Assessing intermediate left main coronary lesions using intravascular ultrasound

Sano, Koichi; Mintz, Gary S.; Carlier, Stéphane; Costa, José de Ribamar; Qian, Jie; Missel, Eduardo; Shan, Shou-Jie; Franklin-Bond, Theresa; Boland, Paul; Weisz, Giora; Moussa, Issam; Dangas, George; Mehran, Roxana; Lansky, Alexandra J.; Kreps, Edward M.; Collins, Michael B.; Stone, Gregg W.; Leon, Martin B.; Moses, Jeffrey W.

doi:10.1016/j.ahj.2007.07.001

Cited by 80 publications

(43 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] In particular, the application of intravascular ultrasound (IVUS) has been useful in determining anatomic configuration, selecting treatment strategy, and defining optimal stenting outcomes in PCI. [17][18][19][20] Indeed, angiography has limitations in assessing lesion morphology and the true luminal size of LMCA because of aortic cusp opacification, streaming of contrast agent, short vessel length, and lack of a normal reference segment. 20 Therefore, IVUS assessment before the procedure cannot only detect significant stenosis but can also select the appropriate diameter and length of the stent.…”

mentioning

confidence: 99%

Impact of Intravascular Ultrasound Guidance on Long-Term Mortality in Stenting for Unprotected Left Main Coronary Artery Stenosis

Park

Kim

Park

et al. 2009

Circ: Cardiovascular Interventions

464

261

View full text Add to dashboard Cite

for the MAIN-COMPARE InvestigatorsBackground-Although intravascular ultrasound (IVUS) guidance has been useful in stenting for unprotected left main coronary artery stenosis, its impact on long-term mortality is still unclear. Methods and Results-In the MAIN-COMPARE registry, patients with unprotected left main coronary artery stenosis in a hemodynamically stable condition underwent elective stenting under the guidance of IVUS (756 patients) or conventional angiography (219 patients). Patients with acute myocardial infarction were excluded. The 3-year outcomes between the 2 groups were primarily compared using propensity-score matching in the entire and separate populations according to stent type. In 201 matched pairs of the overall population, there was a tendency of lower risk of 3-year morality with IVUS guidance compared with angiography guidance (6.0% versus 13.6%, log-rank

show abstract

mentioning

confidence: 99%

Impact of Intravascular Ultrasound Guidance on Long-Term Mortality in Stenting for Unprotected Left Main Coronary Artery Stenosis

Park

Kim

Park

et al. 2009

Circ: Cardiovascular Interventions

464

261

View full text Add to dashboard Cite

show abstract

“…19) In the DES era, IVUS may play an important role in the treatment of complex coronary artery disease. 20,21) However, there is little data about long-term clinical outcomes of IVUS-guided non-complex LMCA disease treated with a single stenting technique. Although the sample size was small, Agostoni, et al 22) showed that there were no differences in the incidence of MACE comprising death, MI, or TVR.…”

Section: Discussionmentioning

confidence: 99%

Three-Year Major Clinical Outcomes of Angiography-Guided Single Stenting Technique in Non-Complex Left Main Coronary Artery Diseases

et al. 2017

View full text Add to dashboard Cite

SummaryThere is limited long-term comparative clinical outcome data concerning angiography-versus intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) in non-complex left main coronary artery (LMCA) disease treated with the single stenting technique in the drug-eluting stent (DES) era.The aim of this study was to investigate whether angiography-guided stenting is comparable to IVUSguided stenting during 3-year clinical follow-up periods in patients with non-complex LM disease treated with the single stenting technique.A total of 196 patients treated with either angiography-guided (n = 74) or IVUS-guided (n = 122) PCI were included. The primary outcome was the occurrence of major adverse cardiac events (MACE) defined as total death, non-fatal myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), and non-target vessel revascularization (Non-TVR). To adjust for any potential confounders, propensity score (PS) adjusted analysis was performed.During 3-year follow-up, the PS adjusted Cox-proportional hazard ratio (HR) was not significantly different between the two groups for total death, cardiac death, and MI. Also, TLR and the combined rates of TVR and non-TVR were not significantly different. Finally, MACE was not significantly different between the two groups (HR: 0.63, 95% Confidence interval (CI): 0.33-1.17; P = 0.149).Angiography-guided PCI for non-complex LMCA diseases treated with the single stenting technique showed comparable results compared with IVUS-guided PCI in reducing clinical events during 3-year clinical follow-up in the DES era. Although IVUS guided PCI is the ideal strategy, angiography-guided PCI can be an option for LMCA PCI in some selected cases.(Int Heart J 2017; 58: 704-713) Key words: Left main coronary artery, Percutaneous coronary intervention, Intravascular ultrasound, Drug eluting stents U ntil recently, left main coronary artery (LMCA) disease was a hotly debated topic among interventional cardiologists as it is a challenging and risky lesion subset. According to recent guidelines, percutaneous coronary intervention (PCI) for an ostial or midshaft lesion of LMCA (non-true bifurcation) is defined as a Class IIa indication. 1) Even though LMCA disease treatment has been traditionally reserved for surgery, there have been numerous registries with drug-eluting stents (DES) that have shown favorable outcomes. 2,3) In this uniquely challenging aspect, the use of intravascular ultrasound (IVUS) may help to evaluate the target lesion and enable optimal stent deployment during PCI; and these optimized procedural results may translate into improved long-term clinical outcomes. A recent study 4) demonstrated that the survival rate and the rate of free of major adverse cardiac events (MACE) after 3 years were higher in the IVUS group, and the incidence of stent thrombosis was lower in the IVUS group. However, recent studies did not focus on the role of IVUS in non-complex LM disease treated with the single stenting tec...

show abstract

“…IVUS assessment pre and post left main intervention is very important to evaluate larger lumen area of the ostial and midshaft left main and adequate post dilatation post stenting. In comparison to native coronary vessels, a minimal luminal area of <6.0 mm2 is a commonly used threshold for significant left main disease (Sano, Mintz et al 2007). While there are no randomized trials to inform practice in this area, registry data has shown a trend toward reduced mortality in IVUS guided UPLM PCI.…”

Section: Guidance For Left Main Stem Interventionmentioning

confidence: 99%

Clinical Applications of Intravascular Ultrasound

Phelan¹,

Matiullah²,

Sharif³

2012

Intravascular Ultrasound

View full text Add to dashboard Cite

Assessing intermediate left main coronary lesions using intravascular ultrasound

Cited by 80 publications

References 14 publications

Impact of Intravascular Ultrasound Guidance on Long-Term Mortality in Stenting for Unprotected Left Main Coronary Artery Stenosis

Impact of Intravascular Ultrasound Guidance on Long-Term Mortality in Stenting for Unprotected Left Main Coronary Artery Stenosis

Three-Year Major Clinical Outcomes of Angiography-Guided Single Stenting Technique in Non-Complex Left Main Coronary Artery Diseases

Clinical Applications of Intravascular Ultrasound

Contact Info

Product

Resources

About