Impact of post physiological assessment after treatment for de novo coronary lesions using drug-coated balloons

Abstract

BackgroundAcute physiological changes after balloon angioplasty are very important because of acute recoil and dissection. However, serial physiological assessments after drug-coated balloons (DCB) have not been investigated. MethodsThis prospective observational single-center study evaluated 50 lesions that underwent optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) with DCB and a 9-months angiographical and OCT follow-up. Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) were measured immediately (FFR0m and, iFR0m) and 15 min (FFR15m and iFR15m) after DCB, and the difference (dif-FFR and, dif-iFR) was calculated. The iFR gradients during lesions treated with DCB were measured. For OCT and quantitative coronary angiography (QCA) data, delta values were calculated. ResultsAt index PCI, three lesions were needed for bailout stenting. At follow-up, 47 lesions were divided into two groups according to the delta minimal lumen area (MLA) on OCT: late lumen enlargement (LLE) (n = 29) and non-LLE (n = 18). In LLE group, FFR15m and iFR15m were significantly high (0.90 ± 0.03 vs. 0.85 ± 0.07, p < 0.001, 0.97 ± 0.02 vs. 0.92 ± 0.10, p = 0.008, respectively) and %AS on OCT, dif-FFR and dif-iFR were significantly low (38.5% (33.6, 42.3) vs. 45.1% (38.9, 54.6), p = 0.03, −0.001 ± 0.006 vs. 0.036 ± 0.032, p < 0.001, −0.002 ± 0.008 vs. 0.019 ± 0.017, p < 0.001, respectively) compared with non-LLE group. However, there were no significant differences in FFR0m, iFR0m, or any other OCT or QCA data. ConclusionsPost-physiological assessment and a decrease in physiological indices in the first 15 min after PCI are important for treating de novo lesions using the DCB strategy.