Angiographic and clinical comparisons of intravascular ultrasound- versus angiography-guided drug-eluting stent implantation for patients with chronic total occlusion lesions: two-year results from a randomised AIR-CTO study.
OBJECTIVE
This study sought to compare angiographic endpoints at one-year follow-up after a drug-eluting stent implantation guided by either intravascular ultrasound (IVUS) or angiography in patients with chronic total occlusion (CTO) lesions.


RESULTS
Patients with at least one CTO lesion recanalised successfully were randomly assigned to the IVUS-guided or the angiography-guided group. The use of IVUS for penetration of the true lumen and optimisation of stent expansion was only done in the IVUS-guided group. The primary endpoint was in-stent late lumen loss (LLL) at one-year follow-up. A total of 230 patients with CTO lesions after successful recanalisation were enrolled and followed with office visits or telephone contact up to 24 months. In-stent LLL in the IVUS-guided group was significantly lower compared to the angiography-guided group at one-year follow-up (0.28±0.48 mm vs. 0.46±0.68 mm, p=0.025), with a significant difference in restenosis of the "in-true-lumen" stent between the two groups (3.9% vs.13.7%, p=0.021). The minimal lumen diameter and minimal stent cross-section area significantly and negatively correlated with LLL (all p<0.001). The rates of adverse clinical events were comparable between the IVUS- and angiography-guided groups at two-year follow-up (21.7% vs. 25.2%, p=0.641).


CONCLUSIONS
The IVUS-guided stenting of the CTO lesion was associated with less LLL and a lower incidence of "in-true-lumen" stent restenosis. Additional study is required to identify the clinical benefit of the IVUS-guided procedure for CTO lesions. [ChiCTR-TRC-10000996].
Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Nai-Liang
NL
Tian
Sandeep-Kumar
SK
Gami
Fei
F
Ye
Jun-Jie
JJ
Zhang
Zhi-Zhong
ZZ
Liu
Song
S
Lin
Zhen
Z
Ge
Shou-Jie
SJ
Shan
Wei
W
You
Liang
L
Chen
Yao-Jun
YJ
Zhang
Gary
G
Mintz
Shao-Liang
SL
Chen
D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000601:surgery*; D023903:Coronary Restenosis / Q000453:epidemiology; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D013927:Thrombosis / Q000453:epidemiology; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional