Restenosis patterns after percutaneous coronary intervention with drug-coated balloons for de novo coronary lesions

Drug-coated balloons (DCBs) are currently used to treat de novo coronary artery lesions. Although controversial, previous studies have suggested the possibility that DCB treatment for de novo coronary artery disease is non-inferior to drug-eluting stent implantation, including small vessel disease1. However, the morphological changes in lesions with target lesion revascularisation (TLR) following DCB treatment have not been fully clarified. Thus, this study examined TLR lesions treated with DCBs using serial optical coherence tomography (OCT) to explore the mechanism of restenosis.

This retrospective observational study was conducted at the Japanese Red Cross Musashino Hospital (Tokyo, Japan). Between April 2018 and April 2024, 408 patients with de novo coronary lesions were subjected to OCT-guided percutaneous coronary intervention (PCI) using paclitaxel-coated balloons (SeQuent Please [B. Braun] or AGENT [Boston Scientific]). Among them, 26 TLR lesions in 24 patients with serial OCT examinations (at index PCI [pre- and post-PCI] and at TLR) were enrolled (Supplementary Figure 1). All TLR were ischaemic or clinically driven (presence of chest symptom or evidence of physiological ischaemia).

OCT images at pre-PCI, post-PCI and at TLR were assessed....