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Purpose: Dissection after plain balloon angioplasty is required to achieve adequate luminal area; however, it is associated with ahigh risk of vascular events. This study aimed to examine the relationship between non-flow limiting coronary dissections andsubsequent lumen loss and long-term clinical outcomes following successful drug-coated balloon (DCB) treatment of de novocoronary lesions. Materials and Methods: A total of 227 patients with good distal flow (Thrombolysis in Myocardial Infarction flow grade 3) followingDCB treatment were retrospectively enrolled and stratified according to the presence or absence of a non-flow limiting dissection. The primary endpoint was late lumen loss (LLL) at 6-month angiography, and the secondary endpoint was target vesselfailure (TVF, a composite of cardiac death, target vessel myocardial infarction, target vessel revascularization, and target vesselthrombosis). Results: The cohort consisted of 95 patients with and 132 patients without a dissection. There were no between-group differencesin LLL (90.8%) returning for angiography at 6 months (0.05±0.19 mm in non-dissection and 0.05±0.30 mm in dissection group, p=0.886) or in TVF (6.8% in non-dissection and 8.4% in dissection group, p=0.799) at a median follow-up of 3.4 years. In a multivariateanalysis, the presence of dissection and its severity were not associated with LLL or TVF. Almost dissections (93.9%) were completelyhealed, and there was no newly developed dissection at 6-month angiography. Conclusion: The presence of a dissection following successful DCB treatment of a de novo coronary lesion may not be associatedwith an increased risk of LLL or TVF (Impact of Drug-coated Balloon Treatment in de Novo Coronary Lesion; NCT04619277).
