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Updated: Aug 6, 2026
Monitoring the Wall Mechanics During Stent Deployment in a Vessel
Published on: May 8, 2012
Radial Wall Strain for Predicting Severe Dissection After Drug-Coated Balloon
Wence Shi1, Qifeng Zhu2, Zhenyan Zhao1
1Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Background:
Although drug-coated balloons (DCBs) demonstrate efficacy in de novo coronary artery disease, patients with non-small vessel lesions (NSVLs, ≥2.75 mm) face elevated risks of rescue stenting due to procedure-related coronary dissection. Radial wall stress maximum (RWSmax), an angiography-derived parameter reflecting plaque vulnerability, may predict dissection severity and optimize patient selection for DCB strategies.
Objectives:
This study aimed to evaluate the predictive value of RWSmax for severe coronary dissection following DCB treatment in de novo NSVL.
Methods:
This study retrospectively analyzed 194 patients with de novo NSVL who were evaluated for DCB angioplasty. Dissections were classified via National Heart, Lung, and Blood Institute criteria: nonsevere (no dissection or Type A/B) vs severe (Type C-F). RWSmax was quantified using electrocardiography-gated angiographic analysis (AngioPlus Core software). Multivariable regression and receiver operating characteristic analyses identified predictors of severe dissection.
Results:
Severe dissections occurred in 32.0% (62 of 194), predominantly Type C (83.9%, 52 of 62). RWSmax increased progressively with dissection severity (Jonckheere-Terpstra P < 0.001) and was higher compared with patients with nonsevere dissections (14.70% [12.80-16.65] vs 12.20% [11.00-13.30], P < 0.001). RWSmax independently predicted severe dissection (adjusted OR per 1%: 1.55; 95% CI: 1.31-1.90; P < 0.001), with an optimal cutoff of 13.7% (area under the curve = 0.752 [0.673-0.831], sensitivity = 61.3% [56.5% to 66.1%], specificity = 81.1%[74.4% to 87.8%]). Incorporating RWSmax into clinical prediction models significantly improved discrimination (Δarea under the curve = +0.093 [0.035-0.151]; P = 0.008). Subgroup analyses confirmed consistency across lesion types, calcification severity, and operator experience levels.
Conclusions:
RWSmax is a robust, angiography-based predictor of severe coronary dissection after DCB in NSVL. A 13.7% cutoff helps identify high-risk patients, supporting precision selection for DCB strategy.