Courtesy of Dr. Carlos Fava.

Drug eluting stents (DES) have shown benefits in terms of restenosis vs. conventional bare metal stents (BMS). Many of the advantages of DES depend on correct implantation, especially in complex lesions.

In complex lesions, the use of intravascular ultrasound (IVUS) provides important information on lesion length, vessel diameter, calcification degree, plaque morphology, etc. We are well aware of the value of IVUS, yet it remains underused, both in developed and underdeveloped countries.

This meta-analyzis included 8 randomized studies of patients with complex lesions (long or requiring ≥4 stents, small vessels, bifurcations or chronic total occlusions) with at least one year follow up.

In all, 3,276 patients were analyzed; 1,635 were guided with IVUS and 1,671 with angiography. Populations were homogeneous. Follow up was at 1.4 ± 5 years.

Combined adverse events rate was reduced 36% with the use of IVUS (6.5% vs. 10.5%; p=0.0001), the same as lesion revascularization rate (5.5% vs. 9.2%; p=0.007) and there was a tendency to less cardiovascular death. There were no differences in events such as stent thrombosis and all cause death.

IVUS guided DES stenting showed significant benefits in combined events reduction in diabetic patients with long lesions undergoing acute coronary syndrome.

Conclusion

This meta-analyzis shows a significant reduction of combined adverse events and revascularization with IVUS guided DES implantation in coronary complex lesions.

Editorial Comment

These data show that the use of IVUS in coronary complex lesions reduces MACE at the expense of reintervention, especially in high risk populations. With this information we should start to use is more frequently.

Courtesy of Dr. Carlos Fava. Favaloro Foundation, Buenos Aires, Argentina.

Original Title: Intravascular ultrasound-guided vs angiography-guided drug-eluting stent implantation in complex coronary lesions: Meta-analysis of randomized trial.

Reference: Chirag Bavishi et al, Am Heart J 2017;185:26-34.

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