ObjectiveTo identify risk factors for severe elastic recoil after percutaneous transluminal angioplasty (PTA) in the femoropopliteal artery disease based on intravascular ultrasound (IVUS) imaging and to develop a risk prediction model. MethodsA retrospective analysis was conducted on the clinical data from the patients with femoropopliteal artery disease treated at the First Affiliated Hospital of Chongqing Medical University from September 2020 to February 2022. Based on the IVUS images, a multivariate logistic regression analysis was conducted to identify the risk factors for severe elastic recoil in the patients with femoropopliteal artery disease after PTA. A nomogram prediction model was established to predict the occurrence of severe elastic recoil, and the area under receiver operating characteristic curve (AUC) was used to evaluate its ability to distinguish the occurrence of severe elastic recoil, which was validated using a calibration curve. ResultsA total of 34 patients with femoropopliteal artery disease who received PTA treatment were enrolled. Of the 803 vessel slices were analyzed, 451 (56.16%) demonstrated severe elastic recoil on IVUS imaging. The multivariate logistic regression analysis showed that the increased plaque burden, luminal eccentric index, external elastic membrane remodeling index, and the external elastic membrane-balloon area ratio were the risk factors for the occurrence of severe elastic recoil (P＜0.05). The AUC of the nomogram prediction model based on these risk factors exhibited moderate discrimination [AUC (95%CI)=0.775 (0.732, 0.818)]. The predicted probability of the nomogram model for severe elastic recoil was in a good agreement with the actual probability (P=0.862). ConclusionThe severe elastic recoil prediction model developed in this study, based on IVUS imaging data, can effectively identify high-risk factors for severe elastic recoil after PTA in patients with femoropopliteal artery disease, demonstrating a moderate predictive discrimination capability.