Arterial remodeling and plaque changes after balloon angioplasty for de novo coronary lesions using DCB

This study evaluated the serial anatomical and morphological changes in de novo coronary lesions treated with a drug-coated balloon (DCB) using integrated-backscatter intravascular ultrasound (IB-IVUS). The aim of this study was to investigate coronary vessel behaviors following balloon angioplasty using DCB. A total of 46 de novo coronary artery lesions treated with IVUS-guided DCB were studied. Each patient underwent coronary angiography and IVUS imaging before/after the intervention, and this was repeated at 8-month follow-up. Quantitative IVUS measurements included the external elastic membrane (EEM), lumen, and plaque plus media (P + M) cross-sectional area (CSA). Plaque composition was classified as lipid pool, fibrosis, dense fibrosis, and calcification using IB-IVUS. The average length and diameter of DCB were 18.7 ± 5.0 and 2.6 ± 0.4 mm, respectively. Acute lumen gain correlated better with vessel dilatation than plaque reduction. Overall mean EEM, P + M, and lumen CSA did not change significantly during follow-up. The Δlumen CSA was negatively correlated with the ΔP + M CSA (r=-0.66, p < 0.001) and positively correlated with ΔEEM CSA (r = 0.52, p < 0.001). By IB-IVUS, ΔP + M CSA correlated positively with both Δfibrosis area and Δlipid pool area. Late lumen gain (Δ lumen CSA > 0) was documented in 30 lesions (65%). Lesions with late lumen gain showed a greater increase in EEM CSA (P = 0.006) and a greater decrease in P + M CSA (P = 0.007), respectively. In conclusion, de novo coronary lesions treated with DCB demonstrated lumen patency with preserved P + M and EEM CSA. A combination of arterial remodeling and plaque changes affected lumen changes during follow-up.