Radial Wall Strain for Predicting Severe Dissection After Drug-Coated Balloon

Area of Science:

• Cardiovascular medicine
• Interventional cardiology
• Medical imaging analysis

Background:

• Drug-coated balloons (DCBs) are effective for de novo coronary artery disease.
• Non-small vessel lesions (NSVLs, ≥2.75 mm) treated with DCBs have higher risks of dissection and rescue stenting.
• Radial wall stress maximum (RWSmax) may predict dissection severity and optimize patient selection.

Purpose of the Study:

• To assess the predictive capability of RWSmax for severe coronary dissection post-DCB in de novo NSVL.
• To determine if RWSmax can improve patient selection for DCB angioplasty in NSVLs.

Main Methods:

• Retrospective analysis of 194 patients with de novo NSVL undergoing DCB angioplasty.
• Coronary dissections classified using National Heart, Lung, and Blood Institute criteria (nonsevere vs. severe).
• RWSmax quantified via electrocardiography-gated angiographic analysis; multivariable regression and ROC analyses performed.

Main Results:

• Severe dissections occurred in 32.0% of patients.
• RWSmax significantly increased with dissection severity (P < 0.001) and was higher in severe dissection cases (14.70% vs. 12.20%, P < 0.001).
• RWSmax independently predicted severe dissection (aOR 1.55 per 1%, P < 0.001) with an optimal cutoff of 13.7% (AUC 0.752).

Conclusions:

• RWSmax is a reliable angiography-based predictor of severe coronary dissection following DCB treatment in NSVL.
• An RWSmax cutoff of 13.7% aids in identifying patients at high risk for severe dissection.
• This finding supports precision selection for DCB strategies in NSVL patients.