The potential clinical utility of intravascular ultrasound guidance in patients undergoing percutaneous coronary intervention with drug-eluting stents

Roy, Probal; Steinberg, Daniel; Sushinsky, Steven; Okabe, Teruo; Slottow, Tina L. Pinto; Kaneshige, Kimberly; Zhang, Xue; Satler, Lowell F.; Kent, Kenneth M.; Suddath, William O.; Pichard, Augusto D.; Weissman, Neil J.; Lindsay, Joseph; Waksman, Ron

doi:10.1093/eurheartj/ehn249

Cited by 258 publications

(104 citation statements)

References 22 publications

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“…2,6,7 Previous studies with bare metal stent and DES have shown that IVUS guidance during percutaneous coronary intervention (PCI) improved clinical outcomes. 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.…”

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confidence: 99%

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

Kim

Hong

et al. 2011

American Heart Journal

101

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confidence: 99%

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

Kim

Hong

et al. 2011

American Heart Journal

101

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“…However, they could not explain the precise mechanism of the late mortality benefit of using IVUS-guided PCI. Roy, et al 23) proposed that using IVUS guidance may improve the long-term survival rate by reducing the risk of stent thrombosis in DES treatment. Park,et al 18) mentioned that the superior benefit of IVUS guidance in DES treatment was not consistently observed in the other Cox model using PS as a covariate for all patients.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies 6,18,23,[26][27][28] did not have a primary focus on the clinical outcomes of non-complex LMCA disease treated with a single stenting technique. Only Agostoni, et al 22) reported that when ostial or mid-LMCA disease is treated with DES, the rate of cardiac events is particularly low.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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SummaryThere is limited long-term comparative clinical outcome data concerning angiography-versus intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) in non-complex left main coronary artery (LMCA) disease treated with the single stenting technique in the drug-eluting stent (DES) era.The aim of this study was to investigate whether angiography-guided stenting is comparable to IVUSguided stenting during 3-year clinical follow-up periods in patients with non-complex LM disease treated with the single stenting technique.A total of 196 patients treated with either angiography-guided (n = 74) or IVUS-guided (n = 122) PCI were included. The primary outcome was the occurrence of major adverse cardiac events (MACE) defined as total death, non-fatal myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), and non-target vessel revascularization (Non-TVR). To adjust for any potential confounders, propensity score (PS) adjusted analysis was performed.During 3-year follow-up, the PS adjusted Cox-proportional hazard ratio (HR) was not significantly different between the two groups for total death, cardiac death, and MI. Also, TLR and the combined rates of TVR and non-TVR were not significantly different. Finally, MACE was not significantly different between the two groups (HR: 0.63, 95% Confidence interval (CI): 0.33-1.17; P = 0.149).Angiography-guided PCI for non-complex LMCA diseases treated with the single stenting technique showed comparable results compared with IVUS-guided PCI in reducing clinical events during 3-year clinical follow-up in the DES era. Although IVUS guided PCI is the ideal strategy, angiography-guided PCI can be an option for LMCA PCI in some selected cases.(Int Heart J 2017; 58: 704-713) Key words: Left main coronary artery, Percutaneous coronary intervention, Intravascular ultrasound, Drug eluting stents U ntil recently, left main coronary artery (LMCA) disease was a hotly debated topic among interventional cardiologists as it is a challenging and risky lesion subset. According to recent guidelines, percutaneous coronary intervention (PCI) for an ostial or midshaft lesion of LMCA (non-true bifurcation) is defined as a Class IIa indication. 1) Even though LMCA disease treatment has been traditionally reserved for surgery, there have been numerous registries with drug-eluting stents (DES) that have shown favorable outcomes. 2,3) In this uniquely challenging aspect, the use of intravascular ultrasound (IVUS) may help to evaluate the target lesion and enable optimal stent deployment during PCI; and these optimized procedural results may translate into improved long-term clinical outcomes. A recent study 4) demonstrated that the survival rate and the rate of free of major adverse cardiac events (MACE) after 3 years were higher in the IVUS group, and the incidence of stent thrombosis was lower in the IVUS group. However, recent studies did not focus on the role of IVUS in non-complex LM disease treated with the single stenting tec...

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“…It has been reported that IVUS is a useful tool for determining optimal DES implantation. Roy et al 23 reprted that the clinical outcomes of 884 patients undergoing IVUS-guided intracoronary DES TAKAYAMA T et al…”

Section: Ivus-guided Des Implantationmentioning

confidence: 99%

Is Angioplasty Able to Become the Gold Standard of Treatment Beyond Bypass Surgery for Patients With Multivessel Coronary Artery Disease? - Therapeutic Strategies for 3-Vessel Coronary Artery Disease: OPCAB vs PCI (PCI-Side) -

Takayama

Hiro

Hirayama

2010

Circ J

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The optimal strategy of revascularization for multivessel disease has been controversial for a long time. In general, the initial trials 1-5 performed in the 1990s to compare PCI and CABG enrolled patients who had relatively low risk and relatively normal left ventricular function. Study participants primarily had 2-vessel disease that was deemed treatable by either method, and none had serious comorbid conditions. Those trials were performed before widespread use of coronary stents and glycoprotein IIb/IIIa inhibitor. The major findings of these trials are outlined in Table, and are all consistent and reveal no differences in overall survival or rate of Q-wave myocardial infarction (MI) in patients with multivessel disease who were randomly assigned to PCI or CABG. There was a lower rate of repeat revascularization in patients who underwent CABG than in those who had PCI.It appeared that patients with treated diabetes who underwent revascularization had lower mortality with CABG than with stenting, but this was dependent on using a left internal mammary artery graft to the left anterior descending artery. Coronary Stenting vs CABGCurrently, more than 80% of PCI procedures are performed using stents, and some clinical trials have clearly demonstrated the benefits of stents compared with plain ordinary balloon angioplasty (POBA) in regard to acute angiography results, need for emergency CABG, and restenosis rates. 1,6,7 Similarly, there has been concomitant growth in pharmacologic adjunctive therapy of dual antiplatelet therapy of aspirin and thienopyrides. In the Era of Bare Metal Stents (BMS)ARTS Trial The largest of these trials was the Arterial Revascularization Therapies Study (ARTS), 1 which included This article reviews the treatment of patients with multivessel coronary artery disease (CAD). Percutaneous coronary intervention (PCI) has been challenging coronary artery bypass grafting (CABG) as the gold standard of care for patients with multivessel disease; however, the application of PCI to these patients has been mainly limited by restenosis. Up to the beginning of the 2000s, many large-scale, randomized trials addressed this issue by comparing CABG to PCI with balloon angioplasty or bare metal stents in not only Western countries but also in Asian countries. These studies demonstrated similar rates of all-cause death and myocardial infarction in both groups, although the need for revascularization remained significantly lower in the CABG group. PCI with drugeluting stents (DES) is safe and may represent a viable alternative to CABG for selected patients with diabetes and multivessel CAD. Moreover, DES implantation under intravascular ultrasound guidance and with fractional flow reserve might have the potential to influence treatment strategy and reduce both DES thrombosis and repeat revascularization. The evolution of DES and advanced vascular imaging would mean that PCI continues to challenge CABG as treatment of choice for patients who need revascularization for a better prognosis. (Circ J 2010; 74:...

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The potential clinical utility of intravascular ultrasound guidance in patients undergoing percutaneous coronary intervention with drug-eluting stents

Abstract: IVUS guidance during DES implantation has the potential to influence treatment strategy and reduce both DES thrombosis and the need for repeat revascularization.

Cited by 258 publications

References 22 publications

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

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

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

Is Angioplasty Able to Become the Gold Standard of Treatment Beyond Bypass Surgery for Patients With Multivessel Coronary Artery Disease? - Therapeutic Strategies for 3-Vessel Coronary Artery Disease: OPCAB vs PCI (PCI-Side) -

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