Impact of various intravascular ultrasound criteria for stent optimization on the six‐month angiographic restenosis

Abstract

We evaluated the impact of different intravascular ultrasound (IVUS) criteria on 6-month angiographic restenosis in 511 patients with 560 lesions. Seven IVUS criteria were evaluated in this study; stent area at lesion segment 1) > or = 100% of distal reference lumen area, 2) > or = 90% of distal reference lumen area, 3) > or = 80% of average reference lumen area, 4) > or = 90% of average reference lumen area, 5) > or = 55% of average reference vessel area, 6) >/= 7 mm(2), and 7) > or = 2). Using the relative measurement (criteria 1-5), the angiographic restenosis rate was not statistically different. However, absolute measurement of stent area > or = 9 mm(2) (criteria 6 and 7) were associated with significantly lower restenosis rate (14.8% vs. 30.9%, P = 0.001, and 13.5% vs. 24.6%, P = 0.006, respectively). In conclusions, using the relative measurement of IVUS criteria, the occurrence of angiographic restenosis might not be predicted. The absolute measurement of IVUS stent area was the predictor of angiographic restenosis.

Impact of Optimal Stent Expansion on Late Outcomes after Sirolimus-Eluting Stent Implantation: An Intravascular Ultrasound Study

“…9) 13) An IVUS sub study, from a large cohort multi-center trial, demonstrated that an MSA of 6.5 mm 2 was the optimal threshold for minimizing target lesion revascularization. 13) A similar finding was also supported by one investigating group, 9) which suggesting that the absolute MSA (≥7.0 mm 2 ) was the optimal threshold for the reduction of the 6-month angiographic restenosis of the seven IVUS criteria examined. In the current study, the absolute MSA(MSA of ≥6.5 mm 2 ) most likely predicted both lower rates of angiographic restenosis and MACE with a BMS(11.4% vs. 33.3%, p=0.039 for and 5.7% vs. 30.0%, p=0.017, respectively).…”

“…5) IVUS observations have been the key to defining optimized stent deployment strategies, and have improved the outcomes and techniques of successful stenting. 6) Of these IVUS findings, the minimal stent area(MSA) has been reported as a consistent predictor of ISR and a poor clinical outcome following bare metal stent (BMS) implantation; [7][8][9] therefore, the "bigger is better" theory is likely to be a superior strategy during BMS implantation. In addition, many studies have suggested several IVUS criteria for optimal stent expansion(OSE) using absolute(which was directly measured from the MSA) or relative MSA(the ratio of MSA and reference lumen area) as a predictor of restenosis; the absolute MSA has been reported to be a more reliable predictor of a good outcome.…”

“…In addition, many studies have suggested several IVUS criteria for optimal stent expansion(OSE) using absolute(which was directly measured from the MSA) or relative MSA(the ratio of MSA and reference lumen area) as a predictor of restenosis; the absolute MSA has been reported to be a more reliable predictor of a good outcome. 9) Drug-eluting stents(DESs) have recently been introduced into practice, and appear to be a promising approach for the treatment of target lesions. 10)11) Because DES can dramatically reduce neointimal proliferation, OSE during DES implantation may have a less important role in determining an improved late outcome.…”

Optimization of Stent Deployment by Intravascular Ultrasound

“…2). IVUS predictors that are associated with increased adverse outcomes include smaller MSA, stent underexpansion, stent edge dissection, incomplete stent apposition, and incomplete lesion coverage [19-26]. In the BMS era, a major problem after stent implantation was stent restenosis, and the main mechanism of this phenomenon was a smaller MSA or stent underexpansion [21,26-30].…”

“…IVUS predictors that are associated with increased adverse outcomes include smaller MSA, stent underexpansion, stent edge dissection, incomplete stent apposition, and incomplete lesion coverage [19-26]. In the BMS era, a major problem after stent implantation was stent restenosis, and the main mechanism of this phenomenon was a smaller MSA or stent underexpansion [21,26-30]. Several studies in the BMS era showed a beneficial effect of IVUS guidance on post-procedural angiographic results and stent restenosis during long-term follow-up, resulting from a larger MSA with a higher post-dilation balloon pressure [7,19,27,31].…”