F Fi ig gu ur re e 1 1. . Esophageal manometry shows weak aperistaltic body contractions (ineffective peristalsis).

Introduction: Intravascular ultrasound is a new imaging modality that facilitate the process of coronary intervention. The angiographic evaluation of left main lesions significance is always questionable, IVUS detect the significance, guide the procedure and some studies proves a benefit in mortality. Objectives: To investigate whether intravascular ultrasound IVUS guided Left Main coronary intervention could improve clinical outcomes compared with angiographic-guided Left main coronary PCI. Patients and Methods: This controlled study was carried out between June 2017 and June 2019, in Tanta university Hospital and San Donato Hospital, Milan, 83 patients eligible to Left Main coronary intervention divided into two groups, IVUS-guided group (n=19) and angiographic-guided group(n=64). The occurrence of major adverse cardiac events (MACE): death, non-fatal myocardial infarction, or target lesion revascularizations) were recorded 6 and18 Months of follow-up. Results: The IVUS-guided group had a lower rate of 18-months MACE than the control group. The incidence of target lesion revascularization was lower in the IVUS-guided group than in the control group. The incidence of TLR after 6 months was not different between both groups (1 cases in IVUS group (5.3%), 6 cases in angiography group (9.4%) (P value 0.686) while the incidence of TLR after 18 months was significantly different between both groups (1 cases in IVUS group (5.3%), 17 cases in angiography group (26.6%) (P value 0.048), However, there were no differences in death, myocardial infarction, stent thrombosis and number of patients treated with CABG in the 2 groups. Conclusion: The present study demonstrates that IVUS-guided LM angioplasty can improve 18 -months MACE events especially the incidence of target lesion revascularization.