1
|
Yang Q, Ma X, Wang Y. Long-term outcomes of IVUS-guided and angiography-guided drug-eluting stent implantation for left main coronary artery disease: a retrospective consort study. J Cardiothorac Surg 2024; 19:407. [PMID: 38951893 PMCID: PMC11218326 DOI: 10.1186/s13019-024-02800-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/25/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND In patients with unprotected left main coronary artery disease (ULMCAD), this study compared the long-term prognosis of drug-eluting stent insertion guided by intravascular ultrasonography (IVUS) vs. angiography. PATIENTS AND METHODS This retrospective consort investigation was performed in December 2021. This analysis included 199 patients who underwent IVUS-guided (IVUS group, n = 81) or angiography-guided (angiography group, n = 118) drug-eluting stent implantation at the Affiliated Hospital of Inner Mongolia Medical University between September 2013 and September 2018. Major adverse cardiac events (MACE) were defined as cardiovascular death, sudden cardiac death, myocardial infarction. RESULTS The IVUS group had considerably lower proportions of MACE within 1 year postoperatively (P = 0.002) and cardiac mortality within 3 years postoperatively (P = 0.018) compared to the angiography group. However, after adjusting for confounding variables, the hazard ratio for 3-year cardiac mortality was similar between the two groups (P = 0.28). In the IVUS group, there was considerably greater minimum lumen diameter (MLD) (P = 0.046), and reduced frequencies of target vessel restenosis (P < 0.050) and myocardial infarction (MI) (P = 0.024) compared to the angiography group. Cox regression analysis for 3-year cardiac mortality found that MSD was independently associated with low cardiac mortality (HR = 0.1, 95% CI: 0.01-14.92, P = 0.030). CONCLUSION IVUS-guided drug-eluting stent implantation may lead to better long-term prognosis in patients with ULMCAD, and MSD may be a predictor for lower cardiac mortality.
Collapse
Affiliation(s)
- Qing Yang
- Department of Emergency Cardiovascular Medicine, Inner Mongolian People Hospital, Hohhot, 010000, China
| | - Xiaoyi Ma
- Department of cardiovascular medicine, Dalat people's Hospital, Erdos, 014300, China
| | - Yuexi Wang
- Department of cardiovascular medicine, Affiliated Hospital of Inner Mongolia Medical University, No. 1, Tongdao North Road, Hohhot, 010000, Inner Mongolia Autonomous Region, China.
| |
Collapse
|
2
|
Ashraf DA, Ahmed U, Khan ZZ, Mushtaq F, Bano S, Khan AR, Azam S, Haroon A, Malik SA, Aslam R, Kumar J, Khan FZ, Faheem A, Kumar S, Hassan S. Long-term clinical outcomes of intravascular imaging-guided percutaneous coronary intervention versus angiography-guided percutaneous coronary intervention in complex coronary lesions: a systematic review and meta-analysis. Future Cardiol 2024; 20:137-150. [PMID: 38623957 PMCID: PMC11216519 DOI: 10.2217/fca-2023-0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/12/2024] [Indexed: 04/17/2024] Open
Abstract
Background: In this study, we aim to discuss the long-term clinical outcomes of intravascular ultrasound imaging-guided percutaneous intervention (IVUS-PCI) versus angiography-guided percutaneous coronary intervention (PCI) in complex coronary lesions over a mean period of 2 years. Methods: A systematic search and meta-analysis were conducted to assess the efficacy of using intravascular ultrasound or optical coherence tomography guidance in coronary artery stenting compared to angiography. Results: A total of 11 randomized controlled trials with 6740 patients were included. For the primary outcome, a pooled analysis (3.2 vs 5.6%). For secondary outcomes, the risk was significantly low in image-guided percutaneous intervention compared with angiography. Conclusion: Intravascular imaging-guided PCI is significantly more effective than angiography-guided PCI in reducing the risk of target lesion revascularization, target vessel revascularization, cardiac death, major adverse cardiovascular events and stent thrombosis.
Collapse
Affiliation(s)
- Danish Ali Ashraf
- Department of Internal Medicine, Foundation University Medical College, Islamabad, 44000, Pakistan
| | - Usman Ahmed
- Department of Internal Medicine, Rawalpindi Medically University, Rawalpindi, 46000, Pakistan
| | - Zainab Zaib Khan
- Department of Internal Medicine, CMH Lahore Medical & Dental College, Lahore, 54810, Pakistan
| | - Fiza Mushtaq
- Department of Internal Medicine, Allama Iqbal Medical College, Lahore, 54700, Pakistan
| | - Shehar Bano
- Department of Internal Medicine, Gujranwala Medical College, Gujranwala, 52250, Pakistan
| | - Ali Raza Khan
- Department of Internal Medicine, Nishtar Medical University, Multan, 66000, Pakistan
| | - Saad Azam
- Department of Internal Medicine, Shaikh Khalifa Bin Zayed Al Nahyan Medical & Dental College, Lahore, 64260, Pakistan
| | - Abdullah Haroon
- Department of Internal Medicine, Ziauddin Medical College, Karachi, 75600, Pakistan
| | - Salman Ahmed Malik
- Department of Internal Medicine, Nishtar Medical University, Multan, 66000, Pakistan
| | - Raza Aslam
- Department of Internal Medicine, Nishtar Medical University, Multan, 66000, Pakistan
| | - Jai Kumar
- Department of Internal Medicine, Wayne State School of Medicine, Detroit, MI 48201, USA
| | - Farva Zaib Khan
- Department of Internal Medicine, Al-Nafees Medical College, Islamabad, 44000, Pakistan
| | - Amna Faheem
- Department of Internal Medicine, Abbottabad Int. Medical College, Abbottabad, Pakistan
| | - Sarwan Kumar
- Department of Internal Medicine, Wayne State School of Medicine, Detroit, MI 48201, USA
| | - Saad Hassan
- Department of Internal Medicine, Foundation University Medical College, Islamabad, 44000, Pakistan
| |
Collapse
|
3
|
Karim K, Akbar MR, Pramudyo M, Martha JW. Intravascular Ultrasound versus Angiography Guided Drug Eluting Stent Implantation in Patients with Left Main Coronary Artery Disease - A Systematic Review and Meta-Analysis. Rev Cardiovasc Med 2024; 25:32. [PMID: 39077662 PMCID: PMC11262383 DOI: 10.31083/j.rcm2501032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/05/2023] [Accepted: 09/14/2023] [Indexed: 07/31/2024] Open
Abstract
Background Several technical limitations exist in angiography procedures, including suboptimal visualization of a particular location and angiography only providing information about the contour of the vascular lumen, while intravascular ultrasound (IVUS) provides information regarding wall composition on coronary vascular lesions. With recent trials demonstrating IVUS benefits over standard angiography, our meta-analysis aimedto evaluate and summarize the current evidence on whether IVUS-guided drug-eluting stent (DES) placement resulted in better outcomes than the angiography-guided DES placement in patients with left main coronary artery (LMCA) disease. This meta-analysis aimed to analyze the current evidence on the IVUS-guided and angiography-guided drug-eluting stent (DES) placement in patients with LMCA disease. Methods Literature searching was performed using Scopus, Embase, PubMed, EuropePMC, and Clinicaltrials.gov using PRISMA guidelines. The intervention group in our study are patients undergoing IVUS-guided percutaneous coronary intervention (PCI) and the control group are patients undergoing angiography alone-guided PCI. Cardiovascular mortality, all-cause mortality, target lesion revascularization, myocardial infarction, and stent thrombosis were compared between the two groups. Results There were 11 studies comprising 24,103 patients included in this meta-analysis. IVUS-guided PCI was associated with lower cardiovascular mortality (hazard ratio (HR) 0.39 [95% CI 0.26, 0.58], p < 0.001; I 2 : 75%, p < 0.001) and all-cause mortality (HR 0.59 [95% CI 0.53, 0.66], p < 0.001; I 2 : 0%, p = 0.45) compared to angiography alone guided PCI. The group receiving IVUS guided PCI has a lower incidence of myocardial infarction (HR 0.66 [95% CI 0.48, 0.90], p = 0.008; I 2 : 0%, p = 0.98), target lesion revascularization (HR 0.45 [95% CI 0.38, 0.54], p < 0.001; I 2 : 41%, p = 0.10) and stent thrombosis (HR 0.38 [95% CI 0.26, 0.57], p < 0.001; I 2 : 0%, p = 0.50) compared to the control group. Conclusions Our meta-analysis demonstrated that IVUS-guided DES placement had lower cardiovascular mortality, all-cause mortality, target lesion revascularization, myocardial infarction, and stent thrombosis than angiography-guided DES implantation.
Collapse
Affiliation(s)
- Kevin Karim
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Padjadjaran, 40161 Bandung, Indonesia
| | - Mohammad Rizki Akbar
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Padjadjaran, 40161 Bandung, Indonesia
| | - Miftah Pramudyo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Padjadjaran, 40161 Bandung, Indonesia
| | - Januar Wibawa Martha
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Padjadjaran, 40161 Bandung, Indonesia
| |
Collapse
|
4
|
Fu PC, Wang JY, Su Y, Liao YQ, Li SL, Xu GL, Huang YJ, Hu MH, Cao LM. Intravascular ultrasonography assisted carotid artery stenting for treatment of carotid stenosis: Two case reports. World J Clin Cases 2023; 11:7127-7135. [PMID: 37946762 PMCID: PMC10631408 DOI: 10.12998/wjcc.v11.i29.7127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/09/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Digital subtraction angiography (DSA), the gold standard of cerebrovascular disease diagnosis, is limited in its diagnostic ability to evaluate arterial diameter. Intravascular ultrasonography (IVUS) has advantages in assessing stenosis and plaque nature and improves the evaluation and effectiveness of carotid artery stenting (CAS). CASE SUMMARY Case 1: A 65-year-old man presented with a five-year history of bilateral lower limb weakness due to stroke. Physical examination showed decreased strength (5-/5) in both lower limbs. Carotid artery ultrasound, magnetic resonance angiography, and computed tomography angiography (CTA) showed a right proximal internal carotid artery (ICA) stenosis (70%-99%), acute cerebral infarction, and severe right ICA stenosis, respectively. We performed IVUS-assisted CAS to measure the stenosis and detected a low-risk plaque at the site of stenosis prior to stent implantation. Post-stent balloon dilatation was performed and postoperative IVUS demonstrated successful expansion and adherence. CTA six months postoperatively showed no significant increase in in-stent stenosis. Case 2: A 36-year-old man was admitted with a right common carotid artery (CCA) dissection detected by ultrasound. Physical examination showed no positive neurological signs. Carotid ultrasound and CTA showed lumen dilation in the proximal CCA with an intima-like structure and bulging in the proximal segment of the right CCA with strip-like low-density shadow (dissection or carotid web). IVUS-assisted DSA confirmed right CCA dissection. CAS was performed and intraoperative IVUS suggested a large residual false lumen. Post-stent balloon dilatation was performed reducing the false lumen. DSA three months postoperatively indicated good stent expansion with mild stenosis. CONCLUSION IVUS aids decision-making during CAS by accurately assessing carotid artery wall lesions and plaque nature preoperatively, dissection and stenosis morphology intraoperatively, and visualizing and confirming CAS postoperatively.
Collapse
Affiliation(s)
- Peng-Cheng Fu
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen 518000, Guangdong Province, China
| | - Jing-Yi Wang
- Faculty of Chinese Medicine, Macau University of Science and Technology, Macau 999078, China
| | - Ying Su
- Graduate School, Guangzhou Medical University, Guangzhou 511495, Guangdong Province, China
| | - Yu-Qi Liao
- School of Medicine, Shenzhen University, Shenzhen 518000, Guangdong Province, China
| | - Shao-Ling Li
- School of Medicine, Shenzhen University, Shenzhen 518000, Guangdong Province, China
| | - Ge-Lin Xu
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen 518000, Guangdong Province, China
| | - Yan-Jiao Huang
- Medical Department, Baise People’s Hospital, Baise 533000, Guangxi Zhuang Autonomous Region, China
| | - Ming-Hua Hu
- Hunan Provincial Key Laboratory of the Research and Development of Novel Pharmaceutical Preparations, Changsha Medical University, Changsha 410219, Hunan Province, China
| | - Li-Ming Cao
- Clinical College of the Shenzhen Second People’s Hospital, Anhui Medical University, Shenzhen 518000, Guangdong Province, China
| |
Collapse
|
5
|
Sung JH, Chang JH. Mechanically Rotating Intravascular Ultrasound (IVUS) Transducer: A Review. SENSORS (BASEL, SWITZERLAND) 2021; 21:3907. [PMID: 34198822 PMCID: PMC8201242 DOI: 10.3390/s21113907] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/31/2021] [Accepted: 06/03/2021] [Indexed: 12/30/2022]
Abstract
Intravascular ultrasound (IVUS) is a valuable imaging modality for the diagnosis of atherosclerosis. It provides useful clinical information, such as lumen size, vessel wall thickness, and plaque composition, by providing a cross-sectional vascular image. For several decades, IVUS has made remarkable progress in improving the accuracy of diagnosing cardiovascular disease that remains the leading cause of death globally. As the quality of IVUS images mainly depends on the performance of the IVUS transducer, various IVUS transducers have been developed. Therefore, in this review, recently developed mechanically rotating IVUS transducers, especially ones exploiting piezoelectric ceramics or single crystals, are discussed. In addition, this review addresses the history and technical challenges in the development of IVUS transducers and the prospects of next-generation IVUS transducers.
Collapse
Affiliation(s)
| | - Jin-Ho Chang
- Department of Information and Communication Engineering, Deagu Gyeongbuk Institute of Science and Technology, Daegu 42988, Korea;
| |
Collapse
|
6
|
Ono M, Kawashima H, Hara H, Gao C, Wang R, Kogame N, Takahashi K, Chichareon P, Modolo R, Tomaniak M, Wykrzykowska JJ, Piek JJ, Mori I, Courtney BK, Wijns W, Sharif F, Bourantas C, Onuma Y, Serruys PW. Advances in IVUS/OCT and Future Clinical Perspective of Novel Hybrid Catheter System in Coronary Imaging. Front Cardiovasc Med 2020; 7:119. [PMID: 32850981 PMCID: PMC7411139 DOI: 10.3389/fcvm.2020.00119] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/05/2020] [Indexed: 12/14/2022] Open
Abstract
Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have been developed and improved as both diagnostic and guidance tools for interventional procedures over the past three decades. IVUS has a resolution of 100 μm with a high tissue penetration and capability of assessing the entire structure of a coronary artery including the external elastic membrane, whereas OCT has a higher resolution of 10–20 μm to assess endoluminal structures with a limited tissue penetration compared to IVUS. Recently, two companies, CONAVI and TERUMO, integrated IVUS and OCT into a single catheter system. With their inherent strength and limitations, the combined IVUS and OCT probes are complementary and work synergistically to enable a comprehensive depiction of coronary artery. In this review, we summarize the performance of the two intracoronary imaging modalities—IVUS and OCT—and discuss the expected potential of the novel hybrid IVUS–OCT catheter system in the clinical field.
Collapse
Affiliation(s)
- Masafumi Ono
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Hideyuki Kawashima
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Hironori Hara
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Chao Gao
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland.,Department of Cardiology, Radboud University, Nijmegen, Netherlands.,Depatrment of Cardiology, Xijing hospital, Xi'an, China
| | - Rutao Wang
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland.,Department of Cardiology, Radboud University, Nijmegen, Netherlands.,Depatrment of Cardiology, Xijing hospital, Xi'an, China
| | - Norihiro Kogame
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Kuniaki Takahashi
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ply Chichareon
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Rodrigo Modolo
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Cardiology Division, Department of Internal Medicine, University of Campinas (UNICAMP), Campinas, Brazil
| | - Mariusz Tomaniak
- Thoraxcentre, Erasmus Medical Centre, Rotterdam, Netherlands.,First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Joanna J Wykrzykowska
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Jan J Piek
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Brian K Courtney
- Schulich Heart Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,Conavi Medical, North York, ON, Canada
| | - William Wijns
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Faisal Sharif
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | | | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| |
Collapse
|
7
|
Pavillard E, Sewall L. A post-market, multi-vessel evaluation of the imaging of peripheral arteries for diagnostic purposeS comparing optical Coherence tomogrApy and iNtravascular ultrasound imaging (SCAN). BMC Med Imaging 2020; 20:18. [PMID: 32059702 PMCID: PMC7023791 DOI: 10.1186/s12880-020-0420-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 01/30/2020] [Indexed: 11/29/2022] Open
Abstract
Background Intravascular imaging plays an important part in diagnosis of vascular conditions and providing insight for treatment strategy. Two main imaging modalities are intravascular ultrasound (IVUS) and optical coherence tomography (OCT). The objective of this study was to prove non-inferiority of OCT imaging to IVUS images in matched segments of peripheral vessels in patients with suspected peripheral vascular disease. Methods The SCAN study was a prospective, non-inferiority clinical study of matched IVUS and OCT images collected along defined segments of peripheral vessels from twelve subjects (mean age 68 ± 10.3 years; 10 men) displaying symptoms of vascular disease. Luminal diameters were measured by both imaging systems at the distal, middle, and proximal points of the defined segments. Three blinded interventional radiologists evaluated the quality of both imaging modalities in identifying layered structures (3-point grading), plaque (5-point grading), calcification (5-point grading), stent structure (3-point grading), and artifacts (3-point grading) from 240 randomly ordered images. Mean grading scores and luminal diameters were calculated and analyzed with Student’s t-Test and Mann-Whitney-Wilcoxon testing. Intrareader reproducibility was calculated by intraclass correlation (ICC) analysis. Results The mean scoring of plaque, calcification, and vascular stent struts by the three readers was significant better in terms of image quality for OCT than IVUS (p < 0.001, p = 0.001, p = 0.004, respectively). The mean scores of vessel wall component visibility and artifacts generated by the two imaging systems were not significantly different (p = 0.19, p = 0.07, respectively). Mean vessel luminal diameter and area at three specific locations within the vessels were not significantly different between the two imaging modalities. No patient injury, adverse effect or device malfunction were noted during the study. Conclusions Imaging by OCT provides the physician with better visualization of some vessel and plaque chacteristics, but both IVUS and OCT imaging are safe and effective methods of examining peripheral vessels in order to perform diagnostic assessment of peripheral vessels and provide information necessary for the treatment strategy of peripheral artery disease. Trial registration NCT03480685 registered on 29 March 2018.
Collapse
Affiliation(s)
- Edward Pavillard
- Pennsylvania Vascular Institute, 420 W. Linfield-Trappe Road Suite 3200, Limerick, PA, 19468, USA.
| | - Luke Sewall
- AMITA Health, 911 N. Elm Street Suite 128, Hinsdale, IL, 60521, USA
| |
Collapse
|