Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan.
Coron Artery Dis. 2023 Nov 1;34(7):463-469. doi: 10.1097/MCA.0000000000001274. Epub 2023 Aug 16.
Previous studies have demonstrated the benefit of intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) for preventing longitudinal geographic miss (LGM). However, it is yet unclear whether IVUS guidance is useful for robotic-PCI (robotic-assisted perctaneous coronary intervention [R-PCI]).
A total of 58 consecutive patients with stable angina who underwent IVUS-guided R-PCI were enrolled. The stent landing position was angiographically marked using a balloon marker before stenting, followed by measurements of the expected stent length using balloon pullback. Subsequently, prestenting IVUS was performed to determine stent landing. All pre-PCI IVUS images were assessed for lesion length and percent plaque volume (%PV) using both IVUS and angiographic marking. LGM was defined as a residual %PV >50% at either the distal or proximal stent edge, any stent edge dissection, or additional stent deployment immediately after stenting.
The included patients had an average age of 67.1 ± 10.1 years. IVUS guidance had significantly longer lesion lengths compared with angiographic marking. Based on IVUS-guided stent deployment, nine cases exhibited LGM immediately after stenting. IVUS-marked landing points had a significantly smaller %PV and significantly larger lumen area compared with those for angiography.
IVUS-guided R-PCI was well-tolerated and may be better at preventing LGM compared with angiography-guided R-PCI.
先前的研究已经证明血管内超声（IVUS）引导经皮冠状动脉介入治疗（PCI）在预防纵向地理性缺失（LGM）方面的益处。然而，IVUS 引导是否对机器人 PCI（机器人辅助经皮冠状动脉介入治疗[R-PCI]）有用仍不清楚。
共纳入 58 例稳定型心绞痛患者，均接受 IVUS 引导的 R-PCI。在支架置入前，使用球囊标记物对支架的血管内超声（IVUS）定位，然后使用球囊回缩测量预期支架长度。随后，进行支架置入前 IVUS 检查以确定支架的位置。使用 IVUS 和血管造影标记评估所有 PCI 前 IVUS 图像的病变长度和斑块体积百分比（%PV）。LGM 定义为支架边缘远端或近端残留的 %PV>50%、任何支架边缘夹层或支架置入后立即进行额外的支架置入。
纳入的患者平均年龄为 67.1±10.1 岁。与血管造影标记相比，IVUS 引导的病变长度明显更长。根据 IVUS 引导的支架置入，9 例患者在支架置入后即刻出现 LGM。与血管造影相比，IVUS 标记的支架置入点具有更小的%PV 和更大的管腔面积。
与血管造影引导的 R-PCI 相比，IVUS 引导的 R-PCI 耐受性良好，并且可能更能预防 LGM。
