Serial Optical Coherence Tomography Assessment of Plaque Phenotype Stabilization after Paclitaxel-Coated Balloon Treatment in De Novo Coronary Lesions

초록

Purpose: There is limited evidence regarding serial plaque changes after paclitaxel-coated balloon (PCB) treatment in de novo coronary target lesions assessed using optical coherence tomography (OCT). Materials and Methods: A prospective serial OCT was performed on de novo target lesions in 48 patients (50 lesions) who underwent PCB treatment. Follow-up OCT was conducted for all lesions after a median of 6 months. The primary analysis evaluated changes in minimum fibrous cap thickness and maximum lipid arc across the imaged lesion segment. Results: In 2550 matched cross-sections from the analyzed lesions, the minimum fibrous cap thickness increased from 40.0 +/- 15.1 & micro;m to 46.6 +/- 15.7 & micro;m (p=0.007), and the maximum lipid arc decreased from 297.8 +/- 68.1 degrees to 252.6 +/- 76.3 degrees (p<0.001). The prevalence of thin-cap fibroatheroma (TCFA) decreased from 24.8% to 17.4% (p<0.001), and macrophage presence declined from 87.0% to 83.1% (p=0.001). At the lesion level, mean lumen area increased from 4.2 +/- 2.7 mm2 to 6.6 +/- 3.1 mm2, and minimum lumen area increased from 1.8 +/- 0.9 mm2 to 4.9 +/- 2.1 mm2 (both p<0.001). At the plaque level, 24 of 37 TCFA plaques at baseline changed to nonTCFA morphology (64.9%), while four of 40 non-TCFA plaques progressed to TCFA (10%). Conclusion: At 6 months after PCB treatment, target-lesion plaques exhibited OCT-derived changes consistent with a shift toward a less vulnerable plaque phenotype. The clinical implications of these imaging findings require further investigation.

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