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Serial Assessment of Vascular Healing Process After Directional Coronary Atherectomy Followed by Drug-Coated Balloon:

Masaaki Okutsu1, Daichi Fujimoto2, Haruhito Yuki3

  • 1Department of Cardiovascular Medicine, New Tokyo Hospital, Chiba, Japan; Department of Cardiology, Tokai University Hachioji Hospital, Tokyo, Japan.

The American Journal of Cardiology
|February 11, 2026
PubMed

Insights

Luminal narrowing after directional coronary atherectomy (DCA) and drug-coated balloon (DCB) procedures primarily occurs within six months, often presenting as a layered pattern. Factors like diabetes and specific medication use influence this progression.

Area of Science:

  • Cardiovascular Interventions
  • Medical Imaging
  • Interventional Cardiology

Background:

  • Percutaneous coronary intervention (PCI) using directional coronary atherectomy (DCA) and drug-coated balloon (DCB) is common for de novo coronary lesions.
  • The mechanisms and patterns of luminal narrowing following these specific interventions remain incompletely understood.
  • Optical coherence tomography (OCT) is a valuable tool for in-vivo assessment of coronary artery morphology.

Purpose of the Study:

  • To investigate the temporal patterns and underlying mechanisms of luminal narrowing after DCA/DCB treatment.
  • To characterize the morphology of luminal narrowing using serial optical coherence tomography (OCT) imaging.
  • To identify patient-related factors associated with luminal narrowing progression.

Main Methods:

  • A prospective study evaluating patients undergoing DCA/DCB for de novo coronary lesions.
  • Serial OCT imaging performed at baseline and at 3, 6, and 18 months post-intervention.
  • Analysis of luminal narrowing patterns, specifically focusing on layered morphology and layer progression.
  • Correlation of luminal narrowing with patient demographics, comorbidities (e.g., diabetes), and medication use (dual-antithrombotic therapy, statins).

Main Results:

  • A layered pattern of luminal narrowing was observed in over 90% of cases at 3, 6, and 18 months post-DCA/DCB.
  • Layer progression, a key indicator of ongoing narrowing, was most frequent between 3 and 6 months (63.6%) and decreased significantly by 18 months (17.4%).
  • Patients exhibiting layer progression were more likely to have diabetes, shorter durations of dual-antithrombotic therapy (DATT), and lower intensity statin use.

Conclusions:

  • Luminal narrowing and layer progression after DCA/DCB predominantly occur within the first six months post-procedure.
  • The findings suggest that diabetes, DATT duration, and statin intensity may play roles in the development of luminal narrowing.
  • Further research is warranted to elucidate the precise mechanisms and optimize management strategies.

Keywords:
antithrombotic therapydirectional coronary atherectomydrug-coated balloonlayer formationoptical coherence tomographystent-less PCI

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