IVUS-XPL: IVUS superior to angiography for guiding DES implantation in long lesions

Original Title: Effect of intravascular ultrasound-guided vs angiography-guided everolimus-eluting stent implantation: the IVUS-XPL randomized clinical trial. Presenter: Hong S-J.

Patients with long coronary lesions have better clinical results after a year of second generation DES implantation when interventions are guided by IVUS, instead of angiography. The benefit was attributed to a lower revascularization rate of ischemia driven target lesions. For the trial, carried out in 20 Korean centers, researchers included 1,400 patients (mean age 64; 69% male) with chest pain or evidence of myocardial ischemia and diffuse long coronary lesions (visually estimatedstent length of  ≥ 28 mm). All patients received the Xience Prime stent (Abbott Vascular) and dual ATP with aspirin and clopidogrel through6 months or more.

In patients randomized to IVUS guided stent implantation online IVUS measurements were used to select stent size and length; adjunct high-pressure dilation was performed at the discretion of the physicians based on IVUS findings.Physicians could perform IVUS at any step of PCI, but IVUS exam was mandatory after PCI.

The average stent length was 39.3 mm. During procedure, patients in the IVUS arm more frequently received adjunct post-dilation (76% vs 57%) and had a larger mean final balloon size (3.14 vs 3.04 mm; P <0.001 for both). As a result, patients who underwent IVUS-guided procedure had a higher minimum lumen diameter (2.64 vs 2.56 mm; P <0.001) and lower diameter stenosis (12.79% vs 13.74%; P = .04) on post-intervention quantitative coronary angiography.

Patients in the IVUS arm required ischemia driven target lesion revascularization 2.5% of times vs. 5% in the control group.