A PROMISING tool could transform how cardiologists treat de novo small vessel disease. Researchers have identified an angiography-based measure that may help predict how well drug-coated balloons perform, revealing key insights into which patients benefit most from this treatment.
Understanding De Novo Small Vessel Disease and Treatment Challenges
De novo small vessel disease (SVD) presents a persistent challenge in interventional cardiology. These lesions, found in small coronary arteries, are difficult to treat effectively because of their delicate size and susceptibility to restenosis. Drug-coated balloons (DCBs) have emerged as an alternative to stents, delivering medication directly to the artery wall without leaving a permanent implant. However, their success varies widely, depending on the nature of the underlying plaque.
Researchers have long sought to understand how plaque vulnerability affects DCB efficacy. The new study introduces a novel angiographic measure called radial wall strain (RWS), which assesses plaque stability directly from angiographic imaging.
Study Design and Key Results
In a post hoc analysis of the PEPCAD China SVD study, investigators evaluated 266 lesions from 260 patients treated with either paclitaxel-coated balloons or plain old balloon angioplasty (POBA). The study defined vulnerable plaques as those with a maximum RWS (RWSmax) of 13% or higher.
At nine-month follow-up, 152 DCB-treated and 72 POBA-treated lesions were analysed. In the DCB group, lesions with RWSmax ≥13% had greater in-segment late lumen loss (0.24±0.53 mm vs 0.05±0.16 mm; p=0.0009), higher rates of binary restenosis (14.9% vs 1.9%; p=0.0040), and more target lesion failure (10.2% vs 1.6%; p=0.022) compared to those with RWSmax <13%. Among vulnerable lesions (RWSmax ≥13%), no significant difference was seen between DCB and POBA outcomes (p=0.49).
Clinical Implications and Future Directions
This study suggests that angiography-derived RWS could become a valuable predictor of clinical and angiographic outcomes in patients with de novo small vessel disease. By identifying vulnerable plaques in advance, clinicians may be able to optimise treatment selection, improving the precision of DCB use and potentially avoiding unnecessary interventions.
Reference
Xu K et al. A novel angiographic index for predicting the efficacy of drug-coated balloons in small vessels. EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2025;21(20):e1209-21.
