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Effect of Intravascular Ultrasound-Guided vs Angiography-Guided Everolimus-Eluting Stent Implantation: The IVUS-XPL Randomized Clinical Trial Usefulness of minimum stent cross sectional area as a predictor of angiographic restenosis after primary percutaneous coronary intervention in acute myocardial infarction (from the HORIZONS-AMI Trial IVUS substudy) Comprehensive intravascular ultrasound assessment of stent area and its impact on restenosis and adverse cardiac events in 403 patients with unprotected left main disease Coronary artery imaging with intravascular high-frequency ultrasound Increased glycated albumin and decreased esRAGE levels in serum are related to negative coronary artery remodeling in patients with type 2 diabetes: an Intravascular ultrasound study Randomized comparison of clinical outcomes between intravascular ultrasound and angiography-guided drug-eluting stent implantation for long coronary artery stenoses Impact of Intravascular Ultrasound-Guided Drug-Eluting Stent Implantation on Patients With Chronic Kidney Disease: Subgroup Analysis From ULTIMATE Trial Coronary plaque redistribution after stent implantation is determined by lipid composition: A NIRS-IVUS analysis Serial intravascular ultrasound assessment of very late stent thrombosis after sirolimus-eluting stent placement Intravascular Ultrasound Guidance Is Associated With Better Outcome in Patients Undergoing Unprotected Left Main Coronary Artery Stenting Compared With Angiography Guidance Alone
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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

BACKGROUND - The 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.


OBJECTIVE - Our 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.

METHODS - From 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.

RESULTS - At 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).

CONCLUSIONS - The 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.
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