Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
Korean Circ J. 2013 May;43(5):303-8. doi: 10.4070/kcj.2013.43.5.303. Epub 2013 May 31.
Intravascular ultrasound (IVUS) is helpful during percutaneous coronary intervention (PCI), because it can be used to confirm good apposition or optimal expansion of stents. In this study, we compared angiographic result as well as clinical outcomes between two different strategies of IVUS-guidance, the selective vs. the routine.
The study population consisted of 279 patients undergoing electric and emergency intracoronary implatation of TAXUS stent from August 2003 through September 2006. For this study, we divided physicians into two groups; doctors to perform PCI under 'routine' IVUS-guidance vs. PCI under 'selective' IVUS-guidance. Among a total of 279 patients (384 lesions) who underwent PCI with TAXUS stent, 87 patients underwent the procedure under the strategy of 'routine' IVUS-guidance, whereas 192 patients under 'selective' IVUS-guidance.
The baseline clinical features of the patients are similar between the two groups. The actual rate of IVUS usage was 89.2% in the routine group and 68.2% in the selective group (p<0.01). A high rate of adjunctive ballooning was determined as a remarkable procedure-related parameter which was comparable between the two groups (72.5% vs. 76.1% in routine vs. selective, p=0.57). The minimal lumen diameter at immediate post-PCI was significantly larger in the routine IVUS group than that in the selective group (2.58 mm vs. 2.48 mm, p=0.03). However, the difference disappeared during the follow-up period (1.98 mm vs. 1.98 mm, p=0.94). Clinical outcomes at 1 year were not different between the two groups.
PCI under the strategy of 'selective' IVUS-guidance was comparable to PCI under 'routine' IVUS-guidance in terms of angiographic and clinical outcomes in circumstances with frequent use of adjunctive ballooning after stenting.
血管内超声（IVUS）在经皮冠状动脉介入治疗（PCI）中很有帮助，因为它可以用于确认支架的良好贴壁或最佳扩张。在这项研究中，我们比较了两种不同的 IVUS 指导策略（选择性与常规性）的血管造影结果和临床结局。
研究人群包括 2003 年 8 月至 2006 年 9 月期间接受电和紧急冠状动脉 TAXUS 支架植入的 279 例患者。在这项研究中，我们将医生分为两组；一组在“常规”IVUS 指导下进行 PCI，另一组在“选择性”IVUS 指导下进行 PCI。在总共接受 TAXUS 支架 PCI 的 279 例患者（384 处病变）中，87 例患者接受了“常规”IVUS 指导下的手术，192 例患者接受了“选择性”IVUS 指导下的手术。
两组患者的基线临床特征相似。常规组实际使用 IVUS 的比例为 89.2%，选择性组为 68.2%（p<0.01）。辅助球囊扩张的高发生率是一个显著的与手术相关的参数，两组之间相似（常规组 72.5%，选择性组 76.1%，p=0.57）。即刻 PCI 后最小管腔直径在常规 IVUS 组明显大于选择性组（2.58mm 对 2.48mm，p=0.03）。然而，在随访期间，这种差异消失了（1.98mm 对 1.98mm，p=0.94）。两组患者 1 年临床结局无差异。
在支架置入后频繁使用辅助球囊扩张的情况下，“选择性”IVUS 指导下的 PCI 在血管造影和临床结局方面与“常规”IVUS 指导下的 PCI 相当。
