We all know the benefits of ultravascular ultrasound (IVUS) in the development of percutaneous coronary intervention, such as more accurate vessel measurement, improved stent expansion and apposition, and complication identification. This is why the use of IVUS is a class IIa recommendation in AHA and ESC guidelines.
The aim of this retrospective study was to assess the use of IVUS in complex PCI and to compare mortality and the need for target vessel revascularization in patients with IVUS guided PCI vs unguided PCI.
Complex lesions included bifurcations, chronic total occlusion, unprotected left main, long lesions >33 mm, instent restenosis, severe calcifications, multivessel PCI, and multiple stenting.
Primary end point was mortality and target vessel revascularization at 2 years.
In 44305 patients receiving complex lesion PCI, 13.9% of procedures were guided by IVUS: 33% of these were on left main lesions, 15% multiple stenting, 14% multivessel PCI, and 14% long lesions. The use of IVUS guided PCI grew from 13% in 2014 to 16% in 2018.
Read also: High Risk of Bleeding after PCI: More Evidence for Short DAPT.
Patients in the IVUS guided arm more often presented ejection fraction >50%, with left main and proximal descending artery compromise, and the use of drug eluting stents, while also less frequently presented recent MI, right coronary artery compromise and lesions in small and tortuous vessels.
As regards results, IVUS guided PCI showed significantly lower mortality and less treated vessel revascularization at followup.
Conclusion
The use of IVUS in complex lesion PCI occurs in low numbers despite the considerable evidence in support of its use. Treating these lesions with IVUS showed reduced morality and target vessel revascularization at midterm compared against PCI without IVUS guidance.
Dr. Andrés Rodríguez
Member of the Editorial Board of SOLACI.org.
Reference: Edward L. Hannan et al Circ Cardiovasc Interv. 2022;15:e011687.
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