Clinical Evidence of Intravascular Ultrasound-Guided Percutaneous Coronary Intervention
Intravascular ultrasound (IVUS) provides anatomic information regarding the coronary artery lumen, wall, and plaques, which can help the accurate evaluation of lesion characteristics with vessel sizing. In addition, after stent implantation, underexpansio
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Clinical Evidence of Intravascular Ultrasound-Guided Percutaneous Coronary Intervention Sung-Jin Hong, Yangsoo Jang, and Byeong-Keuk Kim
Intravascular ultrasound (IVUS) provides anatomic information regarding the coronary artery lumen, wall, and plaques, which can help the accurate evaluation of lesion characteristics with vessel sizing. In addition, after stent implantation, underexpansion, malapposition, or edge dissections can be detected by IVUS. Thus, through further intervention based on these IVUS findings, stent optimization can be achieved, causing the improved clinical outcomes. Current guidelines recommend the use of IVUS to optimize stent implantation for select patients (Class of recommendation IIa, Level of evidence B) [1, 2]. However, recently, many evidences demonstrating the clinical usefulness of IVUS have been accumulated since the prior guidelines were released. In this chapter, clinical evidences of IVUS-guided percutaneous coronary intervention (PCI) will be discussed from observational studies, randomized studies, and meta-analysis.
S.-J. Hong • Y. Jang • B.-K. Kim (*) Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea e-mail: [email protected]
© Springer Nature Singapore Pte Ltd. 2018 M.-K. Hong (ed.), Coronary Imaging and Physiology, https://doi.org/10.1007/978-981-10-2787-1_5
5.1
linical Studies Evaluating C Clinical Usefulness of IVUS- Guidance PCI
Several randomized clinical trials were performed to demonstrate clinical usefulness of IVUS-guidance during PCI. Recently conducted randomized controlled trials comparing IVUS-guidance vs. angiography-guidance particularly using the drug-eluting stent (DES) are summarized in Table 5.1 [3–10]. The first two trials by Jakabacin et al. and Cheiffo et al. failed to prove the clinical benefit of IVUS-guidance because of relatively small number of patients, less than 150 patients in each group were included in their studies [3, 4]. Kim et al. reported that IVUS usage for diffuse long lesions was associated with improved clinical outcomes particularly when used by operators’ decision. In the per-protocol analysis, IVUSguidance group significantly had lower 1-year major adverse cardiovascular event (MACE) (4.0% vs. 8.1%, p = 0.048), although the strategy of routine IVUS for DES implantation did not improve the MACE rates in the intentionto-treat analysis [5]. Recent randomized trials which showed statistically significant clinical benefit were performed mainly for complex lesions, such as left main lesions [7], chronic
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Table 5.1 Recent randomized studies comparing clinical usefulness between IVUS-guided and angiographyguided PCI Study Jakabacin et al. [3]
Chieffo et al. [4] Kim et al. [5]
N (IVUS vs. Enrolled Year angiography) patients 2010 105 vs. 105 Complex cases and high clinical risk profile 2013 142 vs. 142 Complex lesions 2013 269 vs. 274
MOZART 2014 41 vs. 42 [6]
Tan et al. [7]
2015 62 vs. 61
CTOIVUS [8]
2015 201 vs. 201
Tian et al.
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