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IVUS Guidance

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The role of integrated backscatter intravascular ultrasound in characterizing bare metal and drug-eluting stent restenotic neointima as compared to optical coherence tomography Usefulness of intravascular ultrasound to predict outcomes in short-length lesions treated with drug-eluting stents American College of Cardiology Clinical Expert Consensus Document on Standards for Acquisition, Measurement and Reporting of Intravascular Ultrasound Studies (IVUS). A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents Comparison of intravascular ultrasound guided versus angiography guided drug eluting stent implantation: a systematic review and meta-analysis First-in-man evaluation of intravascular optical frequency domain imaging (OFDI) of Terumo: a comparison with intravascular ultrasound and quantitative coronary angiography Incidence and Clinical Outcomes of Stent Fractures on the Basis of 6,555 Patients and 16,482 Drug-Eluting Stents From 4 Centers Intracoronary stenting without anticoagulation accomplished with intravascular ultrasound guidance Intravascular ultrasound-guided implantation of drug-eluting stents to improve outcome: a meta-analysis Atherosclerotic plaque with ultrasonic attenuation affects coronary reflow and infarct size in patients with acute coronary syndrome: an intravascular ultrasound study 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)
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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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