946-104 The Evolving Utility of Intracoronary Ultrasound

Abstract

Although the use of intracoronary ultrasound (ICUS) imaging before and/or after the specific intervention has been reported by many investigators, its utility for altering interventional decision making has not been fully assessed. Eighty four successive cases of ICUS were divided into 2 time periods and studied as to how frequently the ICUS affected the coronary interventional strategy. A 3.5 F, 30 MHz (Boston Scientific) catheter with a HP Intravascular Imaging System was used. An ICUS image that led to a decision not provided by angiographic finding was considered as having changed interventional strategy. Frequency of interventional decision making based on ICUS significantly increased from 48.5% in early series (2/93–10/93) to 84.3% in recent series (11/93–8/94) (p = 00006). ICUS imagings were considered significantly more useful for decision making in stent cases (85.7%) and in directional coronary atherectomy (DCA) or excimer laser coronary angioplasty (ELCA) cases (81.3%) than in PTCA cases (51.5%) (p = 0.0023). Between the 2 periods, there were changes in the indications for ICUS. Post-stenting imaging significantly increased from 15.2% (5/33) to 41.2% (21/51) (p = 0.0154), and post-PTCA imaging significantly decreased from 60.6% (20/33) to 27.5% (14/51) (p = 0.0033). Peri-ELCA or peri-DCA imaging increased from 12.1% (4/33) to 32.4% (16/511 and the imaging of angiographically ambiguous lesions including ostial segments increased from 24.2% (8/33) to 41.1% (22/51) (p = 0.0011). The frequency of decision making based on ICUS findings has increased dramatically in association with a pre-selection of patients having stents, DCA or ELCA, and angiographically ambiguous lesions, indicating that ICUS imaging has changed from being predominantly an investigative tool to a method for supporting clinical decision making.