Routine intravascular ultrasound guidance of percutaneous coronary intervention

Orford, James L.; Lerman, Amir; Holmes, David R.

doi:10.1016/j.jacc.2003.12.035

Cited by 32 publications

(36 citation statements)

References 58 publications

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“…[8][9][10] However, in daily practice, this technique is not used routinely because it is expensive, time-consuming, and there is a learning curve (requiring trained operators and laboratory staff). 11) Moreover, it is difficult to obtain an accurate location of the stent before the stent is released. Stent boost subtract (SBS) is a recently developed imaging technique that enhances stent fluoroscopic visibility.…”

Section: P Ercutaneous Coronary Intervention (Pci) Of Coronary Os-mentioning

confidence: 99%

Stent Boost Subtract Imaging for the Assessment of Optimal Stent Deployment in Coronary Ostial Lesion Intervention

et al. 2015

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SummaryPercutaneous coronary intervention (PCI) of ostial lesions is complex and is technically very demanding. Intravascular ultrasound (IVUS) is considered the gold standard method to guide PCI but has several limitations. Stent boost subtract (SBS) imaging is an enhancement of the radiologic edge of the stent by digital management of regular X-ray images. The purpose of this study was to determine the availability of stent enhancement with SBS during ostial PCI by comparison with IVUS.We investigated SBS and IVUS after stent implantation in 58 ostial lesions in 55 patients. SBS and IVUS were performed in all patients to obtain improved stent location and to detect optimal release and deployment. We defined the SBS and IVUS criteria for accuracy of stent location and adequate stent deployment. IVUS findings showed that stent location was generally good. The location was accurate in 48 (82.8%) and inadequate stent deployment was observed in 10 of 58 (17.2%). Eight SBS images showed inadequate stent expansion. SBS predicted inadequate findings of IVUS with 100% specificity and 80% sensitivity, while a significant positive correlation was observed between SBS-MSA and MSA by IVUS with a regression coefficient of 0.95.Imaging techniques have a primary role during ostial PCI. SBS is a simple and quick method that offers several advantages, enabling improved stent location, adequate stent expansion, and optimal apposition of the struts to the wall. SBS imaging could be conventionally used during ostial PCI, especially in centers where IVUS is not used routinely. (Int Heart J 2015; 56: 37-42) Key words: Percutaneous coronary intervention, Apposition, Stent location, Stent expansion P ercutaneous coronary intervention (PCI) of coronary ostial lesions is technically difficult leading to higher rates of adverse cardiac events compared with PCI of non-ostial coronary lesions.1-4) The challenges of PCI of an ostial lesion may depend not only upon the lesion location (ie, aorto-ostial versus non-aorto-ostial), but also on the plaque burden and lesion morphology. Ostial lesions are less compliant compared with non-ostial lesions due to increased fibrosis, calcification, and muscular/elastic tissue, the latter of which is especially evident in aorto-ostial disease.5) Complete stent coverage of ostial lesions can be problematic, with inaccurate stent placement leading to higher rates of restenosis. 6) Compared with coronary angiography, intravascular ultrasound (IVUS) allows for a more detailed assessment of coronary anatomy, including plaque characteristics and morphology, vessel size, and precise localization of the true ostium.7) The only reliable way to exclude insufficient stent deployment with certainty is IVUS.8-10) However, in daily practice, this technique is not used routinely because it is expensive, time-consuming, and there is a learning curve (requiring trained operators and laboratory staff).11) Moreover, it is difficult to obtain an accurate location of the stent before the stent is released. Stent boost sub...

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Section: P Ercutaneous Coronary Intervention (Pci) Of Coronary Os-mentioning

confidence: 99%

Stent Boost Subtract Imaging for the Assessment of Optimal Stent Deployment in Coronary Ostial Lesion Intervention

et al. 2015

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“…Measures can include time savings or radiation exposure, success rate, or avoiding surgical alternatives. By comparison, the benefit of intravascular ultrasound during percutaneous coronary artery intervention has been inconsistent when tested in large clinical trials, even though it is widely considered a valuable or even essential element of coronary intervention by many operators [22]. In this small series, XFM improved subjective operator ease-of-use and confidence, although we provide no utility measures.…”

Section: How To Measure Benefit?mentioning

confidence: 85%

Technology preview: X‐ray fused with magnetic resonance during invasive cardiovascular procedures

Gutiérrez

Silva

Ozturk

et al. 2007

Cathet Cardio Intervent

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Background-We have developed and validated a system for real-time X-ray fused with magnetic resonance imaging, MRI (XFM), to guide catheter procedures with high spatial precision. Our implementation overlays roadmaps-MRI-derived soft-tissue features of interest-onto conventional X-ray fluoroscopy. We report our initial clinical experience applying XFM, using external fiducial markers, electrocardiogram (ECG)-gating, and automated real-time correction for gantry and table movement.

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“…Intravascular ultrasonography (IVUS) has advantages for the evaluation of coronary atherosclerotic burden and disease progression. [19][20][21][22][23] Third, our study was a retrospective and crosssectional study, and not a randomized and controlled prospective study. Finally, all patients with normal MDCT findings did not undergo CCA.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Patients With a Significant Stenosis in a Conventional Coronary Angiogram With a Normal Multi-Detector Computed Tomographic Coronary Angiogram

et al. 2009

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SummaryMulti-detector computed tomography (MDCT) has high diagnostic value for detecting or excluding coronary artery stenosis. However, conventional coronary angiograms (CCA) are occasionally required in patients having persistent chest pain with normal MDCT.We retrospectively analyzed 90 patients who underwent CCA due to persistent chest pain with normal MDCT. The patients were classified into patients having more than 50% diameter stenosis in CCA (false negative, group I: n = 14, 62.6 ± 7.5 years, 7 males) and those having less than 50% diameter stenosis (true negative, group II: n = 76, 52.1 ± 12.0 years, 42 males). Significant stenosis was observed in 9 patients at the left anterior descending artery, 4 at the right coronary artery, and 1 at the left circumflex artery in group I. Group I patients were older than group II patients (63 ± 8 versus 52 ± 12 years, P < 0.001). There were more patients with hypertension and smoking in group I (64.3% versus 7.9%, 35.7% versus 3.9%, P < 0.001, P < 0.001, respectively). The levels of uric acid and homocysteine were higher in group I than in group II (5.7 ± 1.5 versus 4.6 ± 1.2 mg/dL, 9.6 ± 3.1 versus 7.4 ± 2.5 mol/L, P = 0.008, P = 0.010, respectively). There were more ST or T changes in the electrocardiograms in group I (35.7% versus 1.3%) (P < 0.001). In multivariate analysis, a history of hypertension, uric acid levels, and ischemic evidence in the electrocardiogram were independent factors for a false negative of MDCT (odds ratio 11.11, 4.76, 1.81, 95% confidence interval 4.67 to 10.00, 1.41 to 1.61, 1.05 to 3.33, P = 0.009, P = 0.012, P = 0.046, respectively).In certain situations, the findings of coronary stenosis by MDCT do not always correlate with that of CCA. (Int Heart J 2009; 50: 13-22)

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Routine intravascular ultrasound guidance of percutaneous coronary intervention

Cited by 32 publications

References 58 publications

Stent Boost Subtract Imaging for the Assessment of Optimal Stent Deployment in Coronary Ostial Lesion Intervention

Stent Boost Subtract Imaging for the Assessment of Optimal Stent Deployment in Coronary Ostial Lesion Intervention

Technology preview: X‐ray fused with magnetic resonance during invasive cardiovascular procedures

Characteristics of Patients With a Significant Stenosis in a Conventional Coronary Angiogram With a Normal Multi-Detector Computed Tomographic Coronary Angiogram

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