Key points are not available for this paper at this time.
The mechanisms of luminal narrowing after percutaneous coronary intervention (PCI) with directional coronary atherectomy (DCA) and drug-coated balloon (DCB) remains unclear. This study aimed to investigate the pattern and mechanisms of luminal narrowing after DCA/DCB using optical coherence tomography (OCT). Patients who underwent DCA/DCB for de novo lesions and serial OCT imaging at 3, 6, and 18 months were evaluated to determine the pattern of luminal narrowing. Among 40 patients who had follow-up (F/U) OCT at 3 months post-PCI, 33 and 23 patients had F/U at 6 and 18 months, respectively. Thirty-six of the 40 (90.0%) cases exhibited a layered pattern at the 3-month F/U, 31 of 33 (93.9%) at the 6-month F/U, and 22 of 23 (95.7%) at the 18-month F/U. Layer progression was identified in 21 of 33 (63.6%) and 4 of 23 (17.4%) at the 6- and 18-month F/Us, respectively. The patients with layer progression tended to have a higher prevalence of diabetes (16.7% vs 52.4%, p = 0.067), a lower rate of dual-antithrombotic therapy (DATT) use (58.3% vs 19.0%, p = 0.052) between the 3- and 6-month F/Us, and a significantly higher rate of no or low-intensity statin use (0.0% vs 41.7%, p = 0.037) between the 6- and 18-month F/Us. In Conclusion, layer progression and luminal narrowing occurred mainly during the first 6 months after DCA/DCB. Patients with luminal narrowing tended to have a higher prevalence of diabetes, standard DATT duration, and no or low-intensity statin use.
Okutsu et al. (2026) studied this question.