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Impact of intravascular ultrasound guidance in routine percutaneous coronary intervention for conventional lesions: data from the EXCELLENT trial Consensus from the 5th European Bifurcation Club meeting Comparison of paclitaxel-eluting stents (Taxus) and everolimus-eluting stents (Xience) in left main coronary artery disease with 3 years follow-up (from the ESTROFA-LM registry) Impact of Intravascular Ultrasound-Guided Percutaneous Coronary Intervention on Long-Term Clinical Outcomes in Patients Undergoing Complex Procedures Intravascular ultrasound-derived minimal lumen area criteria for functionally significant left main coronary artery stenosis Intravascular Ultrasound Parameters Associated With Stent Thrombosis After Drug-Eluting Stent Deployment Defining a new standard for IVUS optimized drug eluting stent implantation: the PRAVIO study Contribution of stent underexpansion to recurrence after sirolimus-eluting stent implantation for in-stent restenosis Intravascular Ultrasound-Derived Virtual Fractional Flow Reserve for the Assessment of Myocardial Ischemia Comparison of inhospital mortality, length of hospitalization, costs, and vascular complications of percutaneous coronary interventions guided by ultrasound versus angiography
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Original ResearchMarch, 2018 Volume 71, Issue 11 Supplement

JOURNAL：J Am Coll Cardiol. Article Link

Assessment Of Proximal Left Anterior Descending Artery Size By Intravascular Ultrasound For Optimal Stent Sizing

Shlofmitz E; Matsumura M; Mintz GS et al. Keywords: proximal left anterior descending artery; IVUS; stent sizing

ABSTRACT

BACKGROUND - As the LAD supplies almost half of the myocardium, the proximal LAD (PLAD) should rarely be small. Given the prognostic significance of both the PLAD and minimal stent area, we evaluated PLAD sizes by IVUS.

METHODS - From isolated review of the angiograms from 147 pts who underwent IVUS-guided stenting of de novo PLAD lesions, 4 interventional cardiologists (two of whom were experienced IVUS users) recommended the stent diameter. An IVUS core lab then analyzed the lesion and vessel segments. Based on the smallest mean IVUS vessel diameter (VD), the optimal stent diameter was chosen by downsizing by 0.25-0.5 mm, except in VD >4.0mm.

RESULTS - Mean age was 66 yrs, 30% had diabetes, and 44% presented with ACS. The proximal and distal VDs were 4.5 ± 0.6 mm and 4.0 ± 0.6 mm, respectively. The smallest IVUS VD was 3.9 ± 0.5 mm (occurring in the lesion and distal reference in 44% and 56% of cases). 2% of the smallest VDs were <3.0 mm, and 93% of IVUS-guided optimal stent diameters were ≥3.0 mm (Figure). The mean stent size recommended by the 4 ICs based on angiography was 3.2 ± 0.3 mm; stent size was underestimated by 58% and 65% of experienced and inexperienced IVUS users, respectively. In a logistic model, diabetes was the only predictor for underestimation (OR [95%CI]; 2.48 [1.25- 4.93], P=0.009).

CONCLUSION - Stent diameters in the PLAD are frequently under-estimated based on angiography alone, and should rarely by <3.0 mm. Irrespective of experience, routine IVUS use may result in more appropriate stent sizing in the PLAD.

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