Efficacy and safety of intravascular ultrasound-guided percutaneous coronary intervention

Abstract

Objective. Inclusion of intravascular ultrasound-guided (IVUS) guided percutaneous coronary intervention (PCI) has yet to achieve mainstream in invasive cardiology due to relative high cost of the procedure, ambiguous results in real world studies and steep learning curve. As a tool, IVUS has showed to be irreplaceable in examination of stent apposition, edge dissections and the plaque composition. Purpose of study was to examine efficacy and safety of IVUS-guided PCI vs. angiographically-guided PCI as a novel procedure. Methods. Total of 35 patients was examined by IVUS prior to stent placement and the acquired data was used to determine adequate stent size and length: percentage of stenosis, minimal luminal diameters (MLD), cross-sectional area (CSA) and distal referent diameter. Post PCI IVUS examination was repeated and CSA, residual stenosis and MLD were acquired. Also, stent size and length, deployment pressure and usage of additional post-dilatations were noted. Control group consisted of 35 match pairs with similar demographics, same vessel segment stented and same stent type used. Additional data was acquired from registry regarding acute complications and follow up at six months was also performed regarding target vessel revascularisation (TVR), major adverse cardiovascular events (MACE) and death. Results. Difference was observed in stent sizing, residual stenosis, post-dilatation and MLD in IVUS group. Also, TVR was 36% lower in IVUS group with no significant difference in MACE and death. Conclusion. Intravascular ultrasound-guided percutaneous coronary intervention in our center, upon introduction of the method, has shown reasonable safety and efficacy compared to conventional angiographically-guided percutaneous coronary intervention.