Role of intravascular ultrasound (IVUS) in determining the therapeutic strategy for the patients with intermediate coronary lesions
##plugins.themes.academic_pro.article.main##
Abstract
Background: Coronarography presents some limits in assessing intermediate stenosis. Intravascular ultrasound provides tridimensional measurements of the artery, with more reliable data guiding revascularization decision.
aims: to evaluate the impact of intravascular ultrasound measurements on revascularization decision of intermediate and ambiguous coronary lesions.
methods: We prospectively analysed 40 patients’ coronary arteries from March 2009 to November 2011 by both quantitative coronary angiography (QCA) then intravascular ultrasound, and compared our decision before and after intravascular ultrasound.
results: in the final revascularization decision after intravascular ultrasound, medical treatment rate raised from 22% to 25%, percutaneous coronary intervention dropped from 55% to 50%, and coronary artery bypass graft slightly raised from 23% to 25%. Therapeutic decision changed after intravascular ultrasound in 47% of patients (p=0,01), which reflects an important impact of this technique in management of intermediate coronary lesions.
Conclusion : Intravascular ultrasound provided more accurate measurements which permitted a better detection of ischemia and influenced notably our therapeutic strategies.
Keywords:
Coronarography, intravascular ultrasound, quantitative coronary angiography.##plugins.themes.academic_pro.article.details##
References
- Zir LM, Miller SW, Dinsmore LE et al. Interobserver variability in coronary angiography. Circulation 1976;53:627-32.
- Reiber JHC, Serruys PW, Kooijman CJ et al. Assessement of shrt, medium and long term variations of arterial dimensions from computer assisted quantitation of coronary cineangiograms. Circulation 1985;71:280-8.
- Gould KL, Lipsomb K. Effects of coronary stenoses on coronary flow reserve and resistance. Am J Cardiol 1974;34:50-5.
- Kern MJ, Samady H. Current concepts of integrated coronary physiologyin the catheterization laboratory. J Am Coll Cardiol 2010;55:173-85.
- Eshtehardi P, Luke J, McDaniel MC et al. Intravascularimaging tools in the cardiac catheterization laboratory: comprehensiveassessment of anatomy and physiology. J Cardiovasc Transl Res2011;4:393-403.
- Takayama T, Hodgson JM. Prediction of the physiologic severity ofcoronary lesions using 3D IVUS: validation by direct coronary pressuremeasurements. Catheter Cardiovasc Interv 2001;53:48- 55.
- Abizaid A, Mintz GS, Pichard AD et al. Clinical, intravascularultrasound, and quantitative angiographic determinants of the coronaryflow reserve before and after percutaneous transluminal coronaryangioplasty. Am J Cardiol 1998;82:423-8.
- Nishioka T, Amanullah AM, Luo H et al. Clinical validation ofintravascular ultrasound imaging for assessment of coronary stenosisseverity: comparison with stress myocardial perfusion imaging. J AmColl Cardiol 1999;33:1870-8.
- Briguori C, Anzuini A, Airoldi F et al. Intravascular ultrasound criteriafor the assessment of the functional significance of intermediatecoronary artery stenoses and comparison with fractional flow reserve.Am J Cardiol 2001;87:136-41.
- Abizaid AS, Mintz GS, Mehran R et al. Long-term follow-up afterpercutaneous transluminal coronary angioplasty was not performedbased on intravascular ultrasound findings: importance of lumendimensions. Circulation 1999;100:256-61.
- Kang SJ, Lee JY, Ahn JM et al. Validation of intravascular ultrasoundderivedparameters with fractional flow reserve for assessment ofcoronary stenosis severity. Circ Cardiovasc Interv 2011;4:65-71.
- Bon-Kown K, Hyoung-Mo Y, Jun Hyung D et al. Optimal intravascular ultrasound criteria and their accuracy for defining the functional significance of intermediate coronary stenoses of different locations. J Am J Cardiol Interv 2011;4-803-11.
- Ben-Dor I, Torguson R, Gaglia MA Jr. et al. Correlation betweenfractional flow reserve and intravascular ultrasound lumen area in intermediatecoronary artery stenosis. EuroIntervention 2011;7:225-33.
- Lee CH, Tai BC, Soon CY et al. New set of intravascular ultrasoundderivedanatomic criteria for defining functionally significant stenosesin small coronary arteries (results from Intravascular Ultrasound Diagnostic, Evaluation of Atherosclerosis in Singapore [IDEAS] study).Am J Cardiol 2010;105:1378-84.
- Caracciolo EA, Davis KB, Sopko G et al. Comparison of surgical andmedical group survival in patients with left main equivalent coronary arterydisease. Long-term Cass experience. Circulation 1995;91:2335-44.
- Leesar MA, Masden R, Jasti V. Physiological and intravascularultrasound assessment of an ambiguous left main coronary arterystenosis. Catheter Cardiovasc Interv 2004;62:349- 57.
- Jasti V, Ivan E, Yalamanchili V et al. Correlations between fractional flow reserve and intravascular ultrasoundin patients with an ambiguous left main coronary artery stenosis.Circulation 2004;110:2831-6.
- De la Torre Hernandez JM, Hernà ndez-Hernandez F, Alfonso F et al. Prospective application of pre-definedintravascular ultrasound criteria for assessment of intermediate left main coronary artery lesions: results from the multicenter LITROstudy. J Am Coll Cardiol 2011;58:351-8.
- Fassa AA, Wagatsuma K, Higano ST et al. Intravascular ultrasoundguidedtreatment for angiographically indeterminate left main coronaryartery disease: a long-term follow-up study. J Am Coll Cardiol2005;45:204-11.
- Mc Daniel MC, Eshtehardi P, Sawaya FJ et al. Contemporary Clinical Applications of coronary intravascular ultrasound. J Am Coll Cardiol 2011;4:1156-64.