Intravascular ultrasound scanning improves long-term patency of iliac lesions treated with balloon angioplasty and primary stenting

Buckley, Clifford J.; Arko, Frank R.; Lee, Shirley; Mettauer, Mark; Little, Danny C.; Atkins, Marvin D.; Manning, Larry G.; Patterson, Donald E.

doi:10.1067/mva.2002.119755

Cited by 75 publications

(48 citation statements)

References 27 publications

(42 reference statements)

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“…They concluded that IVUS helped define arterial diameter and adequacy of stent deployment leading to improved patency and negating secondary procedures. 20 Whether routine IVUS usage during endovascular therapy would lead to improvements in treatment of infrainguinal disease remains unknown. Clearly, more work in this arena is needed.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of peripheral atherosclerosis: A comparative analysis of angiography and intravascular ultrasound imaging

Arthurs

Bishop

Feiten

et al. 2010

Journal of Vascular Surgery

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Objective Angiography remains a critical component for diagnostic imaging and therapeutic intervention in peripheral arterial disease (PAD). The goal of this study was to compare angiography to corresponding intravascular ultrasound (IVUS) imaging of the same vessels in patients with PAD. Methods From 2004–2008, patients undergoing angiography for PAD (n=93) were recruited in a prospective observational analysis. At the time of angiography, diseased lower extremities were interrogated via a 10-cm IVUS pullback with registration points. IVUS data were analyzed with radiofrequency techniques for vessel and lumen diameter, plaque volume, plaque composition, and cross-sectional area (VH™, Volcano Corp). Similarly, vascular surgeons (n=3) blinded to the IVUS data graded corresponding angiographic images according to vessel diameter, degree of stenosis, degree of calcification, and extent of eccentricity. Statistical analyses of matched IVUS/angiograms were performed utilizing SPSS 16.0 (Chicago, IL). Results The distribution of demographic and risk variables were typical for PAD: 54% male, 96% hypertension, 78% hyperlipidemia, 44% diabetic, 87% tobacco history, 65% coronary artery disease, and 10% end-stage renal disease. Symptoms precipitating the angiographic evaluation included claudication (53%), rest pain (18%), and tissue loss (29%). Angiographic and IVUS interpretation were similar for luminal diameters, but external vessel diameter was greater via IVUS (7.0 ± 0.7 vs. 5.2 ± 0.8 mm, P < 0.05). There was a significant correlation for stenosis determination (r=0.84) utilizing the two-dimensional diameter method; however, IVUS determination of vessel area stenosis was greater by 10% (95% confidence interval = 0.3–21%, P<0.05). IVUS indicated that a higher proportion of plaques were concentric. Grading of calcification was moderate/severe in 40% by angiography, but only 7% by IVUS (P < 0.05). Conclusions In the evaluation of peripheral arterial disease, angiography and IVUS provide similar luminal diameters and diameter-reducing stenosis measurements. Determination of overall vessel diameter, and interpretation of plaque morphology by angiography are discordant from IVUS derived data.

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Section: Discussionmentioning

confidence: 99%

Evaluation of peripheral atherosclerosis: A comparative analysis of angiography and intravascular ultrasound imaging

Arthurs

Bishop

Feiten

et al. 2010

Journal of Vascular Surgery

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“…These stents allow for higher radial force in the presence of calcification, as well as more precise deployment both in terms of position and diameter. Intravascular ultrasound can be useful in the treatment of these lesions to help with stent sizing in the common and external iliac arteries as well as aorta, potentially leading to improved patency [39]. These stents are advanced to approximately 5 mm above the aortic bifurcation, protected within their respective sheath.…”

Section: Endovascular Approaches To Aortoiliac Occlusionmentioning

confidence: 99%

Strategies for managing aortoiliac occlusions: access, treatment and outcomes

Clair

Beach

2015

Expert Review of Cardiovascular Therapy

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Treatment of severe aortoiliac disease has dramatically evolved from a dependence on open aortobifemoral grafting to hybrid and endovascular only approaches. Open surgery has been the gold standard treatment of severe aortoiliac disease with excellent patency rates, but with increased length of stay and major complications. In contrast, endovascular interventions can successfully treat almost any lesion with decreased risk, compared to open surgery. Although primary patency rates remain inferior, secondary endovascular interventions are often minor procedures resulting in comparable long-term outcomes. The risks of renal insufficiency, embolization and access complications are not insignificant; however, most can be prevented or managed without significant clinical consequence. Endovascular therapies should be considered a first-line treatment option for all patients with aortoiliac disease, especially those with high-risk cardiovascular comorbidities.

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“…A previous study reported that IVUS during EVT procedure significantly improved the long-term patency for the iliac artery lesion by defining the appropriate stent deployment [30]. However, whether long-term primary patency can be improved by well deployed routine IVUS-guided self-expanding stents needs further investigation, but if so it may add further costs to the desire to diminish repeat revascularization.…”

Section: Discussionmentioning

confidence: 89%

Impact of intravascular ultrasound findings on long-term patency after self-expanding nitinol stent implantation in the iliac artery lesion

et al. 2015

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Although intravascular ultrasound (IVUS) predictors of stent patency for the coronary artery lesion have been established, little is known about IVUS predictors of stent patency for the aorto-iliac artery lesion. We analyzed 154 lesions of 122 patients who underwent stent implantation for iliac artery lesions. Quantitative and qualitative IVUS analyses were performed for pre- and post-procedural IVUS imaging in all lesions. Target lesion revascularization (TLR) was defined as clinically driven revascularization with >50 % angiographic stenosis of the target lesion. The mean follow-up period was 39 ± 16 months. TLRs were performed in 13 lesions (8.4 %). Post-procedural minimum stent area (MSA) was significantly smaller in the TLR group compared to the no-TLR group (16.0 ± 5.8 vs. 25.6 ± 8.5 mm(2), p < 0.001). Stent edge dissection was frequently observed in the TLR group compared to the no-TLR group (53.8 vs. 24.1 %, p = 0.04). Multivariate analysis revealed that post-procedural MSA (OR = 0.76, p < 0.01) and stent edge dissection (OR = 10.4, p < 0.01) were independent IVUS predictors of TLR. Receiver-operating characteristic analysis identified post-procedural MSA <17.8 mm(2) as the optimal cut-point for the prediction of TLR (AUC = 0.846). Post-procedural MSA and stent edge dissection could predict long-term stent patency in the iliac artery lesion. Our results propose that adequate stent enlargement without edge dissection might be important to reduce TLR in the iliac artery lesion.

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Intravascular ultrasound scanning improves long-term patency of iliac lesions treated with balloon angioplasty and primary stenting

Cited by 75 publications

References 27 publications

Evaluation of peripheral atherosclerosis: A comparative analysis of angiography and intravascular ultrasound imaging

Evaluation of peripheral atherosclerosis: A comparative analysis of angiography and intravascular ultrasound imaging

Strategies for managing aortoiliac occlusions: access, treatment and outcomes

Impact of intravascular ultrasound findings on long-term patency after self-expanding nitinol stent implantation in the iliac artery lesion

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