Impact of multiple ballooning on coronary lesions as assessed by optical coherence tomography and intravascular ultrasound

Background: Optimal lesion preparation for coronary lesions has been reappraised in the interventional community, given the increasing use of drug-coated balloons for de novo lesions; however, whether multiple ballooning could achieve more favorable angiographic results compared with single ballooning remains unknown. We aimed to investigate the incremental effect of multiple ballooning on de novo coronary lesions over single ballooning as assessed by optical coherence tomography (OCT) and intravascular ultrasound (IVUS) among patients undergoing percutaneous coronary intervention (PCI). Methods: Patients with chronic coronary syndrome (CCS) undergoing PCI were enrolled. Ballooning before stent implantation was repeatedly performed for three times using the same semi-compliant balloon. OCT and IVUS were performed after each balloon dilatation. Primary outcome measure was the difference in the mean lumen area between post-1st ballooning (1B) and post-3rd ballooning (3B) as assessed by OCT. Results: A total of 32 lesions in 30 patients undergoing PCI between May 2021 and August 2022 were analyzed. Major plaque types of the lesions were fibrous (68.8%) and lipid (28.1%). Mean lumen area by OCT was significantly increased from 1B to 3B (5.9 +/- 2.9 mm(2) vs. 6.0 +/- 2.9 mm(2), difference: 0.2 +/- 0.4 mm(2), p = 0.040). There were significant increases from 1B to 3B in minimum lumen area by OCT (3.1 +/- 1.5 mm(2) vs. 3.6 +/- 1.7 mm(2), difference: 0.5 +/- 0.6 mm(2), p < 0.001) and mean dissection angle by OCT (65.6 +/- 24.9 degrees vs. 95.2 +/- 34.0 degrees, difference: 29.6 +/- 25.5 degrees, p < 0.001). Additionally, mean plaque area by IVUS was significantly decreased (8.0 +/- 4.2 mm(2) vs. 7.8 +/- 4.1 mm(2), difference: -0.2 +/- 0.2 mm(2), p < 0.001). Conclusions: Among CCS patients with mainly non-calcified lesions, multiple ballooning significantly increased the lumen area and dissection angle compared with single ballooning.