Clinical Outcome of Intravascular Ultrasound Guided Percutaneous Coronary Intervention of Isolated Ostial Left Anterior Descending Artery Lesions

Abstract

Purpose: Despite recent advances in interventional cardiology procedures, isolated ostial left anterior descending (LAD) lesions remain a challenge in cardiology. Due to the probability of left main (LM) affection, an LM bifurcation stenting technique may be required in certain individuals. So we evaluated result of Intravascular Ultrasound (IVUS) guided percutaneous coronary intervention (PCI) in isolated LAD coronary artery lesions, either by crossing over the ostium or not, with a focus on major adverse cardiovascular events (MACE).
 Methodology: Our prospective study from January2021 to November 2022 included 79 isolated ostial LAD patients with Ostial LAD stenting (OS) or LM to LAD cross-over (CO) stenting at the National Heart Institute. As per the recommended guidelines, the participants were divided into two groups: the first one had IVUS guided PCI and Group (2) had Angiography guided PCI. The data was collected and statistically analyzed with SPSS 23.0 program.
 Findings: No statistically significant difference was present between the groups regarding socio-demographic or clinical data (P-value > 0.05). It was discovered that an increase in Rotablator use, a decrease in Fluoroscopy time (min), a decrease in Contrast volume (ml), and a decrease in PCI duration (min) in patients who had IVUS guided PCI, with statistically significant difference when compared to other group who had Angiography guided PCI (P-value < 0.05). In addition, it was discovered that an increase in the necessity for a cross-over stenting method in group (1), with no statistically significant difference (P-value > 0.05). High prevalence of mortality and morbidity among IVUS guided PCI patients was present with statistical significance regarding TVR (P-value < 0.05).
 Recommendations: IVUS can offer valuable information on vascular lumen, plaque features, stent deployment, & device failure causes. As a result, IVUS-guided PCI may enhance clinical impact among participants, particularly those with complicated coronary lesions & those at high risk. Further reduction in IVUS’s cost, cardiologists’ education and enhancing IVUS use at PCI should be adapted next.