Reference Chart Derived From Post–Stent-Implantation Intravascular Ultrasound Predictors of 6-Month Expected Restenosis on Quantitative Coronary Angiography

Feyter, Pim J. de; Kay, Patrick; Disco, Clemens; Serruys, Patrick W.

doi:10.1161/01.cir.100.17.1777

Cited by 170 publications

(101 citation statements)

References 34 publications

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“…4 -6 Final dimensions after stenting are a strong predictor of outcome. [7][8][9][10] Because lumen and stent dimensions can be accurately determined by intravascular ultrasound (IVUS), guidance of stenting by IVUS has been proposed as a method to reduce restenosis rates. 11 However, randomized studies investigating this strategy have yielded inconsistent results.…”

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confidence: 99%

Intravascular Ultrasound Guidance Improves Angiographic and Clinical Outcome of Stent Implantation for Long Coronary Artery Stenoses

Oemrawsingh

Mintz²,

Schalij³

et al. 2003

Circulation

255

139

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Background-Long coronary lesions treated with stents have a poor outcome. This study compared the 6-month outcome of stent implantation for long lesions in patients randomized to intravascular ultrasound (IVUS; nϭ73) or angiographic guidance (nϭ71). Methods and Results-Stenoses Ͼ20 mm in length and a reference diameter that permitted a stent diameter Ն3 mm were eligible. Primary end points were 6-month minimal lumen diameter (MLD) and the combined end point of death, myocardial infarction, and target-lesion revascularization (TLR). Baseline clinical and angiographic data were comparable in both groups. At 6 months, MLD in the IVUS group (1.82Ϯ0.53 mm) was larger than in the angiography group (1.51Ϯ0.71 mm; Pϭ0.042). TLR and combined end-point rates at 6 months were 4% (nϭ3) and 6% (nϭ4) in the IVUS group and 14% (nϭ10) and 20% (nϭ14) in the angiography group, respectively (Pϭ0.037 for TLR and Pϭ0.01 for combined events). Restenosis (Ͼ50% diameter stenosis) was found in 23% of the IVUS group and 45% of the angiography group (Pϭ0.008). At 12 months, TLR and the combined end point occurred in 10% (nϭ7) and 12% (nϭ9) of the IVUS group and 23% (nϭ17) and 27% (nϭ19)

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mentioning

confidence: 99%

Intravascular Ultrasound Guidance Improves Angiographic and Clinical Outcome of Stent Implantation for Long Coronary Artery Stenoses

Oemrawsingh

Mintz²,

Schalij³

et al. 2003

Circulation

255

139

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“…26 The low restenosis rate observed in the aggressive PTCA group was confirmed by the results in angiographic MLD, diameter stenosis, L-CSA, and clinical event rate. These results are consistent with the favorable outcome observed with IVUS-guided angioplasty in a large single-center registry 17 and in a matched comparison with traditional stenting in long lesions.…”

Section: Long-term Resultsmentioning

confidence: 58%

Intravascular Ultrasound–Guided Balloon Angioplasty Compared With Stent

Schiele¹,

Méneveau²,

Gilard³

et al. 2003

Circulation

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Background-Balloon angioplasty guided by intravascular ultrasound (IVUS) makes it possible to choose the balloon size according to the true vessel diameter and to detect suboptimal results requiring subsequent stent implantation. The Balloon Equivalent to STent (BEST) study aimed to assess whether this strategy would give the same results as systematic stenting. Methods and Results-A total of 132 of 254 patients were randomized to IVUS-guided percutaneous transluminal coronary angioplasty (aggressive PTCA), and 122 were randomized to stenting (stent group). We hypothesized that a difference of Ͻ8% in the 6-month angiographic restenosis rate (primary end point) could be considered noninferior. The aggressive PTCA procedure was longer and had a greater use of contrast medium than stenting. In the aggressive PTCA group, crossover to stent was needed in 58 patients (44%). At 6 months, 20 of 119 patients (16.8Ϯ6.7%) in the aggressive PTCA group and 21 of 116 patients (18.1Ϯ7.0%) in the stent group had restenosis. The difference was Ϫ1.3%, with an upper limit of 95% confidence interval of 7.1% (ie, less than the noninferiority boundary). The in-stent restenosis rate was higher in the stent group (15.5% versus 5%; Pϭ0.02). The differences in minimum lumen diameter, lumen cross-section area, and 1-year event rate were not significant. Conclusions-A strategy of IVUS-guided angioplasty with provisional stenting is feasible and safe. At the cost of a more complex procedure, it reduces the stent rate by half, with similar 6-month angiographic IVUS and clinical outcome compared with stent implantation. (Circulation. 2003;107:545-551.)

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“…A previous IVUS study by de Feyter et al confirmed that minimal stent area was one of the independent risk factors for ISR of bare metal stents 12. In the first‐generation DES era, another report focused on less stringent criteria of minimal stent area <5.5 cm 2 as a risk factor for angiographic restenosis after sirolimus‐eluting stents implantation 13.…”

Section: Discussionmentioning

confidence: 98%

Impact of Angiographic Residual Stenosis on Clinical Outcomes After New‐Generation Drug‐Eluting Stents Implantation: Insights From a Pooled Analysis of the RESET and NEXT Trials

Watanabe

Morimoto

Shiomi

et al. 2018

JAHA

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BackgroundPrevious intravascular ultrasound studies suggested the association of stent underexpansion with increased risk of stent thrombosis and restenosis. However, no previous study has addressed the association of the suboptimal angiographic result with target‐lesion revascularization (TLR) in patients receiving new‐generation drug‐eluting stents (DES).Methods and Results RESET (Randomized evaluation of sirolimus‐eluting versus everolimus‐eluting stent trial) and NEXT (NOBORI biolimus‐eluting versus XIENCE/PROMUS everolimus‐eluting stent trial) are prospective, multicenter, randomized “DES versus DES” trials; 3196 patients and 3235 patients were enrolled in the RESET and NEXT, respectively. Using the pooled individual patient‐level data, the current study population consisted of 3679 patients who received single‐lesion treatment using new‐generation DES such as everolimus‐eluting stent and biolimus‐eluting stent. The study population was divided into 3 groups according to the residual in‐stent % diameter stenosis (%DS) after stent implantation by offline quantitative coronary angiography assessed in a core angiographic laboratory (optimal group: %DS <10%, intermediate group: %DS=10% to 20%, suboptimal group: %DS ≧20%). The cumulative 3‐year incidence of TLR was significantly higher in the suboptimal group than in the intermediate and optimal groups (9.8% versus 5.8% versus 5.7%, log‐rank P=0.004). Even after adjusting for the clinical, angiographic, and procedural characteristics, the excess TLR risk of the suboptimal group relative to the optimal group remained significant (hazard ratio: 1.65, 95% confidence interval, 1.14–2.41, P=0.009). The excess TLR risk of the suboptimal group relative to the optimal group was consistently seen across all the subgroups including heavy calcification.ConclusionsThe residual angiographic in‐stent %DS ≥20% was associated with increased risk for TLR in patients treated with the new‐generation DES.

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Reference Chart Derived From Post–Stent-Implantation Intravascular Ultrasound Predictors of 6-Month Expected Restenosis on Quantitative Coronary Angiography

Cited by 170 publications

References 34 publications

Intravascular Ultrasound Guidance Improves Angiographic and Clinical Outcome of Stent Implantation for Long Coronary Artery Stenoses

Intravascular Ultrasound Guidance Improves Angiographic and Clinical Outcome of Stent Implantation for Long Coronary Artery Stenoses

Intravascular Ultrasound–Guided Balloon Angioplasty Compared With Stent

Impact of Angiographic Residual Stenosis on Clinical Outcomes After New‐Generation Drug‐Eluting Stents Implantation: Insights From a Pooled Analysis of the RESET and NEXT Trials

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