Randomized Comparison of Coronary Stent Implantation Under Ultrasound or Angiographic Guidance to Reduce Stent Restenosis (OPTICUS Study)

Abstract

for the OPTICUS (OPTimization with ICUS to reduce stent restenosis) Study InvestigatorsBackground-Observational studies in selected patients have shown remarkably low restenosis rates after ultrasoundguided stent implantation. However, it is unknown whether this implantation strategy improves long-term angiographic and clinical outcome in routine clinical practice. Methods and Results-A total of 550 patients with a symptomatic coronary lesion or silent ischemia were randomly assigned to either ultrasound-guided or angiography-guided implantation of Յ2 tubular stents. The primary end points were angiographic dichotomous restenosis rate, minimal lumen diameter, and percent diameter stenosis after 6 months as determined by quantitative coronary angiography. Secondary end points were the occurrence rates of major adverse cardiac events (death, myocardial infarction, coronary bypass surgery, and repeat percutaneous intervention) after 6 and 12 months of follow-up. At 6 months, repeat angiography revealed no significant differences between the groups with ultrasound-or angiography-guided stent implantation with respect to dichotomous restenosis rate (24.

Intravascular Ultrasound Guidance Improves Angiographic and Clinical Outcome of Stent Implantation for Long Coronary Artery Stenoses

“…Generally, greater acute gain produces more injury and more late loss. However, similar to other reports, 14 it did not result in increased late loss in the IVUS-guided group in the present study. Analogous to our findings regarding stent length and restenosis, we tend to ascribe this effect to optimization of the luminal geometry.…”

“…11 However, randomized studies investigating this strategy have yielded inconsistent results. [12][13][14][15][16][17] We hypothesized that the potential advantages of IVUS guidance would be most apparent in complex lesions, such as long stenoses. In this report, we compared the clinical and angiographic outcome after stenting of long coronary artery stenoses with randomization to angiographic or IVUS guidance of the intervention.…”

Impact of intravascular ultrasound guidance on long-term clinical outcomes in patients treated with drug-eluting stent for bifurcation lesions: Data from a Korean multicenter bifurcation registry

“…8,9 However, the impact of IVUS on clinical outcomes has been controversial according to different lesion subsets. [10][11][12] Long-term clinical benefits of IVUS guidance during PCI at bifurcation lesions are especially uncertain and need further investigation. Therefore, we evaluated the long-term clinical usefulness of IVUS during PCI with DES for coronary bifurcation lesions using data from a dedicated multicenter registry.…”

Three-Year Major Clinical Outcomes of Angiography-Guided Single Stenting Technique in Non-Complex Left Main Coronary Artery Diseases

“…The DIPO study 11) and the TULIP study 12) also suggested that IVUS-guided PCI could reduce restenosis and MACE. However, the OPTICUS study 13) did not show an effect of IVUS guidance on restenosis. The OPTICUS study investigators explained that the unexpectedly good acute results in the angiographic-guided group were due to the extensive experience with IVUS among the OPTICUS investigators, which might have affected the method used to implant the stents under angiographic guidance.…”