Angiographic and clinical comparisons of intravascular ultrasound- versus angiography-guided drug-eluting stent implantation for patients with chronic total occlusion lesions: two-year results from a randomised AIR-CTO study

Abstract

The IVUS-guided stenting of the CTO lesion was associated with less LLL and a lower incidence of "in-true-lumen" stent restenosis. Additional study is required to identify the clinical benefit of the IVUS-guided procedure for CTO lesions. [ChiCTR-TRC-10000996].

Intravascular ultrasound in percutanous coronary intervention for chronic total occlusions: predictors of use, indications and in-hospital outcome

“…However, in two randomized trials, IVUS use was not associated with a reduction of contrast load [18,19]. Although in our study, less contrast was required in IVUS guided CTO PCI attempts, this did not result in lower incidence of contrast induced nephropathy.…”

“…However, this latter study was underpowered because of low events rate observed in both groups. In the AIR-CTO trial, there were no differences in the composite MACE and in the individual component of clinical adverse events between the 2 study groups at 1-and 2-year follow-ups [18]. Therefore, the impact of IVUS guided CTO PCI on clinical outcome is still not yet well established; further studies are needed to better assess it.…”

“…After stenting, expansion, and apposition can be optimized with IVUS imaging. In the AIR-CTO (Angiographic and clinical comparisons of intravascular ultrasoundversus angiography-guided drug-eluting stent implantation for patients with chronic total occlusion lesions) randomized trial, in comparison with the angiography-guided group, the IVUS-guided group had lower in-stent late lumen loss (0.28 ± 0.48 mm vs. 0.46 ± 0.68 mm; p=0.025), and lower restenosis of the "in-true-lumen" stent (3.9% vs.13.7%; p=0.021) [18].…”

“…Recently, the interest in IVUS use during percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs) has dramatically increased [4][5][6]. Indeed, IVUS has various potential roles in the recanalization of CTOs, some specific to wire crossing, others in common with other complex long calcified lesions such as optimal sizing and expansion of the stents [7].…”

Optical coherence tomography- vs. intravascular ultrasound-guided percutaneous coronary intervention

“…Intravascular imaging including intravascular ultrasound (IVUS) and optical coherence tomography (OCT) represent two techniques that provide essential information on preprocedural lesion characteristics (i.e., lesion severity, landing zone, and plaque composition) and the result after stent implantation (i.e., stent expansion and eccentricity, strut apposition, lesion coverage, tissue protrusion, and dissections). A total of 11 randomized controlled trials investigated the effect of IVUS-guided PCI with mixed results (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). Of note, studies including patients with an increased complexity [i.e., chronic total occlusion (CTO) or lesion length >28 mm] demonstrated a consistent benefit of IVUS-guided PCI as compared with angiography, mainly driven by a reduction of repeat revascularization for restenosis (MACE at 1 year: CTO-IVUS, 2.6% vs. 7.1%, P=0.035; IVUS-XPL, 2.9% vs. 5.8%, P=0.007) (1,2).…”