Short-and long-term clinical impact of intravascular ultrasound-guided endovascular treatment for patients with peripheral artery disease

Abstract

Abstract Background Intravascular ultrasound (IVUS) has become a standard procedure in coronary intervention, but it is unclear whether IVUS usage improves procedural success rate or prognosis in patients with peripheral endovascular therapy (EVT). Methods This study analyzed more than 2,000 consecutive patients from the TOkyo-taMA peripheral vascular intervention research COmraDE (TOMA-CODE) registry that prospectively enrolled consecutive patients with peripheral arterial disease (PAD) in 34 hospitals in Japan from August 2014 to August 2016. The primary outcome is adverse cardiac and cerebrovascular events (MACCE) and limb events including clinical target lesion revascularization (cTLR) and amputation in the median follow-up period of 10.4 month after the first EVT. The secondary outcomes are procedural success rate and major adverse limb events (MALE) in hospital setting. Every analysis was also conducted with adjusted model after propensity score matching. Results In enrolled 2,227 eligible cases, we compared the MACCE and limb events between 784 cases with IVUS usage and 1443 patients without IVUS usage during EVT procedure. There was no significant difference of MACCE and limb events between with and without IVUS usage during EVT procedure over 2 years. However, EVT procedure with IVUS usage contributed significantly higher procedural success rate than that without IVUS usage (98.5% vs 96.7%, p=0.02). Moreover, EVT procedure with IVUS usage contributed less MALE (1.6% vs 4.1%, p=0.02) in hospital setting than that without IVUS usage after propensity score matching. Especially, unscheduled revascularization rate in hospital was less in EVT procedure with IVUS usage than that without IVUS usage (1.5% vs 3.7%, p=0.01). Conclusion IVUS usage for EVT did not improve MACCE or limb events over 2-years. However, IVUS usage improved procedural success rate and contributed less MALE when limited to the period of hospitalization. IVUS usage could be recommended for EVT procedures.Table