Key result
IVUS-guided aggressive PTCA enables stent avoidance in ~47% of patients with low revascularization rates.
Why the study?
The impact of an IVUS-guided PTCA with provisional stenting strategy on long-term clinical outcomes was evaluated to optimize treatment and avoid unnecessary stenting.
Does an IVUS-guided PTCA strategy with provisional stenting allow for the avoidance of stent implantation without worsening clinical outcomes in patients with native coronary artery stenoses?
Cohort (n=284)
Does an IVUS-guided PTCA strategy with provisional stenting allow for the avoidance of stent implantation without worsening clinical outcomes in patients with native coronary artery stenoses?
An IVUS-guided aggressive PTCA strategy allows for the avoidance of stent implantation in approximately half of patients without increasing acute complications or worsening clinical outcomes.
Answers are grounded in this paper and cite their sources.
May support stent avoidance via IVUS-guided PTCA in selected lesions; hypothesis-generating for randomized trials.
Two hundred and eighty-four consecutive patients with 438 native coronary artery stenoses were enrolled prospectively in a study of intravascular ultrasound (IVUS)-guided percutaneous transluminal coronary angioplasty (PTCA) with provisional stenting: (1) aggressive lesion-site media-to-media balloon-sizing; (2) IVUS-assessment of residual lumen dimensions to identify optimal PTCA results (minimum lumen area = 65% of the average of the proximal and distal reference lumen areas or = 6.0 mm(2) and no major dissection); and (3) liberal stent crossover. Overall, 206 stenoses in 134 patients (47%) were treated with PTCA alone. Reasons for crossover were flow-limiting or lumen-compromising dissections in 28% of patients and suboptimal IVUS minimum lumen area in 72% of patients. At one year, 8% of stenoses in the PTCA group and 16% in the stent crossover group required revascularization. In approximately half of the patients treated using an IVUS-guided aggressive PTCA strategy, stent implantation could be avoided without sacrificing an increase in acute complications or worse clinical outcome.
No takes yet. Share an insight, caveat, or question.
Abizaid et al. (2001) conducted a cohort in native coronary artery stenoses (n=284). PTCA alone vs. stent crossover was evaluated on revascularization. An IVUS-guided aggressive PTCA strategy allowed stent avoidance in 47% of patients, with 1-year revascularization rates of 8% for PTCA alone versus 16% for those requiring stent crossover.
Synapse has enriched 10 related papers. Consider them for comparative context: