Precise intervention of drug-coated balloons based on quantitative flow ratio: treatment efficacy and virtual planning adaptability evaluation

OBJECTIVE: To evaluate the efficacy of drug-coated balloon (DCB) treatment for coronary artery stenosis guided by quantitative flow ratio (QFR) and the clinical applicability of virtual balloon planning. METHODS: A single-center retrospective study was conducted on 48 patients (52 lesions). Changes in minimum lumen diameter (MLD) and QFR values before and after treatment were examined. Paired testing and the Bland–Altman method were employed to assess the consistency between the virtual balloon size (length/diameter) and actual size used in clinical practice. RESULTS: MLD and QFR values improved significantly after DCB treatment (MLD: 1.20 ± 0.40 mm to 2.15 ± 0.50 mm, P < 0.001; QFR: 0.78 ± 0.14 to 0.94 ± 0.04, P < 0.001), with a complication rate of 1.92%. The virtual balloon length was significantly shorter than the actual length (15.65 ± 11.88 mm vs. 20 ± 8 mm, P < 0.001). No significant bias was observed in the balloon diameter (2.55 ± 0.6 mm vs. 2.75 ± 0.5 mm, P = 0.443), although the 95% limits of agreement were wide (–0.70 to 0.78 mm), with a clinical concordance rate (± 0.5 mm) of 84.91%. CONCLUSION: QFR-guided DCB treatment effectively improves hemodynamic and anatomical parameters with good short-term safety. However, virtual balloon planning algorithms require optimization to enhance clinical applicability and the accuracy of balloon size prediction.