SPC365

Optimising lesion preparation for DCB PCI: the “sweet spot” between under and over dilatation

Session: Sessão de Posters 06 - Balões revestidos na ICP contemporânea
Speaker: Rita Louro

Congress: CPC 2026
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.2 Coronary Intervention
Session Type: Posters Eletrónicos
FP Number: ---
Authors: Rita Louro; Marta Figueiredo; Rafael Viana; Raquel Silva; Maria Banha; Rita Rocha; Gustavo Sá Mendes; Diogo Brás; David Neves; Ângela Bento; Renato Fernandes; Lino Patrício

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong>Background:</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000">Effective lesion preparation is a key determinant of success in drug-coated balloon (DCB) angioplasty. Both insufficient and excessive dilatation have been associated with suboptimal outcomes. This study aimed to characterise the relationship between the ratio of the pre-dilatation balloon to the DCB diameter (BA_rel) and procedural outcomes, identifying a potential &ldquo;sweet spot&rdquo; for optimal results.</span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong>Methods: </strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000">A single-centre retrospective analysis was conducted on 366 coronary lesions treated exclusively with DCB angioplasty. BA_rel was evaluated as a continuous variable. Two outcomes were assessed: (1) acute procedural failure, defined as the requirement for bailout stenting; one case involved a distal LAD thrombus, which was treated with glycoprotein IIb/IIIa inhibitors rather than stenting; and (2) target lesion revascularisation (TLR) during clinical follow-up. Discrimination for both acute procedural failure and TLR was evaluated using ROC analysis, with optimal thresholds determined by Youden&rsquo;s index. Risk patterns across BA_rel were further examined using logistic regression models.</span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong>Results:</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000">Lesion preparation was performed using either semi-compliant or non-compliant balloons (45.6%), cutting balloons (25.7%), or a combination of both (28.7%), according to operator preference and lesion morphology. The mean pre-dilatation balloon diameter was 2.65 &plusmn; 0.59 mm and the mean DCB diameter 2.83 &plusmn; 0.57 mm, yielding a mean BA_rel of 0.97 &plusmn; 0.28. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000">Lower BA_rel values were associated with a higher risk of TLR The ROC curve constructed specifically for TLR identified an optimal threshold of &le;0.87 (AUC 0.644, p=0.007). In contrast, higher BA_rel values were associated with an increased likelihood of acute procedural failure, and the ROC analysis for this distinct outcome yielded an optimal threshold of &ge;1.19 (AUC 0.649, p=0.053). When BA_rel was modelled as a continuous variable&mdash;considering both outcomes jointly&mdash;the overall risk pattern followed a U-shaped distribution, with greater adverse event rates at both extremes of BA_rel. The intermediate zone between the two ROC-derived thresholds&mdash;approximately 0.9 to 1.2&mdash;corresponded to the lowest predicted risk. Event rates across these three ranges (&lt;0.9, 0.9&ndash;1.2, &gt;1.2) are summarised in the figure.</span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong>Conclusion:</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000">BA_rel demonstrates a non-linear association with outcomes after DCB angioplasty, with increased adverse events at both ends of the spectrum and a procedural &quot;sweet spot&quot; between 0.9 and 1.2. These findings support targeting balanced lesion preparation to optimise drug transfer while minimising vessel injury.</span></span></span></p>