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Rotational Atherectomy

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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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