Clinical and Angiographic Outcomes of Coronary Dissections After Paclitaxel-Coated Balloon Treatment in De Novo CAD

초록

BACKGROUND Coronary dissection is an unavoidable complication of paclitaxel-coated balloon (PCB) treatment for de novo coronary artery disease (CAD). However, the prognostic implications according to dissection severity remain unclear, with some studies suggesting a positive relationship between dissection volume and late lumen enlargement. This study evaluated clinical and angiographic outcomes in patients with coronary dissections after PCB treatment, with particular focus on dissection subtypes. METHODS This study analyzed data from the Korea University Ansan DCB Registry, a prospective all-comer registry. A total of 449 patients (662 lesions) with de novo CAD who underwent DCB-based PCI and had angiographic follow-up were included. Lesions were classified as non-dissection (n = 397) or dissection (n = 265), with the latter further stratified by type A (n = 88), type B (n = 78), and type C (n = 56). Quantitative coronary angiography (QCA) parameters and clinical outcomes, including target vessel failure (TVF: cardiac death, target vessel MI, or TLR), were assessed. RESULTS Coronary dissection occurred in 44.3% of lesions post-PCB treatment. No significant differences were observed in TVF rates between dissection and non-dissection groups (HR 1.29, 95% CI: 0.70–2.41, p = 0.41). On QCA, the dissection group exhibited slightly lower post-PCI MLD (p < 0.001) and greater post-PCI diameter stenosis (p < 0.001). However, MLDs were comparable at the angiographic follow-up. Consequently, late lumen loss (LLL) was significantly lower in the dissection group compared to the non-dissection group (p < 0.001). Among dissection subtypes, type B and type C dissections were associated with the greatest reduction in LLL, while type A dissections had a similar LLL to non-dissection lesions. Correspondingly, the increase in MLD from post-PCI to follow-up was more pronounced in type B and C dissections (both p < 0.001 vs. non-dissection). CONCLUSION Coronary dissection during coronary PCB treatment was common but was not associated with TVF. Dissection severity showed a positive trend for late luminal enlargement, indicating favorable vessel remodeling after PCB treatment.