title: Impact of preintervention intravascular ultrasound imaging on transcatheter treatment strategies in coronary artery disease.
abstract: Preintervention intravascular ultrasound (IVUS) imaging was performed in 313 target lesions in 301 patients. Revascularization strategy intended before imaging was compared with the treatment actually performed; there was a change in therapy in 124 lesions (40%) in 121 patients (40%). This included: (1) assessment of lesion severity leading to revascularization when none had been planned (n = 20, 6%), (2) avoiding surgery or catheter-based revascularization that had originally been planned (n = 21, 7%), and (3) assessment of lesion composition leading to a change in revascularization strategy (n = 20, 6%) or for selecting the revascularization strategy (n = 63, 20%). Nine of these 121 patients were referred for coronary artery bypass graft surgery. IVUS minimal lumen diameter correlated well with angiography (r = 0.83); however, a disagreement was the reason for deciding to perform or not to perform revascularization in 41 lesions (13%). IVUS assessment of target lesion calcification, eccentricity and unusual morphology were the reasons for changing or selecting specific devices: (1) concentric and eccentric lesions with significant superficial calcium were treated with rotational atherectomy, excimer laser angioplasty or surgery; (2) eccentric lesions that did not contain significant superficial calcium were treated with directional atherectomy; (3) dissections and true aneurysms were treated with stent placement even if calcified; (4) thrombus-containing lesions in vein grafts were treated with thrombolytic therapy or extraction atherectomy, or both; and (5) fibrotic vein graft lesions were treated with balloon angioplasty or stent placement.
authors.affiliation: Cardiac Catherization Laboratory, Washington Hospital Center, Washington, D.C. 20010.
authors.forename: G S
authors.initials: GS
authors.lastname: Mintz
authors.forename: A D
authors.initials: AD
authors.lastname: Pichard
authors.forename: J A
authors.initials: JA
authors.lastname: Kovach
authors.forename: K M
authors.initials: KM
authors.lastname: Kent
authors.forename: L F
authors.initials: LF
authors.lastname: Satler
authors.forename: S P
authors.initials: SP
authors.lastname: Javier
authors.forename: J J
authors.initials: JJ
authors.lastname: Popma
authors.forename: M B
authors.initials: MB
authors.lastname: Leon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D017222:Angioplasty, Balloon, Laser-Assisted / Q000379:methods; D017225:Atherectomy, Coronary / Q000379:methods; D015986:Confounding Factors, Epidemiologic; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D012501:Saphenous Vein / Q000637:transplantation; D013223:Statistics as Topic; D013997:Time Factors; D014463:Ultrasonography / Q000379:methods