Intravascular ultrasound guidance improves angiographic and clinical outcome of stent implantation for long coronary artery stenoses: final results of a randomized comparison with angiographic guidance (TULIP Study).
BACKGROUND
Long coronary lesions treated with stents have a poor outcome. This study compared the 6-month outcome of stent implantation for long lesions in patients randomized to intravascular ultrasound (IVUS; n=73) or angiographic guidance (n=71).


RESULTS
Stenoses >20 mm in length and a reference diameter that permitted a stent diameter > or =3 mm were eligible. Primary end points were 6-month minimal lumen diameter (MLD) and the combined end point of death, myocardial infarction, and target-lesion revascularization (TLR). Baseline clinical and angiographic data were comparable in both groups. At 6 months, MLD in the IVUS group (1.82+/-0.53 mm) was larger than in the angiography group (1.51+/-0.71 mm; P=0.042). TLR and combined end-point rates at 6 months were 4% (n=3) and 6% (n=4) in the IVUS group and 14% (n=10) and 20% (n=14) in the angiography group, respectively (P=0.037 for TLR and P=0.01 for combined events). Restenosis (>50% diameter stenosis) was found in 23% of the IVUS group and 45% of the angiography group (P=0.008). At 12 months, TLR and the combined end point occurred in 10% (n=7) and 12% (n=9) of the IVUS group and 23% (n=17) and 27% (n=19) of the angiography group (P=0.018 and P=0.026), respectively.


CONCLUSIONS
Angiographic and clinical outcome up to 12 months after long stent placement guided by IVUS is superior to guidance by angiography.
Oemrawsingh
Pranobe V
PV
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. p.v.oemrawsingh@lumc.nl
Mintz
Gary S
GS
Schalij
Martin J
MJ
Zwinderman
Aeilko H
AH
Jukema
J Wouter
JW
van der Wall
Ernst E
EE
D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography / Q000379:methods; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome