title: Stepwise intravascular ultrasound (IVUS) guidance of high-pressure coronary stenting does not result in an improved acute or long-term outcome: a randomized comparison to "final-look" IVUS assessment.
abstract: The objective of this study was to evaluate the potential benefit of stepwise intravascular ultrasound (IVUS)-guided coronary stent deployment compared to angiographic stent implantation with final IVUS assessment only. Acute procedural success and 6-month angiographic follow-up were compared in both groups. Intravascular ultrasound was performed using a 20- or 30-MHz mechanically rotated catheter in 85 patients who were prospectively randomized to group A (n=42; IVUS-guided) and group B (n=43; angiography +/- final IVUS assessment). There was no difference in the number of stents implanted (1.5+/-0.9 stents/lesion in group A and 1.3+/-0.6 stents/lesion in group B), the duration of the procedure, or the amount of contrast medium used. Defined criteria of optimal stent deployment (stent apposition, stent symmetry, complete coverage of dissections, >90% in-stent lumen area/reference lumen area) were achieved in 54.2% in group A and 56.6% in group B (NS). Angiographic follow-up was 87.1% at 6+/-2 months, and clinical follow-up was 100% at 8+/-1 months. There was no significant difference in restenosis rate (33.3% vs. 34.9%) applying a binary >50% diameter stenosis criterion for both groups. There was no significant difference in minimal in-stent lumen area at both baseline (7.91+/-2.64 mm2 vs. 7.76+/-2.21 mm2) and follow-up (5.84+/-2 mm2 vs. 5.52+/-1.87 mm2). With regard to immediate procedural lumen gain and rate of restenosis, multiple IVUS examinations during the procedure showed no advantage compared to final IVUS assessment only.
authors.affiliation: Department of Cardiology, University Hospital Essen, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Jeremias
authors.forename: G
authors.initials: G
authors.lastname: Görge
authors.forename: T
authors.initials: T
authors.lastname: Konorza
authors.forename: M
authors.initials: M
authors.lastname: Haude
authors.forename: C
authors.initials: C
authors.lastname: von Birgelen
authors.forename: J
authors.initials: J
authors.lastname: Ge
authors.forename: H
authors.initials: H
authors.lastname: Simon
authors.forename: R
authors.initials: R
authors.lastname: Erbel
mesh_terms: D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D015607:Stents; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional