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

Oemrawsingh, Pranobe V.; Mintz, Gary S.; Schalij, Martin J.; Zwinderman, Aeilko H.; Jukema, J. Wouter; Wall, Ernst E. van der

doi:10.1161/01.cir.0000043240.87526.3f

Cited by 259 publications

(161 citation statements)

References 41 publications

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“…Previous studies using bare metal stent showed that IVUS guidance during PCI reduced the rate of in-stent restenosis and the incidence of reintervention. 8,19 One previous study reported the beneficial role of IVUS guidance during PCI on patients who were treated with DES in terms of reducing both stent thrombosis and TLR. 9 Nevertheless, the beneficial effects of IVUS might be uncertain in various study populations or lesion subsets.…”

Section: Discussionmentioning

confidence: 99%

Impact of intravascular ultrasound guidance on long-term clinical outcomes in patients treated with drug-eluting stent for bifurcation lesions: Data from a Korean multicenter bifurcation registry

Kim

Hong

et al. 2011

American Heart Journal

101

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Section: Discussionmentioning

confidence: 99%

Impact of intravascular ultrasound guidance on long-term clinical outcomes in patients treated with drug-eluting stent for bifurcation lesions: Data from a Korean multicenter bifurcation registry

Kim

Hong

et al. 2011

American Heart Journal

101

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“…Treatment of a diffuse, long, coronary artery lesion with overlapping BMS is associated with high rates of restenosis [1][2][3] whereas the use of DES greatly attenuates neointimal proliferation, so that in patients with a diffuse, long, coronary lesion, implantation of multiple overlapping DES has been associated with a good clinical outcome. 9 Corp, Natick, MA, USA).…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] In particular, the implantation of multiple, overlapping, bare metal stents (BMS) has a high restenosis rate. 4,5 Use of drug-eluting stents (DES) results in a significant and sustained suppression of neointimal proliferation, and has greatly attenuated the relationship between stent length and restenosis rate.…”

mentioning

confidence: 99%

Inflammation and Delayed Endothelization With Overlapping Drug-Eluting Stents in a Porcine Model of In-Stent Restenosis

Lim

Jeong

Hong

et al. 2008

Circ J

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iffuse, long coronary lesions are associated with an increased rate of restenosis and poor outcome, despite the development of percutaneous coronary intervention (PCI) techniques. [1][2][3] In particular, the implantation of multiple, overlapping, bare metal stents (BMS) has a high restenosis rate. 4,5 Use of drug-eluting stents (DES) results in a significant and sustained suppression of neointimal proliferation, and has greatly attenuated the relationship between stent length and restenosis rate. As a result, a long DES is usually selected for a diffuse coronary lesion, but if a residual segment of the lesion is left uncovered, additional stenting with some overlap is considered to eliminate the risk of a residual stent gap.Thus in the case of a diffuse, long coronary lesion, overlapping DES are used for complete lesion coverage, but there has been concern whether the overlapping DES have the effect of increasing the local drug dose or whether they Circulation Journal Vol.72, March 2008 could result in dose-related side-effects, such as delayed arterial healing and promotion of inflammation, as compared with overlapping BMS. 6 Few histopathological studies have been done on the response to overlapping DES or BMS, and even less so for the overlapping of different DES, such as the sirolimus-eluting stent (SES) or pacletaxel-eluting stent (PES). Therefore, the present study assessed the histopathological response and the effect on neointimal hyperplasia of overlapping DES or BMS in a porcine model of coronary in-stent restenosis (ISR). Methods Animal Study ProtocolThe animal study was approved by the Ethical Committee of the Chonnam National University Hospital. Study animals were female swine weighing 25-35 kg. To decrease the incidence of acute thrombosis after stenting, premedication with aspirin 100 mg and clopidogrel 75 mg/day was given for 7 days before the procedure. On the day of stent implantation, pigs were anesthetized with ketamine (20 mg/kg intramuscularly) and xylazine (2 mg/kg intramuscularly) and maintained on 3 L/min of supplemental oxygen continuously through a mask. After subcutaneous 2% lidocaine was administered at the cut-down site the left carotid artery was surgically exposed, and a 7F sheath was inserted. Continuous hemodynamic and surface electrocardiographic monitoring was maintained throughout the procedure. After 10,000 units of heparin were administered intravenously as a bolus

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“…[8][9][10] We believe the IVUS-guided improvement in the angiographic MLD was the mechanism responsible for the reduced restenosis, reduced repeat revascularization, and reduced MACE. The DIPO study 11) and the TULIP study 12) also suggested that IVUS-guided PCI could reduce restenosis and MACE. However, the OPTICUS study 13) did not show an effect of IVUS guidance on restenosis.…”

Section: Discussionmentioning

confidence: 99%

Three-Year Major Clinical Outcomes of Angiography-Guided Single Stenting Technique in Non-Complex Left Main Coronary Artery Diseases

et al. 2017

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SummaryThere is limited long-term comparative clinical outcome data concerning angiography-versus intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) in non-complex left main coronary artery (LMCA) disease treated with the single stenting technique in the drug-eluting stent (DES) era.The aim of this study was to investigate whether angiography-guided stenting is comparable to IVUSguided stenting during 3-year clinical follow-up periods in patients with non-complex LM disease treated with the single stenting technique.A total of 196 patients treated with either angiography-guided (n = 74) or IVUS-guided (n = 122) PCI were included. The primary outcome was the occurrence of major adverse cardiac events (MACE) defined as total death, non-fatal myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), and non-target vessel revascularization (Non-TVR). To adjust for any potential confounders, propensity score (PS) adjusted analysis was performed.During 3-year follow-up, the PS adjusted Cox-proportional hazard ratio (HR) was not significantly different between the two groups for total death, cardiac death, and MI. Also, TLR and the combined rates of TVR and non-TVR were not significantly different. Finally, MACE was not significantly different between the two groups (HR: 0.63, 95% Confidence interval (CI): 0.33-1.17; P = 0.149).Angiography-guided PCI for non-complex LMCA diseases treated with the single stenting technique showed comparable results compared with IVUS-guided PCI in reducing clinical events during 3-year clinical follow-up in the DES era. Although IVUS guided PCI is the ideal strategy, angiography-guided PCI can be an option for LMCA PCI in some selected cases.(Int Heart J 2017; 58: 704-713) Key words: Left main coronary artery, Percutaneous coronary intervention, Intravascular ultrasound, Drug eluting stents U ntil recently, left main coronary artery (LMCA) disease was a hotly debated topic among interventional cardiologists as it is a challenging and risky lesion subset. According to recent guidelines, percutaneous coronary intervention (PCI) for an ostial or midshaft lesion of LMCA (non-true bifurcation) is defined as a Class IIa indication. 1) Even though LMCA disease treatment has been traditionally reserved for surgery, there have been numerous registries with drug-eluting stents (DES) that have shown favorable outcomes. 2,3) In this uniquely challenging aspect, the use of intravascular ultrasound (IVUS) may help to evaluate the target lesion and enable optimal stent deployment during PCI; and these optimized procedural results may translate into improved long-term clinical outcomes. A recent study 4) demonstrated that the survival rate and the rate of free of major adverse cardiac events (MACE) after 3 years were higher in the IVUS group, and the incidence of stent thrombosis was lower in the IVUS group. However, recent studies did not focus on the role of IVUS in non-complex LM disease treated with the single stenting tec...

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

Cited by 259 publications

References 41 publications

Impact of intravascular ultrasound guidance on long-term clinical outcomes in patients treated with drug-eluting stent for bifurcation lesions: Data from a Korean multicenter bifurcation registry

Impact of intravascular ultrasound guidance on long-term clinical outcomes in patients treated with drug-eluting stent for bifurcation lesions: Data from a Korean multicenter bifurcation registry

Inflammation and Delayed Endothelization With Overlapping Drug-Eluting Stents in a Porcine Model of In-Stent Restenosis

Three-Year Major Clinical Outcomes of Angiography-Guided Single Stenting Technique in Non-Complex Left Main Coronary Artery Diseases

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