Abstract
AimsTo assess the serial changes of de novo coronary lesions treated with paclitaxel-coated balloon (PCB) using intravascular ultrasound virtual histology (IVUS-VH) and fractional flow reserve (FFR).Method and ResultsThis prospective observational study enrolled 27 patients with coronary artery disease treated with PCB who underwent coronary angiography, IVUS-VH and FFR before, immediately after intervention and at 9 months. 28 de novo lesions were successfully treated with PCB. Angiographic late luminal loss was 0.02 ± 0.27mm. Mean vessel and lumen areas showed increase at 9 months (12.0 ± 3.5mm2 to 13.2 ± 3.9mm2, p <0.001; and 5.4 ± 1.2mm2 to 6.5 ± 1.8mm2, p <0.001, respectively). Although mean plaque area was unchanged (6.6 ± 2.6mm2 to 6.6 ± 2.4mm2, p = 0.269), percent atheroma volume decreased significantly (53.4 ± 7.9% to 49.5 ± 6.4%, p = 0.002). The proportion of plaque compositions including fibrous, fibrofatty, dense calcium and necrotic core by IVUS-VH was unchanged at 9 months. The FFR of the treated lesion was 0.71 ± 0.13 pre-procedure, 0.87 ± 0.06 post-procedure and 0.84 ± 0.06 at follow-up.ConclusionsDe novo coronary lesions treated with PCB showed persistent anatomical and physiological patency with plaque redistribution and vessel remodeling without chronic elastic recoil or plaque compositional change during follow-up.
Highlights
Non-stent based local drug delivery using paclitaxel-coated balloons (PCB) has emerged as a new clinical treatment alternative by maintaining the anti-proliferative properties of drug-eluting stents (DES).[1]
De novo coronary lesions treated with PCB showed persistent anatomical and physiological patency with plaque redistribution and vessel remodeling without chronic elastic recoil or plaque compositional change during follow-up
Small vessel de novo lesions treated with PCB in unselected patients showed low rates of target lesion revascularization and major adverse cardiac events
Summary
Non-stent based local drug delivery using paclitaxel-coated balloons (PCB) has emerged as a new clinical treatment alternative by maintaining the anti-proliferative properties of drug-eluting stents (DES).[1] As the caged vessel after metal stent implantation excludes late lumen enlargement and vascular remodelling, PCB might have an additional benefit.[2] In a recent study, small vessel de novo lesions treated with PCB in unselected patients showed low rates of target lesion revascularization and major adverse cardiac events. PCB was suggested as an alternative treatment option to drug eluting stents[3].[4] despite the effectiveness of PCB in de novo lesion, anatomical and physiological responses after PCB have not been fully explored. The aim of our study was to assess the serial changes of de novo lesions treated with PCB. Fractional flow reserve (FFR), and intravascular ultrasound virtual histology (IVUS-VH) measurements before and immediately after intervention, and at 9 months follow-up in de novo lesions treated with PCB
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