TCT 2018 | ULTIMATE: IVUS Guided DES Implantation for All Vessels, for All Lesions

Intravascular Ultrasound (IVUS) guided drug eluting stent (DES) implantation is associated with less adverse events compared against angiography guided stenting. This is especially clear for certain populations (with left main PCI as paradigmatic) but not so clear when dealing with all comers.

1448 all comer patients requiring DES stenting were randomized 1:1 to IVUS guided vs. angiography guided procedures.  Primary end point at 12 months was a composite of cardiac death, target vessel myocardial infarction or clinically driven target vessel revascularization. The procedure was considered successful if all IVUS optimal implantation criteria were met.

At 12 months, there was 2.9% events rate in the IVUS group vs 5.4% in the angiography guided group (p=0.019). These events happen in only 1.6% of patients who complied with optimal implantation criteria by IVUS. If one criterion was not met, the figure would rise to 4.4% (p=0.029).

Read also: TCT 2018 | SYNTAXES: 10 Year Follow Up is ‘Trendy’.

There was also significant reduction of target vessel revascularization and definite thrombosis.

IVUS was shown to reduce events in an unselected population of patients, and not only in complex PCI.

Original title: Intravascular Ultrasound-Guided Versus Angiography-Guided Implantation of Drug- Eluting Stent in All-Comers: The ULTIMATE trial.

Presenter: Junjie Zhang.

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