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A new intravascular ultrasound‐guided stenting strategy compared with angiography on stent expansion and procedural outcomes in patients with positive lesion remodeling
Author(s) -
Hakim Diaa,
Abdallah Mouhamad,
Effat Mohamed,
Al Solaiman Firas,
Alli Oluseun,
Leesar Massoud A.
Publication year - 2021
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28727
Subject(s) - intravascular ultrasound , medicine , stent , lumen (anatomy) , stenosis , lesion , angiography , target lesion , radiology , balloon , cardiology , nuclear medicine , percutaneous coronary intervention , surgery , myocardial infarction
Objectives We investigated the role of a new intravascular ultrasound (IVUS)‐guided stenting strategy versus angiography on optimal stent expansion (OSE) and procedural outcomes in patients with positive lesion remodeling. Background There are no IVUS criteria on how to achieve OSE. Methods A total of 100 patients were assigned to a new IVUS‐guided stenting strategy (IVUS group) versus angiography‐guided stenting (Angio group). In the IVUS group, among patients with positive lesion remodeling, defined as a remodeling ratio (RR; lesion external elastic membrane (EEM) area/distal reference EEM area) >1.05, the stent was expanded with a balloon sized to the distal reference EEM diameter. In the Angio group, the stent was expanded by visual estimation. In both groups, IVUS was performed after postdilation. Results Minimum stent area (MSA) and stent volume index were significantly larger in the IVUS versus Angio group (7.1 ± 1.9 vs. 5.9 ± 1.5 mm 2 , and 8.7 ± 2.1 vs. 7.5 ± 1.8 mm 3 /mm, respectively; p < .01). The percentages of OSE, defined as an MSA ≥5.4 mm 2 , MSA ≥90% of distal reference lumen area (DRLA), or MSA > DRLA, were significantly higher in the IVUS versus Angio group (80 vs. 56%, 78 vs. 54%, and 71 vs. 38%, respectively; p < .01). Stent underexpansion, malapposition, and residual reference segment stenosis were significantly higher in the Angio versus IVUS group (44 vs. 12%, 16 vs. 4%, and 12 vs. 0%, respectively; p < .05). In the IVUS group, owing to positive remodeling, there was no incidence of dissection or perforation. Conclusions This new strategy of IVUS‐guided stenting in patients with positive lesion remodeling, compared with angiography, significantly increased stent expansion and decreased stent underexpansion, malapposition, and residual reference segment stenosis with no complications.