Final Results of the Can Routine Ultrasound Influence Stent Expansion (CRUISE) Study

Abstract

These data suggest that ultrasound guidance of stent implantation may result in more effective stent expansion compared with angiographic guidance alone.

Relation of Fractional Flow Reserve After Drug-Eluting Stent Implantation to One-Year Outcomes

“…2 This might be due to angiographically inapparent incomplete stent expansion, coronary dissection, dislocation of plaque at either edge of the stent, or other factors. 3,4 Intravascular ultrasonography is recognized as the standard method for evaluating the PCI results. Previous studies have shown that the FFR correlates with the intravascular ultrasound findings for assessing optimal stent deployment.…”

“…Several studies have demonstrated that coronary pressure measurement has a good correlation with intravascular ultrasound findings in the evaluation of the success of PCI, thereby informing optimal stent deployment. [3][4][5][6][7] The fractional flow reserve (FFR) can identify a residual hyperemic pressure gradient that results in abnormal resistance across both the stented and the adjacent segments. Although the FFR measured after bare metal stent implantation correlated with the 6-month clinical outcomes in a previous study, 8 it is unknown whether the same applies to DES implantation.…”

Intravascular Ultrasound Guidance Improves Angiographic and Clinical Outcome of Stent Implantation for Long Coronary Artery Stenoses

“…11 However, randomized studies investigating this strategy have yielded inconsistent results. [12][13][14][15][16][17] We hypothesized that the potential advantages of IVUS guidance would be most apparent in complex lesions, such as long stenoses. In this report, we compared the clinical and angiographic outcome after stenting of long coronary artery stenoses with randomization to angiographic or IVUS guidance of the intervention.…”

Diretriz de indicações do ultra-som intracoronariano na prática clínica

“…Dois estudos relataram significativa redução na cifra de nova revascularização do vasoalvo, utilizando, contudo, método menos uniforme. O estudo CRUISE (Can Routine Ultrasound Influence Stent Expansion), que mostrou a superioridade do ultra-som, não realizou nova cinecoronariografia, e o SIPS (Strategy for Intracoronary Ultrasound-Guided PTCA and Stenting), relata similaridade nas taxas de reestenose angiográfica intra-stent aos seis meses (29% versus 35%, ultra-som e angiografia quantitativa; p=NS), porém informa significante redução na realização de novos procedimentos de revascularização do vaso-alvo em período mais prolongado, após dois anos de evolução clínica (17% versus 29%, ultra-som e angiografia quantitativa; p=0,02) 54,55 . Por outro lado, no estudo OPTICUS (Optimization with Intracoronary Ultrasound to reduce stent restenosis), os pacientes que tiveram o implante do stent monitorado por meio do ultra-som intracoronariano necessitaram de maior quantidade de meio de contraste e o dobro do tempo de radioscopia, elevando o tempo total do procedimento (em quase 30min).…”