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.

More articles by this author

Coronary Artery Disease in Aortic Stenosis: CABG + SAVR vs. TAVR + PCI: Data from Spanish Centers

Multiple randomized studies have shown comparable or superior efficacy of transcatheter aortic valve replacement (TAVR) vs. coronary artery bypass graft (CABG).  However, many of...

Evolution of Small Balloon-Expandable Valves

Small aortic rings (20 mm) have posed a significant challenge for both surgery and transcatheter aortic valve implantation (TAVI) due to their association with an...

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 – ECLIPSE: Randomized Study of Orbital Atherectomy vs Conventional PCI in Severely Calcified Lesions

Coronary calcification is associated with stent under-expansion and increased risk of both early and late adverse events. Atherectomy is an essential tool for uncrossable...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Severe Tricuspid Regurgitation: Surgical vs. Transcatheter Edge-to-Edge Repair

While highly prevalent, tricuspid regurgitation is a notably undertreated valvulopathy. Its progression has been associated with higher mortality and significant disability. According to the...

ACCESS-TAVI: Comparing Post TAVR Vascular Closure Devices

Transcatheter aortic valve replacement (TAVR) is a well-established option to treat elderly patients with severe symptomatic aortic valve stenosis. Technical advances and device development...

Endovascular Treatment of Iliofemoral Disease for the Improvement of Heart Failure with Preserved Ejection Fraction

Peripheral artery disease (PAD) is a significant risk factor in the development of difficult-to-treat conditions, such as heart failure with preserved ejection fraction (HFpEF)....