rich group (−3.6%; P = 0.045). Conversely, maxLCBI 4 mm significantly decreased in the lipid-rich group compared with the non-lipid-rich group (−240 vs. −42; P = 0.0030), resulting in comparable values at the 8-month follow-up. CONCLUSIONS Despite limited plaque regression, lipid-rich lesions demonstrated favorable vascular responses, including LLE and plaque stabilization, following DCB angioplasty. This study was registered in the UMIN Clinical Trials Registry (UMIN000043158). https://www.umin.ac.jp/ What is Known Vascular responses, such as vessel enlargement and plaque regression, are frequently observed following drug-coated balloon (DCB) angioplasty, contributing to late lumen enlargement (LLE). What the Study Adds Plaque regression is less likely to occur in lipid-rich lesions. LLE occurs at a similar rate between lipid-rich and non-lipid-rich lesions. Lipid-rich lesions show a significant reduction in lipid burden.