Use of intravascular ultrasound for optimal vessel sizing in chronic total occlusion percutaneous coronary intervention

Abstract

AimThe aim of this study is to provide evidence on how use of standardized intravascular ultrasound (IVUS) use impacts stent size choice in the setting of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) compared to visual estimation.Methods and resultsData of 82 consecutive patients who had successfully undergone IVUS-guided revascularization of CTO at the University Medical Center Mainz were analyzed. Angiography-based stent size prediction for the proximal and distal vessels was compared to the implanted stent diameter after IVUS assessment. Angiography-based stent size prediction for the proximal vessel was 3.09 ± 0.41, whereas IVUS use demonstrated larger vessel diameter, resulting in larger implanted stent diameter (3.24 ± 0.45, p < 0.001). Proximal vessel stent size prediction was underestimated in the majority of patients by angiographic estimation. Angiography-based stent size prediction for the distal vessel was 2.79 ± 0.38, whereas IVUS use demonstrated larger vessel diameter, resulting in larger implanted stent diameter (2.92 ± 0.39, p < 0.001).ConclusionPre-stent IVUS assessment in CTO PCI provides important information on vessel morphology and size. Angiography-based stent size prediction for the proximal and distal vessels was frequently underestimated, IVUS use demonstrated larger vessel diameter, resulting in significantly larger implanted stent diameter.

Clinical and Procedural Outcomes of IVUS-Guided vs. Angiography-Guided CTO-PCI: A Systematic Review and Meta-Analysis

“…In addition, the additional information provided by IVUS might have been reflected into a more personalized technique, although this is technically more difficult to capture in traditional clinical studies. Our findings are consistent with recently published studies, showing that IVUS allows for better visualization of vessel size and morphology before stent placement [28]. IVUS guidance is characterized by a significantly higher procedure and fluoroscopy time.…”

The clinical and angiographic impact of intravascular ultrasound guided stenting of unprotected left main and proximal left anterior descending coronary artery. A prospective randomized controlled study in Egypt

“…Angiography-based stent size prediction for the proximal and distal vessels was frequently underestimated, IVUS use demonstrated larger vessel diameter, resulting in a signifi cantly larger implanted stent diameter. 41 Since our study was limited by a small population we recommended many multi-center studies with a larger sample size and a longer period of follow up to investigate the benefi t of IVUS guided PCI.…”