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血管内超声指导

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Comprehensive intravascular ultrasound assessment of stent area and its impact on restenosis and adverse cardiac events in 403 patients with unprotected left main disease Comparison of plaque characteristics in narrowings with ST-elevation myocardial infarction (STEMI), non-STEMI/unstable angina pectoris and stable coronary artery disease (from the ADAPT-DES IVUS Substudy) Combined use of OCT and IVUS in spontaneous coronary artery dissection Long-term outcomes with use of intravascular ultrasound for the treatment of coronary bifurcation lesions Intravascular Ultrasound Parameters Associated With Stent Thrombosis After Drug-Eluting Stent Deployment 3-Year Outcomes of the ULTIMATE Trial Comparing Intravascular Ultrasound Versus Angiography-Guided Drug-Eluting Stent Implantation Role of intravascular ultrasound in patients with acute myocardial infarction undergoing percutaneous coronary intervention Contribution of stent underexpansion to recurrence after sirolimus-eluting stent implantation for in-stent restenosis Intracoronary stenting without anticoagulation accomplished with intravascular ultrasound guidance Mechanisms of in-stent restenosis after drug-eluting stent implantation: intravascular ultrasound analysis

Clinical Trial2013 Feb;81(3):456-63.

JOURNAL:Catheter Cardiovasc Interv. Article Link

Intravascular ultrasound-guided systematic two-stent techniques for coronary bifurcation lesions and reduced late stent thrombosis

Chen SL, Ye F, Zhang JJ et al. Keywords: IVUS; coronary bifurcation lesions; two-stent technique; late stent thrombosis;

ABSTRACT


BACKGROUNDThe effects of intravascular ultrasound (IVUS)-guided complex approaches using drug-eluting stents (DES) for coronary bifurcation lesions on clinical outcomes has not yet been studied in detail.


OBJECTIVEOur objective was to analyze the difference in 1-year outcomes following two-stent techniques involving implantation of DES for coronary bifurcation lesions between IVUS-guided and angiography-guided groups.

METHODSFrom May 26, 2007 to March 24, 2010, 628 patients received two-stent techniques (324 in the IVUS-guided group and 304 angiography-guided) and were prospectively studied. We compared major adverse cardiac events (MACE, including cardiac death, stent thrombosis [ST], myocardial infarction [MI] and target lesion/vessel revascularization) at 12-months follow-up, before and after adjusting for propensity score matching.

RESULTSAt 12-months after the indexed procedure, patients in the angiography-guided group had significantly increased in-stent restenosis. Compared to the angiography-guided group, the IVUS-guided group had a significantly lower overall unadjusted ST rate (1.2% vs. 6.9%, P < 0.001), definite ST (0.6% vs. 5.3%, P < 0.001), late ST (0.6% vs. 4.3%, P = 0.003), MI (4.6% vs. 8.9%, P = 0.038) and cardiac death (0.9% vs. 3.3%, P = 0.049). By propensity score matching, 123 paired patients were matched. The late ST at 12-months follow-up was 0% in the IVUS-guided group versus 4.9% in the angiography-guided group (P = 0.029), resulting in significant differences in ST-elevation MI between the two groups (2.4% vs. 9.8%, P = 0.030).

CONCLUSIONSThe IVUS-guided two-stent technique was associated with significantly reduced late stent thrombosis, with a resultant reduction in ST-elevation MI. © 2012 Wiley Periodicals, Inc.

Copyright © 2012 Wiley Periodicals, Inc.