Fitzgerald P J, Oshima A, Hayase M, Metz J A, Bailey S R, Baim D S, Cleman M W, Deutsch E, Diver D J, Leon M B, Moses J W, Oesterle S N, Overlie P A, Pepine C J, Safian R D, Shani J, Simonton C A, Smalling R W, Teirstein P S, Zidar J P, Yeung A C, Kuntz R E, Yock P G
Stanford University Medical Center, Stanford, CA 94305-5246, USA.
Circulation. 2000 Aug 1;102(5):523-30. doi: 10.1161/01.cir.102.5.523.
Intravascular ultrasound (IVUS) can assess stent geometry more accurately than angiography. Several studies have demonstrated that the degree of stent expansion as measured by IVUS directly correlated to clinical outcome. However, it is unclear if routine ultrasound guidance of stent implantation improves clinical outcome as compared with angiographic guidance alone.
The CRUISE (Can Routine Ultrasound Influence Stent Expansion) study, a multicenter study IVUS substudy of the Stent Anti-thrombotic Regimen Study, was designed to assess the impact of IVUS on stent deployment in the high-pressure era. Nine centers were prospectively assigned to stent deployment with the use of ultrasound guidance and 7 centers to angiographic guidance alone with documentary (blinded) IVUS at the conclusion of the procedure. A total of 525 patients were enrolled with completed quantitative coronary angiography, quantitative coronary ultrasound, and clinical events adjudicated at 9 months for 499 patients. The IVUS-guided group had a larger minimal lumen diameter (2.9+/-0.4 versus 2.7+/-0. 5 mm, P<0.001) by quantitative coronary angiography and a larger minimal stent area (7.78+/-1.72 versus 7.06+/-2.13 mm(2), P<0.001) by quantitative coronary ultrasound. Target vessel revascularization, defined as clinically driven repeat interventional or surgical therapy of the index vessel at 9 month-follow-up, occurred significantly less frequently in the IVUS-guided group (8.5% versus 15.3%, P<0.05; relative reduction of 44%).
These data suggest that ultrasound guidance of stent implantation may result in more effective stent expansion compared with angiographic guidance alone.
血管内超声（IVUS）比血管造影更能准确评估支架形态。多项研究表明，通过IVUS测量的支架扩张程度与临床结果直接相关。然而，与单纯血管造影引导相比，支架植入的常规超声引导是否能改善临床结果尚不清楚。
CRUISE（常规超声能否影响支架扩张）研究是支架抗血栓治疗研究的一项多中心研究IVUS子研究，旨在评估IVUS在高压时代对支架植入的影响。9个中心前瞻性地被分配为使用超声引导进行支架植入，7个中心仅采用血管造影引导，并在手术结束时进行记录（盲法）IVUS。共有525例患者入组，完成了定量冠状动脉造影、定量冠状动脉超声检查，并对499例患者在9个月时的临床事件进行了判定。通过定量冠状动脉造影，IVUS引导组的最小管腔直径更大（2.9±0.4对2.7±0.5mm，P<0.001），通过定量冠状动脉超声，最小支架面积更大（7.78±1.72对7.06±2.13mm²，P<0.001）。在9个月随访时，定义为对靶血管进行临床驱动的重复介入或手术治疗的靶血管血运重建在IVUS引导组中发生的频率显著更低（8.5%对15.3%，P<0.05；相对降低44%）。
这些数据表明，与单纯血管造影引导相比，支架植入的超声引导可能导致更有效的支架扩张。
