In-Hospital and 1-Year Results of Intravascular Ultrasound-Guided Versus Angiography-Guided Intervention for Type C Coronary Lesions

Abstract

Background: Class C lesions are considered to have the highest degree of lesion complexity so we compared between Intravascular Ultrasound (IVUS)-guided and angiography-guided PCI for Type C coronary lesions regarding procedural success and occurrence of Major Adverse Cardiac Events (MACE). Results: Our study was conducted on patients undergoing elective PCI for type C coronary lesions. The study included 50 patients who underwent IVUS guided PCI and 50 patients who underwent angiographic guided PCI. We evaluated IVUS guidance on clinical outcomes. MACE, all-cause mortality, ST elevation infarction, and target lesion revascularization, were end points for comparison. Follow-up duration was 12 months. Adding IVUS to the procedure was associated with more procedure time but with less amount of contrast. Patients with IVUS-guided PCI underwent more direct stenting, post-dilatation, larger maximal stent diameter, and greater number of implanted stents. The IVUS guided group had significantly better final diameter stenosis but at 1-year follow up, IVUS use failed to reduce MACE significantly in comparison to angiographic guidance. In conclusion: use of IVUS is associated with lower amount of radiographic contrast used during the procedure, more procedural time, more post dilatation and less postintervention final diameter stenosis. In addition, use of IVUS in complex lesions allows optimizing PCI procedures and stent apposition. A strategy of IVUS for stent implantation in complex coronary lesions didn’t reduce the 1-year MACE rates and thus, isn’t recommended routinely