Intravascular ultrasound-guided unprotected left main coronary artery stenting in the elderly

Tan, Qiang; Wang, Qingsheng; Liu, Dongtian; Zhang, Shuangyue; Zhang, Yang; Li, Yang

doi:10.15537/smj.2015.5.11251

Cited by 92 publications

(73 citation statements)

References 13 publications

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“…A total of 7 trials (n=3192) were included in the meta-analysis. [14][15][16][26][27][28][29] The measures of the study quality are summarized in Table I 26 whereas one trial treated complex lesions. 28 The follow-up time ranged from 12 to 24 months.…”

Section: Included Studiesmentioning

confidence: 99%

“…Trials were listed in the forest plot for the individual outcome only if the outcome was reported by the trial. [14][15][16][26][27][28][29] The relative size of the data markers indicates the weight of the sample size from each study. In IVUS-XPL, myocardial infarction was defined as target lesion myocardial infarction.…”

Section: Elgendy Et Al Ivus-versus Angiography-guided Des Implantationmentioning

confidence: 99%

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Outcomes With Intravascular Ultrasound-Guided Stent Implantation

Elgendy

Mahmoud

Bavry

2016

Circ: Cardiovascular Interventions

163

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I ntravascular ultrasound (IVUS) is a useful tool for optimization of stent implantation by insuring good stent expansion and apposition. [1][2][3][4][5] Despite this benefit, routine IVUS is limited by cost considerations and additional time that is needed to perform the procedure. It is also unknown which coronary lesion characteristics are best served by IVUS. A meta-analysis of randomized trials in the era of bare-metal stents concluded that IVUS guidance was associated with a reduction in major adverse cardiac events (MACE) and repeat revascularization with a neutral effect on death and myocardial infarction (MI).6 Percutaneous coronary intervention (PCI) is currently performed with drug-eluting stents, which has significantly reduced the risk for restenosis, compared with bare-metal stents.7 A large-scale network meta-analysis demonstrated that all drug-eluting stents (and in particular second generation drug-eluting stents) reduce adverse events compared with bare-metal stents.8 Accordingly, in present day practice, there may be less need for a routine IVUS-guided PCI approach. Meta-analyses in the era of drug-eluting stents were influenced by including observational studies. [9][10][11][12][13] Furthermore, the results of additional multicenter randomized trials have become available.14-16 Therefore, we aimed to conduct an updated comprehensive meta-analysis of randomized trials to evaluate clinical outcomes associated with IVUSguided PCI compared with angiography-guided PCI in the era of drug-eluting stents.Background-In the era of drug-eluting stents, it is unknown if intravascular ultrasound (IVUS) guidance for percutaneous coronary intervention should be routinely endorsed. This study aimed to determine if IVUS-guided stent implantation is associated with improved outcomes. Methods and Results-Randomized trials that reported clinical outcomes and compared routine IVUS-guided stent implantation with an angiography-guided approach in the era of drug-eluting stents were included. Summary estimates were constructed primarily using the Peto model. Seven trials with 3192 patients were analyzed. The mean length of the coronary lesions was 32 mm. At a mean of 15 months, routine IVUS-guided percutaneous coronary intervention was associated with a reduction in the risk of major adverse cardiac events (6.5% versus 10.3%; odds ratio, 0.60; 95% confidence interval, 0.46-0.77; P<0.0001), mainly because of reduction in the risk of ischemia-driven target lesion revascularization (4.1% versus 6.6%; odds ratio, 0.60; 95% confidence interval, 0.43-0.84; P=0.003). The risk of cardiovascular mortality (0.5% versus 1.2%; odds ratio, 0.46; 95% confidence interval, 0.21-1.00; P=0.05), and stent thrombosis (0.6% versus 1.3%; odds ratio, 0.49; 95% confidence interval, 0.24-0.99; P=0.04) also appeared to be lower in the IVUS-guided group. Conclusions-In the era of drug-eluting stents for diffuse coronary lesions, IVUS-guided percutaneous coronary intervention is superior to angiography-guided percutaneous coronary intervention...

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Section: Included Studiesmentioning

confidence: 99%

Section: Elgendy Et Al Ivus-versus Angiography-guided Des Implantationmentioning

confidence: 99%

Outcomes With Intravascular Ultrasound-Guided Stent Implantation

Elgendy

Mahmoud

Bavry

2016

Circ: Cardiovascular Interventions

163

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“…None of the included studies had selective reporting or incomplete reporting. Three studies were of high methodological quality, seven of moderate quality, and the remaining two studies of low quality. Figures and present the summary of the quality assessment process.…”

Section: Resultsmentioning

confidence: 99%

“…During full‐text reading of the 37 included articles, 25 articles were then excluded. Finally, a total of 12 studies published between 2010 and 2017 were assessed for eligibility in the meta‐analysis (Figure ).…”

Section: Resultsmentioning

confidence: 99%

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Comparison of clinical outcomes between intravascular ultrasound‐guided and angiography‐guided drug‐eluting stent implantation: A meta‐analysis of randomised control trials and systematic review

Tan

Man

Liu

et al. 2019

International Wound Journal

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This systematic review was designed to evaluate the overall efficacy of angiography‐guided drug‐eluting stent (DES) implantation vs intravascular ultrasound‐guided (IVUS) implantation for percutaneous coronary intervention. The electronic databases CENTRAL, PubMed, Cochrane, and EMBASE were searched for systematic reviews to investigate angiography‐guided and IVUS‐guided DES implantation. We measured the following six parameters in each patient: cardiovascular death, stent thrombosis, target lesion revascularisation (TLR), myocardial infarction (MI), major adverse cardiac events (MACEs), and all‐cause death. Twelve studies involving 6268 subjects were included, with 2984 receiving IVUS‐guided DES implantation and 3284 using angiography‐guided DES implantation. With regard to MACEs, TLR, MI, cardiovascular death, and all‐cause death, the IVUS‐guided DES implantation group had remarkably improved clinical outcomes. However, there was no significant statistical difference in stent thrombosis between the two groups. Dramatic decrease in MACEs through IVUS guidance was presented by trial sequential analysis. Remarkably improved clinical outcomes, including MACEs, cardiovascular death, all‐cause death, and TLR, were identified through IVUS‐guided DES implantation in comparison with angiography‐guided DES implantation. Nonetheless, the effect on stent thrombosis and MI required further confirmation. In this meta‐analysis, eligible randomised clinical trials were warranted to verify the findings and to determine the beneficial effect of IVUS guidance for patients.

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Management of failed stenting of the unprotected left main coronary artery

Moroni

Marin

Venturi

et al. 2023

Cathet Cardio Intervent

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Percutaneous coronary intervention (PCI) is increasingly accepted as treatment for unprotected left main coronary artery (ULMCA) disease especially in those patients who are unsuitable for cardiac surgery. Treatment of any stent failure is associated with increased complexity and worse clinical outcomes when compared with de novo lesion revascularization. Intracoronary imaging has provided new insight into mechanisms of stent failure and treatment options have developed considerably over the last decade. There is paucity of evidence on the management strategy for stent failure in the specific setting of ULMCA. Treating any left main with PCI requires careful consideration and consequently treatment of failed stents in ULMCA is complex and provides unique challenges. Consequently, we provide an overview of ULMCA stent failure, proposing a tailored algorithm to guide best management and decision in daily clinical practice, with a special focus on intracoronary imaging characterization of causal mechanisms and specific technical and procedural considerations.

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Intravascular ultrasound-guided unprotected left main coronary artery stenting in the elderly

Cited by 92 publications

References 13 publications

Outcomes With Intravascular Ultrasound-Guided Stent Implantation

Outcomes With Intravascular Ultrasound-Guided Stent Implantation

Comparison of clinical outcomes between intravascular ultrasound‐guided and angiography‐guided drug‐eluting stent implantation: A meta‐analysis of randomised control trials and systematic review

Management of failed stenting of the unprotected left main coronary artery

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