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Vats V, Elahi A, Hidri S, Abdelkader RE, Munaf F, Prince JM, Asif MA, Cheema HA, Ahmad A, Rehman WU, Nashwan AJ, Ahmed R, Lakhter V, Virk HUH, Vincent RP. Optical coherence tomography-guided vs. intravascular ultrasound-guided percutaneous coronary intervention: a systematic review and meta-analysis of randomized controlled trials. Front Cardiovasc Med 2024; 11:1395606. [PMID: 38883988 PMCID: PMC11176458 DOI: 10.3389/fcvm.2024.1395606] [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: 03/18/2024] [Accepted: 05/20/2024] [Indexed: 06/18/2024] Open
Abstract
Background Optical coherence tomography (OCT) and intravascular ultrasound (IVUS) are superior to coronary angiography for guiding percutaneous coronary intervention (PCI). However, whether one technique is superior to the other is inconclusive. Methods We searched PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov from inception to November 2023 for randomized controlled trials (RCTs) comparing OCT and IVUS in patients undergoing PCI. RevMan 5.4 was used to pool outcomes with risk ratio (RR) as the effect measure. Results Six RCTs (4,402 patients) were included in this meta-analysis. There was no significant difference between the OCT- and IVUS-guided PCI groups in the risk of major adverse cardiovascular events (RR 0.87, 95% CI: 0.65, 1.16; I2 = 0%) and cardiac mortality (RR 0.73, 95% CI: 0.24, 2.21; I2 = 0%). The results were consistent across the subgroups of the presence or absence of left main disease (P interaction >0.1). There were no significant differences between OCT and IVUS in the risk of target lesion revascularization (RR 0.78, 95% CI: 0.47, 1.30; I2 = 0%), target vessel revascularization (RR 1.06, 95% CI: 0.69, 1.62; I2 = 0%), target-vessel myocardial infarction (RR 0.79, 95% CI: 0.40, 1.53; I2 = 0%), stent thrombosis (RR 0.59, 95% CI: 0.12, 2.97; I2 = 0%), and all-cause mortality (RR 1.01, 95% CI: 0.53, 1.90; I2 = 0%). Conclusions Our meta-analysis demonstrated similar clinical outcomes in OCT- and IVUS-guided PCI. New large-scale multicenter RCTs with long-term follow-up are required to confirm or refute our findings and provide more reliable results. Systematic Review Registration PROSPERO, identifier, CRD42023486933.
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Affiliation(s)
- Vaibhav Vats
- Department of Medicine, Smt. Kashibai Navale Medical College and General Hospital, Pune, India
| | - Aarij Elahi
- Department of Medicine, Royal Glamorgan Hospital, Pontyclun, United Kingdom
| | - Sinda Hidri
- Department of Internal Medicine, East Carolina University, Greenville, NC, United States
| | | | - Farhan Munaf
- Department of Medicine, Liaquat National Medical College, Karachi, Pakistan
| | - Jennifer Mercika Prince
- Department of Haematology-Oncology, National University Hospital (NUH), Singapore, Singapore
| | - Muhammad Ahsan Asif
- Department of Radiology and Medical Imaging, Jinnah Hospital, Lahore, Pakistan
| | | | - Adeel Ahmad
- Department of Internal Medicine, Mass General Brigham-Salem Hospital, Salem, MA, United States
| | - Wajeeh Ur Rehman
- Department of Internal Medicine, United Health Services Hospital, Johnson, NY, United States
| | | | - Raheel Ahmed
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
- Department of Cardiology, Royal Brompton Hospital, London, United Kingdom
| | - Vladimir Lakhter
- Cardiology Division, Department of Internal Medicine, Temple University Hospital, Philadelphia, PA, United States
| | - Hafeez Ul Hassan Virk
- Department of Cardiovascular Disease, Adena Regional Medical Center, Chillicothe, OH, United States
| | - Royce P Vincent
- Department of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, London, United Kingdom
- Honorary Senior Lecturer, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
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Benedict T, Hassan E, Mir M, Boike S, Gao J, Khan SA. Early stent fractures in superficial femoral artery resulting multiple pseudoaneurysm formation within one year: a case report. CVIR Endovasc 2023; 6:45. [PMID: 37688689 PMCID: PMC10492725 DOI: 10.1186/s42155-023-00391-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/15/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Though fracture is known complication of stenting, pseudoaneurysm asscoiated with stent fracture is an extremely rare complication. This has previoulsy been described to occur at least one or more years following initial stent placement. Here we present a case of multi-site stent fracture leading to two separate SFA pseudoaneurysms within one year of placement, successfully treated with covered stents. CASE PRESENTATION A 72-year-old male presented with severe claudication of his left lower extremity (Rutherford 3), found to have long segment SFA chronic total occlusion (CTO). Patient successfully underwent endovascular revascularization. Follow-up duplex ultrasound (US) at one year demonstrated a focus of severe in-stent restenosis (ISR). During repeat angiogram for treatment of the stenosis, stent fracture and pseudoaneurysm was seen in the distal SFA, which was treated successfully with a self-expanding covered stent. Additional stent fractures and pseudoanerusyms were subseuqently identified on follow-up, necessitating a third angiogram, and these were successfully repaired using overlapping covered stents, without further recurrence. CONCLUSIONS Superficial femoral artery stent fractures leading to pseudoaneurysms are extremely rare, particularly within first year of stent placement. Endovascular repair with covered stents has proven to be an effective treatment option with decreased procedural morbidity compared to surgical repair.
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Affiliation(s)
- Taylor Benedict
- University of Minnesota Medical School, Minneapolis, MN, 55455, USA
| | - Esraa Hassan
- Critical Care Medicine, Mayo Clinic Health System, Mankato, MN, 56001, USA
| | - Mikael Mir
- University of Minnesota Medical School, Minneapolis, MN, 55455, USA
| | - Sydney Boike
- University of Minnesota Medical School, Minneapolis, MN, 55455, USA
| | - Jidi Gao
- Department of Radiology, Mayo Clinic Health System, Mankato, MN, 56001, USA.
| | - Syed Anjum Khan
- Critical Care Medicine, Mayo Clinic Health System, Mankato, MN, 56001, USA
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Abdul-Kafi O, Toole M, Montes-Rivera M, Shroff A, Ardati A. Measure Twice, Cut Once: Adjunctive Physiology and Imaging in Left Main PCI. CURRENT CARDIOVASCULAR IMAGING REPORTS 2021. [DOI: 10.1007/s12410-021-09562-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Quintana B, Ibrahim A. Role of Intravascular Ultrasound in Guiding Complex Percutaneous Coronary Interventions. US CARDIOLOGY REVIEW 2020. [DOI: 10.15420/usc.2020.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Complex percutaneous coronary interventions (PCIs) are increasing in frequency due to the rapid advances in interventional cardiology. This has had a favorable impact on patients with extensive coronary artery disease and multiple comorbidities with regard to symptomatic relief and mortality. With this increase, cardiologists must develop a standardized way to approach complex PCI in an era in which angiographic guidance alone yields suboptimal results. Intravascular ultrasound (IVUS) has been shown to improve outcomes with better preprocedural planning, improved stent placement, and larger stent diameters. Considering the supportive data, the use of IVUS is crucial in all cases of complex PCI.
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Affiliation(s)
| | - Akram Ibrahim
- Southeastern Cardiology Associates, Columbus, GA; Emory University School of Medicine, Atlanta, GA
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