Intravascular ultrasound criteria for determination of optimal longitudinal positioning of sirolimus-eluting stents.
BACKGROUND
Several studies have indicated that the clinical outcomes of sirolimus-eluting stents (SES) are significantly associated with longitudinal positioning of the stent relative to the underlying plaque distribution.


RESULTS
Optimal SES landing was determined using unique stepwise intravascular ultrasound (IVUS) criteria, mainly targeting the sites with plaque burden <50% (plaque area/external elastic membrane area x100). To verify the criteria, (1) achievability and (2) actual impact on clinical and angiographic outcomes were assessed. A total of 162 consecutive patients with 180 lesions were enrolled and treated according to the IVUS criteria. Plaque burden at the proximal and distal margins was 41.4+/-13.6% (n=144) and 34.9+/-15.6% (n=170), respectively (within 3 mm of stent ends). The target was achieved in 72.3% of the proximal and 84.1% of the distal margin for the criteria. A strikingly low angiographic margin re-stenosis rate (2.7% of proximal and 1.4% of distal margin) and low target lesion revascularization rate (2.2%) were achieved. Receiver operator characteristic curve indicated that plaque burden was the strongest predictor of margin re-stenosis and its threshold (51.6%) was almost identical to that of the criteria.


CONCLUSIONS
The proposed stepwise IVUS criteria mainly targeting plaque burden <50% are feasible and useful in the real-world practice of SES implantation.
Division of Cardiology, Tokai University School of Medicine, Isehara 259-1193, Japan. ymorino@is.icc.u-tokai.ac.jp
Yoshihiro
Y
Morino
Seiji
S
Tamiya
Naoki
N
Masuda
Yota
Y
Kawamura
Masakazu
M
Nagaoka
Takashi
T
Matsukage
Nobuhiko
N
Ogata
Gaku
G
Nakazawa
Teruhisa
T
Tanabe
Yuji
Y
Ikari
D000368:Aged; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic; D019919:Prosthesis Implantation / Q000379:methods*; D020123:Sirolimus / Q000008:administration & dosage*; D018084:Ultrasonography, Interventional
D020123:Sirolimus