Intravascular ultrasound and stent implantation: Intraobserver and interobserver variability

Blessing, Erwin; Hausmann, Dirk; Stürm, Matthias; Wolpers, H. G.; Amende, Ivo; Mügge, Andreas

doi:10.1053/hj.1999.v137.93032

Cited by 28 publications

(13 citation statements)

References 19 publications

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“…A p value < 0.05 was considered statistically significant. Intra- and interobserver variability were reported previously from our laboratory [9]. Correlation coefficient for intra- and interobserver measurements were 0.96 and 0.93 for proximal and 0.94 and 0.92 for distal reference segments.…”

Section: Methodsmentioning

confidence: 65%

Incomplete Expansion of Palmaz-Schatz Stents despite High-Pressure Implantation Technique: Impact on Target Lesion Revascularization

Blessing

Hausmann²,

Stürm³

et al. 1999

Cardiology

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Improved expansion of stents using high-pressure implantation technique with subsequent antiplatelet therapy has improved patient outcome regarding the incidence of subacute stent thrombosis, bleeding complications and restenosis. Whether high-pressure implantation per se guarantees adequate stent expansion remains unclear. The aim of the study was to determine (1) stent expansion after high-pressure implantation technique and (2) whether stent expansion influences rate of target lesion revascularization within 6 months of follow-up. One hundred Palmaz-Schatz stents were implanted in 98 lesions (91 native vessels, 7 graft vessels) of 94 patients using high-pressure implantation technique (balloon pressure 12–20 atm). Stent expansion was investigated using intravascular ultrasound imaging (IVUS). Clinical follow-up of the patients was performed for 6 months. After implantation, stent/mean reference ratio was 0.81 ± 0.16. Noncompliant balloons used for implantation were chosen by angiographic criteria. Mean balloon/reference ratio was 1.08 ± 0.22; therefore balloons were not undersized. Additional balloon dilataion using higher pressures and/or larger balloons based on IVUS criteria and subsequent IVUS measurements was performed in 52 patients (55%); in these patients, stent expansion improved from 79 ± 16 to 91 ± 15% (mean ± SD) of average reference areas (p < 0.002). Within the 6 months’ clinical follow-up, target lesion revascularization was performed in 19 patients (20%). The only prognostic factors for the development of in-stent restenosis requiring target lesion revascularization were the vessel size (p < 0.05) and the extent of plaque distal to the stents (p < 0.05). Implantation of Palmaz-Schatz stents using high-pressure technique does not guarantee adequate stent expansion. Additional dilatation with higher pressures and/or larger balloons improves stent expansion. The size of the stented vessel and the extent of plaque at the distal stent end (residual outflow stenosis) but not the degree of stent expansion were predictors for target lesion revascularization within 6 months’ follow-up.

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Section: Methodsmentioning

confidence: 65%

Incomplete Expansion of Palmaz-Schatz Stents despite High-Pressure Implantation Technique: Impact on Target Lesion Revascularization

Blessing

Hausmann²,

Stürm³

et al. 1999

Cardiology

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“…Due to differences in reflected signals from different tissues, conventional gray-scale IVUS can distinguish normal vessel lumen and vessel wall from atherosclerotic plaque, intraluminal thrombus, and intimal dissection with high sensitivity. 1 Within the atherosclerotic plaque, it can further identify the deposition of lipid (hypoechoic signal) and calcium (hyperechoic signal with distal shadowing). The probe is mounted near the tip of a monorail catheter that tracks over a 0.014-in guidewire (Fig.…”

Section: The Ivus Modality For Neurointerventions: Equipment Techniqmentioning

confidence: 99%

Utility of intravascular ultrasound in intracranial and extracranial neurointerventions: experience at University at Buffalo Neurosurgery–Millard Fillmore Gates Circle Hospital

Kan¹,

Mokin

Abla³

et al. 2012

FOC

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Intravascular ultrasound (IVUS) generates high-resolution cross-sectional images and sagittal reconstructions of the vessel wall and lumen. As a result, this imaging modality can provide accurate measurements of the degree of vessel stenosis, allow the detection of intraluminal thrombus, and analyze the plaque composition. The IVUS modality is widely used in interventional cardiology, and its use in neurointerventions has gradually increased. With case examples, the authors illustrate the utility of IVUS as an adjunct to conventional angiography for a wide range of intracranial and extracranial neurointerventions.

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“…IVUS measurements have been shown to correlate well with phantom image measurements [19][20][21]. Correlation studies must, however, be supplemented by Bland-Altman analysis, as the clinical relevance of a correlation coefficient is hard to determine and systematic errors are not picked up [22].…”

Section: Ivus Measurement Reproducibilitymentioning

confidence: 99%

Intravascular Ultrasound: Technique, Measurements and Angioplasty Guidance

Gaster¹,

Thayssen²

2002

Heart Drug

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Coronary angiography has been the gold standard for decades for the evaluation of coronary artery disease. Although it offers the best overview of coronary artery anatomy, it has been known to underestimate the amount and severity of coronary artery lesions. This is probably due to the method being based on luminography, with the evaluation of the seat of coronary artery disease, the vessel wall, based on deduction. Intravascular ultrasound (IVUS) provides the investigator with the possibility of direct inspection of the vessel lumen as well as the vessel wall independently of vessel tortuosity, vessel overlap and ostial position. Thus, equivocal angiographically imaged vessels can be investigated by supplementing coronary angiography with IVUS. By guiding percutaneous coronary intervention with IVUS and angiography, a lower target vessel revascularisation rate can be expected, presumably due to the more physiologically correct device sizing possible. It seems that although IVUS guidance represents an incremental cost, long-term costs are reduced due to the lower revascularisation rates. Which lesions to guide by IVUS and angiography and which can be guided by angiography alone has still not been clarified in randomised trials.

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Intravascular ultrasound and stent implantation: Intraobserver and interobserver variability

Cited by 28 publications

References 19 publications

Incomplete Expansion of Palmaz-Schatz Stents despite High-Pressure Implantation Technique: Impact on Target Lesion Revascularization

Incomplete Expansion of Palmaz-Schatz Stents despite High-Pressure Implantation Technique: Impact on Target Lesion Revascularization

Utility of intravascular ultrasound in intracranial and extracranial neurointerventions: experience at University at Buffalo Neurosurgery–Millard Fillmore Gates Circle Hospital

Intravascular Ultrasound: Technique, Measurements and Angioplasty Guidance

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