Intravascular ultrasound-guided drug-eluting stent implantation
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REVIEW ARTICLE
Intravascular ultrasound-guided drug-eluting stent implantation Tadayuki Kadohira1
•
Yoshio Kobayashi1
Received: 23 October 2016 / Accepted: 30 October 2016 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2016
Abstract Intravascular ultrasound (IVUS) is a reliable imaging tool to guide percutaneous coronary intervention. There has been increasing evidence supporting the clinical utility of IVUS-guided drug-eluting stent (DES) implantation, including randomized trials, observational studies, and meta-analyses of both. IVUS provides cross-sectional views of the coronary artery wall, and allows us to assess stenosis severity, identify plaque morphology, optimize stent implantation, and understand mechanism of stent failure. IVUS guidance can increase DES efficacy and decrease clinical events. In this review article, we summarize available evidence on IVUS-guided DES implantation. Keywords Intravascular ultrasound Percutaneous coronary intervention Drug-eluting stent Stent thrombosis Restenosis
Introduction Intravascular ultrasound (IVUS) has been used clinically for more than 20 years and established as a reliable imaging tool to guide percutaneous coronary intervention (PCI). In Japan, IVUS is utilized in over 80% of PCI procedures [1]. IVUS provides cross-sectional views of the coronary artery wall, and allows us to optimize stent implantation and understand mechanism of stent failure
& Tadayuki Kadohira [email protected] 1
Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba 260-8677, Japan
(thrombosis and restenosis) that can be missed using coronary angiography. In this review article, we summarize available evidence on IVUS-guided drug-eluting stent (DES) implantation. IVUS- versus angiography-guided DES implantation IVUS-guided DES implantation has been reported to influence treatment strategy and provide better clinical outcomes compared with angiography-guided DES implantation [2–7]. A recent meta-analysis, involving 7 randomized trials and 18 observational studies with 31,283 patients, found that IVUS guidance reduced major adverse cardiac events, death, myocardial infarction, stent thrombosis, and target lesion and vessel revascularization [2]. In ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) [3], the largest observational study of IVUS use to date, IVUS guidance was associated with reduced 1-year rates of stent thrombosis, myocardial infarction, and major adverse cardiac events, as well as target lesion and vessel revascularization. The benefits of IVUS guidance were evident in patients with acute coronary syndromes and complex lesions. Based on IVUS findings, the operators changed the PCI strategy in 74% of patients and used a larger stent/balloon, a longer stent, higher inflation pressures, additional post-dilatation, and additional stent placement. In meta-analyses of 7 randomized trials, including 3192 patients, a favorable result for IVUS
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