Intravascular Ultrasound (IVUS) has shown, in several studies, its great benefits for both restenosis and mortality reduction.
Even though several variables have been studied, so far minimal stent area (MSA) has been disregarded as important.
The OPTIVUS-Complex PCI looked at 961 patients with 1,957 lesions, and found 1.6% TLR incidence (30 lesions).
There were no significant differences between patients presenting TLR and those who did, except for a higher incidence of hemodialysis in the second group.
As regards the procedure, there were no differences in pre and post dilation, lesion complexity, chronic occlusions, vessel diameter, QCA, lesion length, or proximal reference area.
Time from PCI to TLR was 251 days (167-325), and 73% happened after 180 days.
Read also: Association Between Radial Wall Strain (RWS) and Risk of Acute Myocardial Infarction.
66.7% of TLR was ischemia driven.
Even though hemodialysis and MSA were more frequent in TLR patients, the difference did not reach statistical significance.
Conclusion
At present, TLR incidence after IVUS guided PCI at one year is quite low. Minimal stent area, but not other stent expansion criteria, has been associated with TLR upon multivariable analysis. Independent factors were calcified lesions and small proximal reference lumen area. Therefore, these findings should be interpreted with caution, seeing the low number of TLR events, the limited number of complex lesions and the short followup.
Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.
Original Title: Target Lesion Revascularization After Intravascular Ultrasound-Guided Percutaneous Coronary Intervention.
Reference: Yamamoto, et al. Circ Cardiovasc Interv.2023;16:e012922.DOI:10.1161/CIRCINTERVENTIONS.123.012922.
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