Efficacy And Safety Of IVUS-Guided Percutaneous Coronary Interventions

The inclusion of IVUS-guided PCI has yet to become a routine approach in invasive cardiology due to the relatively high cost of the procedure, equivocal positive results in important studies and the steep learning curve. As an additional diagnostic tool, IVUS seems to be irreplaceable in stent apposition research, edge dissections and the determination of plaque composition.

To examine the efficacy and safety of IVUS-guided PCI vs. angiographically guided PCI in a centre without prior experience.

A total of 35 patients were examined using IVUS prior to stent placement, and the gathered data were used to determine adequate implanted stent size and length. The acquired parameters were as follows: percentage of stenosis, MLD, CSA and distal reference diameter. After PCI, IVUS studies were repeated and data on the CSA, residual stenosis and MLD were acquired. Additionally, stent size and length, deployment pressure and the use of additional post-dilatations were recorded. There were 35 patients with similar demographic data in the control group who underwent treatment of the same vessel segment with the same stent type. Additional data regarding acute complications (dissections, slow flow during or after the procedure, IM) were obtained from the existing database and complications after six months, such as the need for TVR, MACE and death, were also obtained.

Significant differences were observed in terms of stent size and length, residual stenosis, post-dilatation and MLD in favour of the IVUS group; in addition, TVR was 36% lower in the IVUS group with no significant difference in MACE and death between the groups.

After introduction of the method, IVUS-guided PCI exhibited reasonable safety and efficacy compared to conventional angiographically guided PCI at centres without prior experience.