Use Of Intravascular Ultrasound Research Articles

National Trends, Mortality and Outcomes in Intravascular Imaging-Guided Versus Angiography-Guided Percutaneous Coronary Intervention in the United States.

Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have become increasingly utilized in patients undergoing percutaneous coronary intervention (PCI). Despite these purported advantages, prior reports regarding the use of IVUS and OCT have indicated that contemporary use of intravascular imaging remains low with significant regional variation. Here, we present the findings of an updated contemporary analysis regarding the use of IVUS/OCT guided PCI vs. angiography-guided PCI in the United States. We also evaluated in-hospital mortality and clinical outcomes between IVUS/OCT-guided PCI versus angiography-guided PCI-only over million patients in the United States. There has been a significant decrease in the number of PCIs performed, while there has been increasing in trend of IVUS/OCT-guided PCI over this period. Most importantly, we found that IVUS/OCT guided PCI were associated with better clinical outcomes in terms of in-hospital mortality, compare with angiography guided PCI.

Comparative Effectiveness of Intravascular Ultrasound versus Angiography in Abdominal and Thoracic Endovascular Aortic Repair: Systematic Review and Meta-Analysis

The effectiveness of intravascular ultrasound (IVUS) with angiography compared with angiography-guidance alone in the treatment of aortic conditions, such as dissections, aneurysms, and blunt traumatic injuries, remains unclear. This systematic review and meta-analysis evaluates the current literature for IVUS use during thoracic (TEVAR) and abdominal (EVAR) endovascular aortic repair. A comprehensive search of MEDLINE, EMBASE, and Cochrane CENTRAL databases was conducted in March 2024 adhering to the PRISMA guidelines. Studies comparing outcomes of TEVAR/EVAR with and without IVUS were identified. The outcomes of interest included contrast volume, fluoroscopy and procedural time, perioperative endoleak, and reinterventions and all-cause mortality during follow-up. Data with 95% confidence intervals (CIs) were extracted. Pooled analysis was performed using a random-effect model. Subgroup analysis was performed stratified by the condition being treated. Risk of bias was assessed using the Newcastle-Ottawa Scale for observational studies. A total of 4219 patients (n=2655 IVUS and n=1564 non-IVUS) from 9 observational studies were included. The IVUS group exhibited a reduction in contrast agent volume (weighted mean difference (WMD) [95% CI] = -34.65 mL [-54.73, -14.57]) and fluoroscopy time (WMD [95% CI] = -6.13 min [-11.10, -1.15]), with no difference in procedural time. The perioperative type I and III endoleak occurrence were similar (RR [95% CI] = 2.36 [0.55-10.11], RR [95% CI] = 0.72 [0.09-5.77], respectively). Reintervention and mortality during follow-up were comparable (HR [95% CI] = 0.80 [0.33-1.97], HR [95% CI] = 0.75 [0.47-1.18], respectively). All the included studies had low risks of bias. In conclusion, this meta-analysis provides evidence that IVUS enables the safe deployment of TEVAR/EVAR with reduced contrast agent less radiation exposure.

Repeat drug-coated balloon angioplasty for femoropopliteal lesions: 12-month results from a retrospective observational study

BackgroundThe clinical implications of restenosis after drug-coated balloon (DCB) treatment remain unclear. We compared the clinical outcomes between DCB angioplasty for restenosis and de novo femoropopliteal artery lesions. This single-center retrospective study included 571 patients (737 limbs) who underwent either repeat (54 patients, 64 limbs) or de novo DCB (517 patients, 673 limbs) without bailout stenting. After propensity score matching, 49 matched pairs were analyzed. The primary endpoint was the 1-year primary patency, with secondary endpoints including the freedom from target lesion revascularization (TLR), major adverse limb events (MALE), and early restenosis. Predictors of restenosis were identified using multivariable Cox regression analysis.ResultsThe repeat-DCB group displayed significantly lower rates of 1-year primary patency and freedom from TLR compared to those of the de novo-DCB group (50.1% vs. 77.4%, p = 0.029 and 54.9% vs. 83.6%, p = 0.0.44, respectively). No significant differences were observed in early restenosis or MALE (10.7% vs. 5.9%, p = 0.455 and 48.3% vs. 73.4%, p = 0.055, respectively). Restenosis after DCB angioplasty was associated with repeat DCB (hazard ratio [HR], 5.13; 95% confidence interval [CI], 1.43–18.4; p = 0.012) and small vessel size of < 4.5 mm (HR, 6.25; 95% CI, 1.17–33.4; p = 0.032). Furthermore, restenosis after repeat DCB angioplasty was associated with the Peripheral Artery Calcification Scoring System (PACSS) grade 4 (HR, 4.20; 95% CI, 1.08–16.3; p = 0.038), small vessel size of < 4.5 mm (HR, 9.44; 95% CI, 1.21–73.7; p = 0.032), and intravascular ultrasound (IVUS) use (HR, 0.05; 95% CI, 0.01–0.44; p = 0.007).ConclusionsThe 1-year primary patency rate following repeat DCB angioplasty for femoropopliteal lesions was notably lower than that of DCB treatment for de novo lesions. Repeat DCB strategy was associated with an increased risk of patency loss. Regarding repeat restenosis after DCB treatments, PACSS grade 4 calcification and small vessel diameter of < 4.5 mm were associated with an increased risk of restenosis, whereas IVUS use correlated with a decreased risk of restenosis.

Early results of transcatheter electrosurgical aortic septotomy for endovascular repair of chronic dissecting aortoiliac aneurysms

ObjectiveEndovascular repair of chronic dissecting aortoiliac aneurysms is challenging given the rigid septum, compressed true lumen (TL), and target vessels frequently originating in the false lumen. We have used transcatheter electrosurgical aortic septotomy (TEAS) before stent graft implantation under intravascular ultrasound (IVUS) and fusion guidance. The purpose of this study is to assess the outcomes of TEAS during complex endovascular repair of dissecting aneurysms. MethodsFrom 2021 to 2023, 17 patients underwent TEAS. The primary end point was technical success, with secondary end points of proximal and distal seals, target vessel instability, aortic and iliac TL and cross-sectional area (CSA) expansion, and aortic-related death. During the procedure, the aortic septum is crossed through a pre-existing entry or via electrocautery-activated 0.018-in. Astato XS20 wire (Asahi-Intecc) under IVUS and fusion guidance. The penetrated wire is then snared in the false lumen and pulled through the ipsilateral femoral access. A 1-cm length of the middle of the Astato wire coating is kinked in a three-sided polygonal configuration, denuded the inner surface of the wire using a no. 15 blade, and positioned at the apex of the septum. Both ends of the Astato wire are insulated with 0.018-in. microcatheters, and the back end of the wire is denuded and connected to cautery. Gentle traction is applied to the wire, and short bursts of electrocautery cutting are applied at 60 to 80 W. ResultsThe technical success of the septotomy was 100%. No incidence of visceral or lower extremity malperfusion, vascular injury, or distal embolization occurred. Of the 17 patients, 4 underwent thoracic endovascular aneurysm repair, 2 underwent endovascular aortic repair, and 11 underwent fenestrated/branched endovascular aneurysm repair after septotomy. All target vessels were successfully stented. A distal landing zone seal with exclusion of the false lumen was achieved in 16 of the 17 patients (94.1%). One patient required embolization of the false lumen of the celiac artery after septotomy. The TL mean diameter and CSA of the descending thoracic aorta after septotomy was expanded by 7.01 ± 1.9 mm (relative mean diameter expansion, 42.3%; P < .0001) and 2.71 ± 0.4 cm2 (relative mean CSA expansion, 57.3%, P<.0001). For patients who required septotomy through the common iliac arteries, the mean TL was expanded by 8.1 ± 3.7 mm (relative mean diameter expansion, 76%; P < .0001) and 1.76 ± 0.91 cm2 (relative mean CSA expansion, 209%; P < .0001). The 1-year freedom from target vessel instability was 91%. ConclusionsThe use of IVUS and fusion-guided TEAS offers a promising technique to facilitate TL expansion and false lumen exclusion in chronic dissecting aortic aneurysms before repair. The durability and long-term outcomes of this technique in a larger cohort remain to be elucidated.

Long-term impact of intravascular ultrasound-guidance for percutaneous coronary intervention on unprotected left main. The IMPACTUS-LM, an observational, multicentric study

IntroductionThe potential benefit on long term outcomes of Percutaneous Coronary Intervention (PCI) on Unprotected Left Main (ULM) driven by IntraVascular UltraSound (IVUS) remains to be defined. MethodsIMPACTUS LM-PCI is an observational, multicenter study that enrolled consecutive patients with ULM disease undergoing coronary angioplasty in 13 European high-volume centers from January 2002 to December 2015. Major Adverse Cardiovascular Events (MACEs) a composite of cardiovascular (CV) death, target vessel revascularization (TVR) and myocardial infarction (MI) were the primary endpoints, while its single components along with all cause death the secondary ones. Results627 patients with ULM disease were enrolled, 213 patients (34%) underwent IVUS-guided PCI while 414 (66%) angioguided PCI. Patients in the two cohorts had similar prevalence of risk factors except for active smoking and clinical presentation. During a median follow-up of 7.5 years, 47 (22%) patients in the IVUS group and 211 (51%) in the angio-guided group underwent the primary endpoint (HR 0.42; 95% CI [0.31–0.58] p < 0.001). After multivariate adjustment, IVUS was significantly associated with a reduced incidence of the primary endpoint (adj HR 0.39; 95% CI [0.23–0.64], p < 0.001), mainly driven by a reduction of TVR (ad HR 0.30, 95% CI [0.15–0.62], p = 0.001) and of all-cause death (adj HR 0.47, 95% CI [0.28–0.82], p = 0.008). IVUS use, age, diabetes, side branch stenosis, DES and creatinine at admission were independent predictors of MACE. ConclusionsIn patients undergoing ULM PCI, the use of IVUS was associated with a reduced risk at long-term follow-up of MACE, all-cause death and subsequent revascularization.

Effect of ticagrelor versus clopidogrel after implantation of drug-eluting stents guided by either intravascular ultrasound or angiography in patients with acute coronary syndrome-propensity score matching analysis.

The effect of different dual antiplatelet therapies on thrombotic events on the background of intravascular ultrasound (IVUS) guidance is unclear. We investigated whether ticagrelor can provide any additional benefit to clopidogrel in reducing thrombotic events in acute coronary syndrome (ACS) treated with drug- eluting stent (DES), when guided by IVUS or not. A total of 5,666 ACS patients who underwent DES implantation and who were discharged on dual antiplatelet therapy were enrolled and grouped according to the use of IVUS or not. Each group was subdivided into two subgroups according to the type of P2Y12 inhibitor used after discharge. Propensity score matching (PSM) was used between the IVUS and no-IVUS groups. Covariate adjustment of Cox proportional hazards model was used between the ticagrelor and clopidogrel groups. Thrombotic event at 12 months was compared in groups separately. After PSM, 12-month follow-up data were available for 1,174 patients. Major adverse cardiac events (MACE) were less frequent in the IVUS-guided group (2.2% vs. 4.3%, P = 0.081) with a trend toward statistical significance. Comparison of antiplatelet regimens revealed significantly fewer major adverse cardiac and cerebrovascular events (MACCE) with ticagrelor in the entire PSM cohort and angiography-guided subgroup (2.9% vs. 5.7%, P = 0.035; 3.1% vs. 6.4%, P = 0.020, respectively). Among patients in the IVUS-guided group the outcome was comparable (2.5% vs. 4.4%, P = 0.312). Ticagrelor was associated with increasing bleeding incidence in the entire PSM cohort (1.3% vs. 3.3%, P = 0.030), mainly due to Bleeding Academic Research Consortium type 2 bleeding (0.7% vs. 2.6%, P = 0.010). The results were consistent after covariate adjustment of Cox proportional hazards model. The comparison of ischemic benefit between ticagrelor and clopidogrel was similar in patients receiving IVUS guidance during stent implantation, probably due to the precise implantation of IVUS. Multicenter, randomized studies should be performed to validate this conclusion.

Association between aortic pathology, surgeon experience, and regional variability on use of intravascular ultrasonography during thoracic endovascular aortic repair

ObjectiveIntravascular ultrasound (IVUS) is a useful adjunct to obtain precise intraluminal measurements during thoracic endovascular aortic repair (TEVAR), but IVUS examination is not routinely used by all surgeons or centers during TEVAR. We sought to identify patient- and system-related factors that influence the decision to use IVUS examination during TEVAR. MethodsA retrospective review of the Vascular Quality Initiative (VQI) database was performed to identify all patients undergoing TEVAR from 2015 to 2019. Multivariable logistic regression modeling with three-fold repeated cross-validation was performed to identify predictors of IVUS use during TEVAR. Association of IVUS use with contrast volume and radiation exposure was also assessed. ResultsA total of 12,414 patients undergoing TEVAR met the inclusion criteria. Of these, IVUS examination was used in 41.3% of cases (n = 5121). IVUS use was more common in younger patients with fewer comorbidities; however, IVUS examination was also more commonly deployed in symptomatic patients and those with a higher preoperative American Society of Anesthesiology classification. IVUS examination was use in 80% (n = 3385/4213) TEVAR procedures performed for type B aortic dissection, which accounted for 50% of total IVUS use and only 11% of cases during which IVUS examination was not used (n = 822/7293) (P < .01). In multivariable analysis, the strongest independent predictor of IVUS use was aortic dissection (odds ratio, 13.7; 95% confidence interval, 11.7-16.3; P < .001, with aortic aneurysm as the reference). Surgeon years of independent practice experience was not associated with IVUS use, but when accounting for clustering on physicians and geographic regions, these variables explained 15% of the variance observed in the final risk-adjusted model. After adjustment for confounding factors, IVUS use was associated with a significant decrease in fluoroscopy time and contrast volume (both P < .001). ConclusionsThe decision to use IVUS examination during TEVAR is most heavily influenced by aortic pathology. Although surgeon experience was not associated with the decision to use IVUS examination, there was substantial variation in IVUS examination use among individual surgeons and VQI regions. IVUS use was associated with decreased contrast administration and fluoroscopy use but did not appear to have an impact on survival or re-intervention. Although aortic dissection was strongly associated with IVUS use, a significant number of TEVAR for dissection were performed without IVUS examination. Further research is warranted to identify the barriers to IVUS use as well as the risks and benefits of IVUS use during TEVAR so that quality benchmarks can be established and resource use is improved.

Routine functional testing in high-risk patients after imaging- or physiology-guided percutaneous coronary intervention

Abstract Background Imaging-guided or physiology-guided percutaneous coronary intervention (PCI) improved clinical outcomes in complex coronary artery disease. However, it is not known to what extent routine functional testing after imaging or physiology-guided PCI affect clinical outcomes among high-risk patients. Objectives To assess clinical impact of routine functional test or standard care alone after intravascular ultrasound (IVUS) or fractional flow reserve(FFR) guided PCI. Methods Of the 1706 randomized patients with high-risk anatomical or clinical features enrolled in the POST-PCI (Pragmatic Trial Comparing Symptom-Oriented versus Routine Stress Testing in High-Risk Patients Undergoing Percutaneous Coronary Intervention) trial, 1269 patients underwent IVUS-guided PCI and 609 patients underwent FFR-guided PCI. The primary outcome was a composite of death from any cause, myocardial infarction, or hospitalization for unstable angina at 2 years. Results The rate of the 2-year primary outcomes was similar between strategies of routine functional-testing or standard-care in IVUS use group (5.3% vs. 6.6%, respectively; HR, 0.79; 95% CI, 0.50–1.24; P=0.30) and in IVUS non-use group (5.7% vs. 3.8%, respectively; HR,1.52; 95% CI, 0.63–3.68; P=0.21); there was no significant interaction between IVUS use and follow up strategies (p for interaction=0.21). The rate of the 2-year outcomes was not significantly different with functional-testing or standard-care in FFR use group (2.6% vs. 3.9%, respectively; HR, 0.65; 95% CI, 0.26–1.58, P=0.34) and in FFR non-use group (7.0% vs. 7.1%, respectively; HR, 0.99; 95% CI, 0.63–1.55, P=0.97) without significant interaction (p for interaction=0.59). Conclusions In patients with high-risk PCI, IVUS and FFR use did not affect clinical outcome of routine surveillance stress testing and standard-care alone during follow-up.TableFigure

Trends and outcomes of intravascular imaging in patients undergoing percutaneous coronary intervention for coronary chronic total occlusion: a 5-year retrospective analysis

Abstract Background Elderly patients with coronary chronic total occlusions (CTO) represent a vulnerable population with comorbid conditions and complex coronary anatomy. Intracoronary imaging has become an important tool in the treatment of complex lesions with percutaneous coronary intervention (PCI). There is limited data on its impact in patients undergoing percutaneous coronary intervention (PCI) for coronary CTO. Purpose We aimed to identify the trends in utilization of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) in patients undergoing single vessel (SV) - CTO PCI and its impact on clinical outcomes. Methods We queried the Nationwide Inpatient Sample database to identify hospitalizations for SV PCI between 2016 – 2020. Patients with CTO were identified using the ICD-10 diagnosis code. The use of IVUS and OCT was identified using the ICD-10 codes. We compared utilization of IVUS-OCT for SV-CTO PCI to those without and studied the impact of their utilization on clinical outcomes. The primary outcome was major adverse cardiovascular and cerebrovascular events (MACCE). Secondary outcomes included in-hospital mortality, re-infarction, stroke and post-procedural AKI. Outcomes were compared using univariate and multivariate logistic regression analysis. Results A total of 135,745 weighted hospitalizations for SV CTO-PCI were identified of which 13,610 (10%) utilized IVUS/OCT (mean age 66+/-12, 26.5 % females). Hospitalizations were stratified by patient age into a younger cohort &amp;lt;75 years (mean age 61 ± 9 years) and an older cohort ≥75 years (mean age 81 + 4). Male sex, Caucasians, and admissions to a large urban hospital were associated with higher IVUS/OCT use in both cohorts (p &amp;lt; 0.001). The use of IVUS/OCT was associated with significantly lower MACCE (aOR 0.73, 95% CI 0.6 - 0.8, p &amp;lt; 0.001) and lower incidence of re-infarction in both cohorts (OR 0.6, 95% CI 0.5-0.6, p&amp;lt;0.001 for both cohorts). In-hospital mortality was significantly lower in both cohorts utilizing intravascular imaging (OR 0.8, 95% CI 0.7-1.0, p&amp;lt;0.05 for age ≥75 years and OR 0.6, 95% CI 0.5-0.7, p &amp;lt;0.001) for age &amp;lt; 75). Overall, the rates of stroke and length of stay (4 + 5 days) were comparable but associated with higher hospitalization costs (153k-170k vs 110k-120k, p &amp;lt; 0.001). In patients undergoing CTO-PCI, there was an increasing trend towards the utilization of IVUS and OCT over the study period. Conclusion The use of IVUS/OCT guidance for CTO-PCI was associated with a significant reduction in MACCE, re-infarction and in hospital mortality regardless of age. There was a significant increase in the utilization of IVUS and OCT for the study period in all groups.

Abstract 17475: Intravascular Ultrasound versus Angiography in Percutaneous Coronary Interventions: A Meta-Analysis Unveiling Compelling Evidence of Ultrasound's Superiority

Objective: This meta-analysis aims to compare the effectiveness of intravascular ultrasound (IVUS) versus angiography alone in percutaneous coronary intervention (PCI) procedures. Methods: A comprehensive literature search was conducted to identify relevant studies comparing IVUS-guided PCI with angiography-guided PCI. The primary outcome measure was major adverse cardiac events (MACE) including cardiac death, myocardial infarction, and target vessel revascularization. Secondary outcomes included all-cause mortality, stent thrombosis, and angiographic outcomes. Results: A total of 41 eligible studies involving 712635 patients were included in the meta-analysis. IVUS-guided PCI was associated with a significantly lower risk of MACE compared to angiography-guided PCI (pooled odds ratio [OR] 1.38, 95% confidence interval [CI] 1.24-1.53, p&lt;0.00001). The use of IVUS also resulted in a lower risk of all-cause mortality (pooled OR 1.61, 95% CI 1.41-1.83, p&lt;0.00001) and reduced rates of stent thrombosis (pooled OR 2.28, 95% CI 1.82-2.86, p&lt;0.00001) and TVR (pooled OR 1.31, 95% CI 1.21-1.42, p&lt;0.00001). Conclusion: This meta-analysis provides evidence supporting the use of IVUS-guided PCI over angiography-guided PCI. IVUS-guided procedures were associated with reduced MACE rates, improved procedural success, decreased stent thrombosis, and superior angiographic outcomes. The findings suggest that incorporating IVUS into PCI procedures may lead to improved clinical outcomes and more optimal stent deployment. However, further studies are warranted to explore potential subgroup differences and to evaluate the cost-effectiveness of IVUS-guided PCI.

Abstract 14832: Comparative Effectiveness of Intravascular Ultrasound versus Angiography in Abdominal and Thoracic Endovascular Aortic Repair: Systematic Review and Meta-Analysis

Introduction: The effectiveness of intravascular ultrasound (IVUS) with angiography compared with angiography guidance alone in the treatment of aortic conditions remains unclear. Objective: This systematic review and meta-analysis evaluates the evidence for IVUS use during thoracic (TEVAR) and abdominal (EVAR) endovascular aortic repair. Methods: A comprehensive search of MEDLINE, EMBASE, and Cochrane CENTRAL databases was conducted to identify studies comparing outcomes of patients undergoing TEVAR/EVAR with and without IVUS. The primary outcome was all-cause mortality during follow-up. Secondary outcomes included contrast volume, fluoroscopy time, perioperative mortality, and reinterventions during follow-up. Continuous variables, risk ratios (RRs), and hazard ratios (HRs) with 95% confidence intervals (CIs) were extracted from each study. Pooled analysis was performed using a random-effects model. Results: A total of 6,888 patients (n=4,226 IVUS and n=2,662 non-IVUS) from nine observational studies were included in the meta-analysis. The follow-up period ranged from 9 months to 25 months. The IVUS group exhibited a reduction in contrast agent volume (weighted mean difference (WMD) [95% CI] = -34.65 mL [-54.73, -14.57]) and fluoroscopy time (WMD [95% CI] = -6.13 min [-11.10, -1.15]) ( Figure 1A&amp;B ). Perioperative mortality was comparable between both groups (RR [95% CI] = 0.67 [0.40-1.12], respectively). Reintervention rates and all-cause mortality during the follow-up period were similar between the two groups (HR [95% CI] = 0.80 [0.33-1.97], HR [95% CI] = 0.75 [0.47-1.18], respectively) ( Figure 1C ). Conclusions: This systematic review and meta-analysis provides evidence that the use of IVUS enables safe and effective deployment of TEVAR and EVAR with reduced contrast agent usage and shorter fluoroscopy duration. These findings support the potential of IVUS as a valuable tool in endovascular aortic interventions.

Abstract 15540: Comparative Outcomes of Femoropopliteal Intravascular Ultrasound Interventions: A Report From the XLPAD Registry

Background: Intravascular ultrasound (IVUS) during peripheral artery intervention is being increasingly used, however there is limited real-world procedural and outcomes data. Methods: We examined 4847 patients from the XLPAD Registry (NCT01904851) from 2006-2021 that underwent femoropopliteal (FP) endovascular intervention. The primary outcome was the incidence of major adverse limb events (MALE), which includes death, clinically driven revascularization, amputation, myocardial infarction (MI), and stroke. Comparative analyses were done between patients with IVUS and no IVUS interventions. Results: 322 (6.6%) patients underwent an IVUS guided FP intervention and 4525 without. Mean age 67, predominantly men (83% IVUS-group vs. 71% non-IVUS, p&lt;0.0001) and Caucasian (71% vs. 69%, p=NS). IVUS patients had worse risk profiles, with more smokers (59% vs. 47 %, p&lt;0.0001), heart failure (20% vs. 14%, p=0.006) and prior-MI (31% vs. 22%, p&lt;0.0001), and similar proportion of hypertensives, diabetics, dyslipidemics, or those with chronic kidney disease. IVUS patients had more multivessel intervention (2.4 vs. 1.9 lesions, p&lt;0.0001), SFA being the most common artery, followed by the popliteal artery in both groups. Balloon angioplasty was more common in the non-IVUS group (68% vs. 75%, p=0.005), whereas drug coated balloons (19% vs. 12%, p=0.005), drug-eluting stents (15 vs. 9%, p=0.001) and vascular mimetic stents (13 vs. 4%, p&lt;0.0001) were more frequent in the IVUS patients. Fluoroscopy time was longer in IVUS patients (35 min vs 30 min., p=0.005) with similar rates of procedural (90% vs. 93, p=NS) and technical success (94% vs. 95%, p=NS). There were no differences in peri-procedural complications, or 12-month MALE (21% vs. 20%, p=NS). Only death from any cause was significantly higher in the non-IVUS group (0.7 vs 3.0%, p=0.017). Conclusion: IVUS use is under 7% of all FP interventions in the XLPAD registry with IVUS guidance is used in patients with more adverse clinical risk profile, however with no difference in technical, procedural success and 12-month MALE events.

Enhancing Coronary Intervention Outcomes Using Intravascular Ultrasound: Analysis of Long-Term Benefits in a Japanese Multicenter Registry

BackgroundAlthough the use of intravascular ultrasound (IVUS) during percutaneous coronary intervention (PCI) has been shown to improve clinical outcomes, its utilization remains inconsistent. We aimed to assess the association between IVUS-guided PCI and long-term outcomes in Japan, where a high proportion of patients undergo IVUS. MethodsWe analyzed 8721 consecutive patients in a multicenter PCI registry. The primary outcome was a composite of death, acute coronary syndrome, and heart failure requiring admission and coronary artery bypass grafting at 2 years after discharge. The secondary outcome was each component of the primary outcome. We used inverse probability-weighted analysis for adjustment. Subgroup analysis was conducted on patients with complex coronary anatomy (eg, those with bifurcation, chronic total occlusion, type C lesion, left main and those who underwent rotational atherectomy). ResultsOverall, 83.8% of patients underwent IVUS-guided PCI (mean age, 68.3 ± 11.3 years). After adjustments, the IVUS group had significantly lower rates of death and coronary bypass compared to no IVUS group (hazard ratio [HR], 0.73; 95% CI, 0.55-0.96; and HR, 0.62; 95% CI, 0.39-0.98) at 2-year follow-up, although the primary outcome showed only marginal differences (HR, 0.85; 95% CI, 0.71-1.01). In the subgroup analysis of complex coronary anatomy, the use of IVUS was significantly associated with a reduced risk of the primary outcome (HR, 0.72; 95% CI, 0.55-0.93) as well as death, coronary bypass, and heart failure. ConclusionsIVUS was frequently utilized in our registry and demonstrated potential benefit in reducing mortality and need for coronary bypass surgery, particularly in patients with complex coronary anatomy.

Outcomes With Intravascular Ultrasound and Optical Coherence Tomography Guidance in Percutaneous Coronary Intervention

Intracoronary imaging has become an important tool in the treatment of complex lesions with percutaneous coronary intervention (PCI). This retrospective cohort study identified 1,118,475 patients with PCI from the Nationwide Readmissions Database from 2017 to 2019. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) were identified with appropriate International Classification of Diseases, Tenth Revision codes. The primary outcome was major adverse cardiac events. The secondary outcomes include net adverse clinical events (NACEs), all-cause mortality, myocardial infarction (MI) readmission, admission for stroke, and emergency revascularization. The multivariate Cox proportional hazard regression was used to adjust for demographic and co-morbid confounders. Of 1,118,475 PCIs, 86,140 (7.7%) used IVUS guidance and 5,617 (0.5%) used OCT guidance. The median follow-up time was 184days. The primary outcome of major adverse cardiac events was significantly lower for the IVUS (6.5% vs 7.6%; hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.86 to 0.91, p <0.001) and OCT (4.4% vs 7.6%; HR 0.69, 95% CI 0.61 to 0.79, p <0.001) groups. IVUS was associated with significantly lower rates of NACEs (8.4% vs 9.4%; HR 0.92, 95% CI 0.89 to 0.94, p <0.001), all-cause mortality (3.5% vs 4.3%; HR 0.85, 95% CI 0.82 to 0.88, p <0.001), readmission for MI (2.7% vs 3.0%; HR 0.95, 95% CI 0.91 to 0.99, p=0.012), and admission for stroke (0.5% vs 0.6%; HR 0.86, 95% CI 0.78 to 0.95, p=0.002). OCT was associated with significantly lower rates of NACEs (6.6% vs 9.4%; HR 0.81, 95% CI 0.73 to 0.89, p <0.001) and all-cause mortality (1.8% vs 4.3%; HR 0.51, 95% CI 0.42 to 0.63, p <0.001). Emergency revascularization was not significantly different with IVUS guidance. Readmission for MI, stroke, and emergency revascularization were not significantly different with OCT guidance. A subgroup analysis of patients with ST-elevation MI and non-ST-elevation MI showed similar results. In conclusion, the use of IVUS and OCT guidance with PCI were associated with significantly lower rates of morbidity and mortality in real-world practice.

Clinical and Procedural Outcomes of IVUS-Guided vs. Angiography-Guided CTO-PCI: A Systematic Review and Meta-Analysis.

Chronic total occlusions (CTO) in coronary angiographies present a significant challenge nowadays. Intravascular ultrasound (IVUS) is a valuable tool during CTO-PCI, aiding in planning and achieving procedural success. However, the impact of IVUS on clinical and procedural outcomes in CTO-PCI remains uncertain. This meta-analysis aimed to compare IVUS-guided and angiography-guided approaches in CTO-PCI. The study included five studies and 2320 patients with stable coronary artery disease (CAD) and CTO. The primary outcome of major adverse cardiac events (MACE) did not significantly differ between the groups (p = 0.40). Stent thrombosis was the only secondary clinical outcome that showed a significant difference, favoring the IVUS-guided approach (p = 0.01). Procedural outcomes revealed that IVUS-guided procedures had longer stents, larger diameters, and longer procedure and fluoroscopy times (p = 0.007, p < 0.001, p = 0.03, p = 0.002, respectively). Stent number and contrast volume did not significantly differ between the approaches (p = 0.88 and p = 0.33, respectively). In summary, routine IVUS use did not significantly improve clinical outcomes, except for reducing stent thrombosis. Decisions in CTO-PCI should be individualized based on patient characteristics and supported by a multi-parametric approach.

Intravascular Ultrasound Guidance During Peripheral Vascular Interventions: Long-term Clinical Outcomes and Costs From the Japanese Perspective.

The value of intravascular ultrasound (IVUS) guidance during peripheral vascular revascularization procedures is incompletely understood. Moreover, data on long-term clinical outcomes and costs are limited. The objective of this study was to compare outcomes and costs between IVUS and contrast angiography alone in patients undergoing peripheral revascularization procedures in Japan. This retrospective comparative analysis was performed using the Japanese Medical Data Vision insurance claims database. All patients undergoing revascularization for peripheral artery disease (PAD) between April 2009 and July 2019 were included. Patients were followed until July 2020, death, or a subsequent revascularization procedure for PAD. Two patient groups were compared: one undergoing IVUS imaging or the other contrast angiography alone. The primary end point was major adverse cardiac and limb events, including all-cause-mortality, endovascular thrombolysis, subsequent revascularization procedures for PAD, stroke, acute myocardial infarction, and major amputations. Total health care costs were documented over the follow-up and compared between groups, using a bootstrap method. The study included 3956 patients in the IVUS group and 5889 in the angiography alone group. Intravascular ultrasound was significantly associated with reduced risk of a subsequent revascularization procedure (adjusted hazard ratio: 0.25 [0.22-0.28]) and major adverse cardiac and limb events (0.69 [0.65-0.73]). The total costs were significantly lower in the IVUS group, with a mean cost saving over follow-up of $18 173 [$7 695-$28 595] per patient. The use of IVUS during peripheral revascularization provides superior long-term clinical outcomes at lower costs compared with contrast angiography alone, warranting wider adoption and fewer barriers to IVUS reimbursement for patients with PAD undergoing routine revascularization. Intravascular ultrasound (IVUS) guidance during peripheral vascular revascularization has been introduced to improve the precision of the procedure. However, questions over the benefit of IVUS in terms of long-term clinical outcome and over cost have limited its use in everyday clinical practice. This study, performed in a Japanese health insurance claims database, demonstrates that use of IVUS provides a superior clinical outcome over the long term at a lower cost compared to angiography alone. These findings should encourage clinicians to use IVUS in routine peripheral vascular revascularization procedures and encourage providers to reduce barriers to use.

Prognostic Impact of Operator Experience and IVUS Guidance on Long-Term Clinical Outcomes After Complex PCI

BackgroundAlthough consistent clinical data support intravascular ultrasound (IVUS) use during complex percutaneous coronary intervention (PCI), long-term follow-up outcomes on differential effects of IVUS according to operator experience are scarce. ObjectivesThe current study aimed to evaluate the influence of operator experience on lesion complexity, long-term clinical outcomes, and the interactions of IVUS guidance in patients undergoing complex PCI. MethodsA total of 6,005 patients who underwent PCI with drug-eluting stents for complex lesions were recruited from the institutional registry of Samsung Medical Center. The study population was stratified by the use of IVUS and operator experience (less experienced operator [lifetime independent experience with PCI ≤5 years] vs experienced operator). The primary endpoint was a composite of cardiac death or target vessel myocardial infarction (TVMI) up to 10 years. ResultsCompared with less experienced operators, experienced operators used IVUS more frequently (29.6% [1,128/3,805] vs 24.8% [546/2,200]; P < 0.001) and achieved a lower risk of cardiac death or TVMI (experienced vs less experienced, adjusted HR: 0.779; 95% CI: 0.663-0.915; P = 0.002). IVUS use was associated with a significantly lower risk of cardiac death or TVMI than angiography alone for less experienced operators (23.5% vs 11.4%; adjusted HR: 0.477; 95% CI: 0.337-0.673; P < 0.001) as well as experienced operators (18.0% vs 13.5%; adjusted HR: 0.747; 95% CI: 0.559-0.998; P = 0.048). There were significant interactions for the risk of cardiac death or TVMI between IVUS use and operator experience (P = 0.037). ConclusionsPCI by experienced operators and the use of IVUS during complex PCI were independently associated with lower long-term risks of cardiac death or TVMI. The beneficial effects of IVUS were more prominent for less experienced operators. (Prospective Percutaneous Coronary Intervention Registry [SMC-PCI]; NCT05624905)

IVUS Improves Outcomes With SUPERA Stents for the Treatment of Superficial Femoral-Popliteal Artery Disease.

Nitinol interwoven bare metal stents represent an advancement in stent technology; however, nominal deployment remains an area of focus. Intravascular ultrasound (IVUS) has been shown to improve outcomes in both the coronary and peripheral vasculature by providing the operator with greater vessel detail; however, the use of adjunctive IVUS with nitinol bare metal stents has not been widely studied. This studies aims to determine the effect of IVUS when used adjunctively with nitinol interwoven bare metal stents in the management of femoropopliteal lesions. Retrospective study. This study included a cohort of 200 consecutive patients with peripheral artery disease. All patients were treated with ≥1 Supera bare metal stent, and 91 received adjunctive IVUS imaging prior to stent deployment. Deployment conditions of nominal, compressed, and elongated were measured, and the primary clinical outcomes included target lesion reintervention, amputation, and mortality. This study also showed that 8.3 number needed to treat (NNT) patients must be treated with IVUS to avoid an additional revascularization event. The patients who received IVUS had a significantly greater number of nominally deployed stents (p<0.001). Patients who had IVUS imaging also had significantly lower reintervention rates compared with those who did not receive IVUS imaging (p=0.047). The IVUS and angiography decreases clinically-driven target lesion reintervention and increases nominal deployment compared with angiography alone in femoropopliteal lesions treated with interwoven bare metal nitinol stents. Endovascular surgones may conisder the adjuctive use of IVUS when using the Supera stent for the treatment of infra inguinal superficial femoral artery lesions. The adjunct use of IVUS may lead to improved sizing, vessel prep, deployment, and ultiamtely reduction in CD-TLR.

Trends and impact of intravascular ultrasound and optical coherence tomography on percutaneous coronary intervention for myocardial infarction.

Intravascular imaging with either intravascular ultrasound (IVUS) or optical coherence tomography (OCT) during percutaneous coronary intervention (PCI) is associated with improved outcomes, but these techniques have previously been underutilized in the real world. We aimed to examine the change in utilization of intravascular imaging-guided PCI over the past decade in the United States and assess the association between intravascular imaging and clinical outcomes following PCI for myocardial infarction (MI). We surveyed the National Inpatient Sample from 2008 to 2019 to calculate the number of PCIs for MI guided by IVUS or OCT. Temporal trends were analyzed using Cochran-Armitage trend test or simple linear regression for categorical or continuous outcomes, respectively. Multivariable logistic regression was used to compare outcomes following PCI with and without intravascular imaging. A total of 2,881,746 PCIs were performed for MI. The number of IVUS-guided PCIs increased by 309.9% from 6,180 in 2008 to 25,330 in 2019 (P-trend<0.001). The percentage of IVUS use in PCIs increased from 3.4% in 2008 to 8.7% in 2019 (P-trend<0.001). The number of OCT-guided PCIs increased 548.4% from 246 in 2011 to 1,595 in 2019 (P-trend<0.001). The percentage of OCT guidance in all PCIs increased from 0.0% in 2008 to 0.6% in 2019 (P-trend<0.001). Intravascular imaging-guided PCI was associated with lower odds of in-hospital mortality (adjusted odds ratio 0.66, 95% confidence interval 0.60-0.72, p<0.001). Although the number of intravascular imaging-guided PCIs have been increasing, adoption of intravascular imaging remains poor despite an association with lower mortality.

Factors affecting short- and long-term survival of patients with acute coronary syndrome treated invasively using intravascular ultrasound and fractional flow reserve: Analysis of data from the Polish Registry of Acute Coronary Syndromes 2017-2020.

Intravascular ultrasound (IVUS) and fractional flow reserve (FFR) are invasive procedures increasingly used in treating acute coronary syndrome (ACS). This study aimed to evaluate the frequency of IVUS and FFR use in patients with ACS in Poland and to assess the safety of these procedures as well as their impact on short- and long-term survival. This retrospective study included 103849 patients enrolled in the Polish Registry of Acute Coronary Syndromes in 2017-2020. IVUS was performed in 1727 patients, FFR in 1537 patients, and both procedures in 37 patients. The frequency of performing FFR in ACS patients increased over the years from 1.3% to 1.8% (P <0.0001) and IVUS from 1.7% to 2.3% (P <0.0001). In the FFR and/or IVUS group, a similar incidence of stroke, reinfarction, target vessel revascularization, and major bleeding was observed while in-hospital mortality was lower (0% for IVUS + FFR vs. 0.9% for FFR vs. 2.3% for IVUS vs. 3.7 for no procedure; P <0.0001). FFR and IVUS did not affect the 30-day and one-year prognosis. In recent years, the number of FFR and IVUS procedures performed in patients with ACS in Poland has increased. There was lower in-hospital mortality in the FFR and/or IVUS group in ACS patients, and no differences in the incidence of stroke, reinfarction, target vessel revascularization, and major bleeding were observed. Performing FFR and IVUS in ACS patients does not significantly affect 30-day or one-year mortality.