Key result
IVUS-guided PCI for very long lesions yields a ~2.5% 1-year target vessel failure rate.
Why the study?
PCI in long coronary artery lesions (≥30 mm) is associated with more frequent TVF and persistent post-PCI ischemia, prompting investigation into the impact of IVUS guidance on functional results and 1-year TVF.
What is the impact of IVUS-guided PCI validated with FFR on functional and anatomical procedural results and 1-year target vessel failure in patients with very long coronary artery lesions (≥30 mm)?
Cohort (n=80)
Non-blinded
No
What is the impact of IVUS-guided PCI validated with FFR on functional and anatomical procedural results and 1-year target vessel failure in patients with very long coronary artery lesions (≥30 mm)?
In patients undergoing PCI for very long coronary lesions (mean stent length 62 mm), combining IVUS guidance with FFR assessment completely eliminated residual ischemia (FFR ≤ 0.8) and resulted in a very low 1-year target vessel failure rate of 2.5%, even though only 25% of patients met both strict anatomical and physiological optimization criteria.
IVUS-guided PCI linked to low failure and no residual ischemia in long lesions; hypothesis-generating, needs RCTs before practice change.
Background: Studies have shown that percutaneous coronary intervention (PCI) in long coronary artery lesions (≥30 mm) is associated with more frequent target vessel failure (TVF), and a significant proportion of patients have lesions that continue to induce ischemia after PCI (FFR ≤ 0.8). We investigated the impact of intravascular ultrasound (IVUS) on the functional PCI result and one-year TVF rate after the percutaneous treatment of long coronary artery lesions. Methods: A total of 80 patients underwent IVUS-guided PCI in long coronary artery lesions. The PCI results were validated with IVUS and FFR. Procedural outcomes were the proportion of patients with: (1) optimal physiology result (post PCI FFR value ≥ 0.9); (2) optimal anatomy result (all IVUS PCI optimization criteria met); and (3) optimal physiology and anatomy result. The clinical outcome was TVF during a one-year follow-up (target vessel (TV)-related death, TV myocardial infarction, ischemia-driven TV revascularization). Results: The mean stented segment length was 62 mm. The target vessel (TV) was the left anterior descending artery in 82.5% of cases. There were no patients with residual ischemia (FFR ≤ 0.8) after PCI. Optimal coronary flow (FFR ≥ 0.9) was achieved in 37.5%; optimal anatomy, as assessed by IVUS, was achieved in 68.4%; and both optimal flow and anatomy were achieved in 25% of patients. Target vessel failure during the 12-month follow-up was 2.5%. Conclusions: In the percutaneous treatment of very long coronary artery lesions, the use of IVUS guidance is associated with a low TVF rate during a one-year follow-up and no residual myocardial ischemia, as assessed by FFR.
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Budrys et al. (2022) conducted a cohort in Long coronary artery lesions (requiring stent length ≥30 mm) (n=80). Intravascular ultrasound (IVUS)-guided PCI validated with IVUS and fractional flow reserve (FFR) was evaluated on Target vessel failure (composite of target vessel-related death, target vessel myocardial infarction, and ischemia-driven target vessel revascularization) at 12 months. IVUS-guided PCI in very long coronary artery lesions resulted in a 2.5% 1-year target vessel failure rate and 0% residual myocardial ischemia (FFR ≤ 0.8).
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