Impact of Intravascular Ultrasound Imaging on Early and Late Clinical Outcomes Following Percutaneous Coronary Intervention With Drug-Eluting Stents

Claessen, Bimmer E.; Mehran, Roxana; Mintz, Gary S.; Weisz, Giora; Leon, Martin B.; Dogan, Ozgen; Costa, José de Ribamar; Stone, Gregg W.; Apostolidou, Irene; Morales, A. R.; Chantziara, Vasiliki; Syros, George; Sanidas, Elias; Xu, Ke; Tijssen, Jan G.P.; Henriques, José P.S.; Piek, Jan J.; Moses, Jeffrey W.; Maehara, Akiko; Dangas, George

doi:10.1016/j.jcin.2011.07.005

Cited by 107 publications

(54 citation statements)

References 14 publications

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“…Recently, in nonleft main lesions, IVUSguided PCI with DES reduced both stent thrombosis and the combination of death and myocardial infarction compared with an angiographically-guided strategy. 3,4 Similar benefits also have been noted in left main lesions. In 145 propensitymatched patients undergoing unprotected left main PCI with DES from the multicenter MAIN-COMPARE (revascularization for unprotected left MAIN coronary artery stenosis: COMparison of Percutaneous coronary Angioplasty versus surgical Revascularization) registry, the 3-year mortality was lower with IVUS-guidance (4.7% versus 16.0%, Pϭ0.048).…”

Section: Article See P 562supporting

confidence: 67%

“…Increasing evidence suggests that IVUS-guidance reduces adverse events in PCI with DES in various clinical settings. 3,4 This likely relates to the preintervention assessment of appropriate stent size and interventional strategy, as well as the postintervention detection and correction of suboptimal stent deployment, such as dissections, underexpansion, geographic miss, plaque/tissue prolapse, and incomplete stent apposition. Of these, stent underexpansion most consistently has been associated with adverse events in nonleft main PCI with DES.…”

Section: Article See P 562mentioning

confidence: 99%

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Stent Area by Intravascular Ultrasound and Outcomes in Left Main Intervention With Drug-Eluting Stents

McDaniel

Douglas

2011

Circ: Cardiovascular Interventions

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W hile the standard revascularization for left main lesions traditionally has been surgical coronary artery bypass grafting, increasingly studies suggest that percutaneous coronary intervention (PCI) with drug-eluting stents (DES) may be an acceptable alternative to surgery for selected patients. In total, the current evidence suggests that rates of death, myocardial infarction, and stroke may be similar between patients managed with PCI and coronary artery bypass grafting, but revascularization occurs less frequently in patients undergoing surgery. This was illustrated in the recently published randomized PRECOMBAT (Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease) trial, where the 2-year risk of death, myocardial infarction, or stroke was similar (hazard ratio: 0.92; 95% confidence interval (CI), 0.43 to 1.96; Pϭ0.83) in patients with unprotected left main disease managed with PCI using DES (Nϭ300) and coronary artery bypass grafting (Nϭ300), but revascularizations were more common in patients undergoing PCI (hazard ratio: 2.18; 95% CI, 1.10 -4.32; Pϭ0.02). 1 A recent meta-analyses of 1611patients from 4 randomized trials comparing PCI with coronary artery bypass grafting for unprotected left main lesions found similar results. 2 Article see p 562Given the significant consequences associated with stent thrombosis and restenosis in the left main, intravascular ultrasound (IVUS) guidance has been advocated to optimize stent deployment in this important lesion subset. Increasing evidence suggests that IVUS-guidance reduces adverse events in PCI with DES in various clinical settings. 3,4 This likely relates to the preintervention assessment of appropriate stent size and interventional strategy, as well as the postintervention detection and correction of suboptimal stent deployment, such as dissections, underexpansion, geographic miss, plaque/tissue prolapse, and incomplete stent apposition. Of these, stent underexpansion most consistently has been associated with adverse events in nonleft main PCI with DES. 5,6 However, the optimal cut-off values to define "adequate stent expansion" in left main lesions are unknown.In the current issue of Circulation: Cardiovascular Interventions, Kang et al investigated the relationship between underexpansion in left main PCI with DES and adverse events. 7 Specifically, the authors evaluated the relationship between poststent area by IVUS on 9-month angiographic restenosis, and 2-year clinical outcomes in 403 consecutive patients undergoing left main PCI with DES from a single center. In the study, IVUS measurements were made at 4 locations: proximal left main, at the polygon of confluence, ostial left anterior descending, and ostial left circumflex in order to determine the stent area cut-off values associated with optimal outcomes. Of the patients undergoing PCI in this study, 13% were ostial/midshaft and 87% were bifurcation lesions. Two thirds of the bifurcation lesions were ...

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Section: Article See P 562supporting

confidence: 67%

Section: Article See P 562mentioning

confidence: 99%

Stent Area by Intravascular Ultrasound and Outcomes in Left Main Intervention With Drug-Eluting Stents

McDaniel

Douglas

2011

Circ: Cardiovascular Interventions

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“…1 In the DES era, a meta-analysis including this trial and 10 registries reported that IVUS guidance may reduce ST and cardiac death after DES, although TVR rates were reduced only in complex lesion cohorts. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] The present study reports by far the largest experience with IVUS guidance of DES implantation, with a major strength being enrollment of an all-comers population. In this population, IVUS guidance was associated with lower rates of ST, MI, and ischemia-driven TLR and TVR compared with angiography guidance alone.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Nonetheless, definitive randomized trials to demonstrate whether IVUS guidance improves clinical outcomes after stent implantation have not been performed, with most prior trials being underpowered and restricted to noncomplex lesions. The benefits of IVUS after drug-eluting stent (DES) use are particularly controversial given the improved outcomes with DES compared with bare metal stents.…”

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confidence: 99%

Relationship Between Intravascular Ultrasound Guidance and Clinical Outcomes After Drug-Eluting Stents

et al. 2014

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Background-Prior small to modest-sized studies suggest a benefit of intravascular ultrasound (IVUS) guidance in noncomplex lesions. Whether IVUS guidance is associated with improved clinical outcomes after drug-eluting stent (DES) implantation in an unrestricted patient population is unknown. Methods and Results-Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents (ADAPT-DES) was a prospective, multicenter, nonrandomized "all-comers" study of 8583 consecutive patients at 11 international centers designed to determine the frequency, timing, and correlates of stent thrombosis and adverse clinical events after DES. Propensity-adjusted multivariable analysis was performed to examine the relationship between IVUS guidance and 1-year outcomes. IVUS was utilized in 3349 patients (39%), and larger-diameter devices, longer stents, and/or higher inflation pressures were used in 74% of IVUS-guided cases. IVUS guidance compared with angiography guidance was associated with reduced 1-year rates of definite/probable stent thrombosis (0.

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“…Already in the past decade, several large studies have been published showing that IC imaging guidance may be important for achieving optimal DES expansion, lower malapposition rates and, consequently, better clinical outcomes, especially in complex PCI. [55][56][57][58][59] In particular, OCT is considered an established tool for the diagnosis and treatment of coronary lesions and its usefulness in improving clinical outcomes of patients undergoing PCI has been demonstrated. 60 OCT enables better visualization of the struts and the vessel wall, with a 10-fold higher axial resolution (14 μm) than intravascular ultrasound.…”

Section: Disclosuresmentioning

confidence: 99%

ST-Segment Elevation Myocardial Infarction

Scalone

Brugaletta

Gómez-Monterrosas

et al. 2015

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp BVS as compared with metallic platform DES may include: decrease in late adverse events through complete biodegradation of stent struts preventing the risk of thrombus formation at the site of impaired endothelialization; normalization of vasomotion and compensatory remodeling during follow-up, thus suggesting restoration of normal vessel physiology after complete biodegradation of the stent struts; no interference with diagnostic or therapeutic measures (eg, coronary artery bypass graft) in case of disease progression; improved vascular healing; and discontinuation of long-term antiplatelet therapy in patients with single-vessel coronary artery disease. In particular, some crucial points in STEMI patients have to be emphasized. First of all, culprit lesions are frequently localized in the proximal segments of the coronary artery tree; restoration of physiological vasomotion may therefore have a greater effect in patients with STEMI as compared with patients with stable coronary artery disease. Secondly, vulnerable plaque of STEMI lesions, often characterized by necrotic core, interferes with vascular healing after metallic stent implantation, thus leading to coronary evagination or late acquired malapposition, both of which have been correlated with adverse ischemic outcomes. 14 Recent study suggests that BVS may eventually decrease the incidence of angina during follow-up, by reducing fixed and dynamic restenoses and by improving vasomotor responses. 15 Finally, the potential advantages of implanting BVS (vs. other DES) in STEMI may be mostly related to the young age of these patients. Indeed, they usually have less extensive coronary artery disease (compared with non-STrimary percutaneous coronary intervention (PCI) currently represents the first choice of treatment in experienced centers for patients presenting with ST-segment elevation myocardial infarction (STEMI) with limited time delay. 1 In this context, first-generation drug-eluting stents (DES) have reduced the need for repeat revascularization compared with bare metal stents (BMS). 2-4 However, the 1st-generation DES have been associated with late complications, such as neo-atherosclerosis, late restenosis, and stent thrombosis. 5 In particular, in the acute thrombotic setting, the antiproliferative drug elution used in DES has been shown to interfere with vascular healing processes, creating the background for delayed strut coverage, and persistent or acquired malapposition. 6,7 Possible explanations for this phenomenon are thrombus sequestration behind the struts, which subsequently resolves with acquired malapposition, and vasoconstriction during the acute phase. 8 The newer-generation DES with improved biocompatibility of polymers have also shown a lower rate of clinical events in acute patients as compared with either 1st-generation DES or BMS. 9-12 The clinical introduction of bioresorbable scaffolds resulted in a revolutionary change among local c...

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Impact of Intravascular Ultrasound Imaging on Early and Late Clinical Outcomes Following Percutaneous Coronary Intervention With Drug-Eluting Stents

Abstract: IVUS-guided stent implantation appears to be associated with a reduction in both early and long-term clinical events. Further investigation in randomized controlled trials is warranted.

Cited by 107 publications

References 14 publications

Stent Area by Intravascular Ultrasound and Outcomes in Left Main Intervention With Drug-Eluting Stents

Stent Area by Intravascular Ultrasound and Outcomes in Left Main Intervention With Drug-Eluting Stents

Relationship Between Intravascular Ultrasound Guidance and Clinical Outcomes After Drug-Eluting Stents

ST-Segment Elevation Myocardial Infarction

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