Value of intravascular ultrasound guidance in the assessment of percutaneous intervention treatment for patients with left main coronary artery disease

Abstract

Objective To explore the value of application of intravascular ultrasound (IVUS) guidance and analyze the limitations of coronary angiography in the assessment and to provide valuable information for percutaneous coronary intervention (PCI) treatment of left main (LM) lesion. Methods The 60 patients with LM lesion were enrolled in this study.The patients were divided into two groups: ostium and trunk lesion of LM group and distal or bifurcation lesion of LM group, 30 cases in each group.Combined coronary angiography (CAG) and IVUS was used to assess the lesion, guide the PCI treatment and evaluate the immediate effect of PCI after stent implantation.Differences of two groups were compared. Results The mean reference diameter, the minimum lumen diameter and the minimum lumen area of LM lesion measured by coronary angiography were significantly smaller than that by IVUS (all P<0.05). In 8 cases (26.7%) of the ostium and trunk of LM lesion group, the measurement parameters of were significantly different between those CAG and IVUS results.CAG and IVUS guidance for distal left main bifurcation stent policy show larger differences, those who do not match were up to 30%.The proportion of post-dilation was significantly higher in IVUS guided group than in angiography guided group (P<0.05). Conclusions Compared with IVUS, CAG cannot accurately diagnose coronary artery disease with left main disease, treatment with PCI CAG guidance accuracy is also limited.We recommend the routine application of IVUS in the PCI treatment of LM lesion. Key words: Left main coronary artery; Angioplasty, transluminal, percutaneous coronary; Coronary artery angiography; Ultrasonography, interventional