Intravascular ultrasound (IVUS) is a medical imaging methodology for Percutaneous Coronary Intervention (PCI). Clinical data consistently shows the benefits of IVUS to determine treatment strategy, guide stent placement, and assess procedural results for optimized long-term outcomes.¹ IVUS is a cornerstone of the SYNTAX II study design and was used 84.1% of the time. This trial demonstrates the importance of IVUS use to ensure the effectiveness of PCI.
Adequate stent expansion and apposition
IVUS usage post stent implantation led to further optimization of the stented lesion in 30.2% of lesions, predominantly further post-dilatation.
Visualization of a larger minimal stent area
Larger post-procedural MSA, evaluated by IVUS, was independently associated with the lower rate of Target Lesion Revascularization (TLR) at 2 years.
Coronary angiography has limitations
IVUS defines the extent and type of disease
SEE
IVUS confirms lesion modification
PREP
IVUS confirms optimal stent deployment
TREAT
Using IVUS to inform treatment planning and guide DES implantation.
The ADAPT-DES² study evaluated outcomes in patients undergoing PCI with IVUS use versus no IVUS use. IVUS guidance led to the use of larger stents or balloons, more post-dilatation, additional stents, or higher pressures in 74% of patients. The IVUS use group reported a significant reduction in MI (38%), ST (53%), MACE (35%), and TLR (20%). IVUS use was identified as an independent predictor of lower ST incidence.
Utilization of IVUS-guided PCI vs angiography-guided PCI alone leads to a statistically significant difference in major adverse cardiac events.
ULTIMATE TVF⁴ (n=1448)
RENOVATE-COMPLEX-PCI TVF⁵ (n=1639)
IVUS guidance to assess lesion morphology during stent implantation will improve both immediate and long-term clinical outcomes.
The IVUS-XPL⁶ Study found that, among patients with long coronary lesions (defined as greater than 28mm), IVUS- versus angiography-guided stent implantation led to an immediate divergence of clinical events at stent implantation that continued out to five years post procedure.
Data from the 2023 randomized controlled trial RENOVATE-COMPLEX-PCI⁷ proved an optimal procedure can reduce restenosis significantly a sub-optimal one. Stent optimization was defined as sufficient stent expansion without major stent malapposition to the vessel wall or edge dissection.
Developed in partnership with physicians to simplify IVUS workflow, IVUS 123 Essentials is a step-by-step guide that shows you how to easily incorporate imaging throughout every PCI procedure. Optimize outcomes by incorporating these 3 simple steps in your post PCI workflow.
A network meta-analysis presented by Dr Gregg W. Stone, MD at European Society of Cardiology congress 2023 showed reduced all-cause mortality and myocardial infarction (MI) rates with percutaneous coronary intervention (PCI) guided by intravascular imaging than with angiography guidance alone.⁸ This includes 20 randomized trials covering 12,428 patients with a mean follow-up of 26.4 months. 16 out of the 20 trials studied in this meta-analysis performed intra-vascular ultrasound (IVUS). Intravascular imaging (IVUS or OCT) guidance of PCI compared with angiography guidance of PCI resulted in
31% reductions in the primary composite outcome of target lesion failure
46% reductions in cardiac death
20% reductions in target vessel myocardial infarction
29% reductions in target lesion revascularization by 29%,
52% reduction in stent thrombosis
1. Banning AP, Serruys P, et al. Five-year outcomes after state-of-the-art percutaneous coronary revascularization in patients with de novo three-vessel disease: final results of the SYNTAX II study. Eur Heart J. 2022 Mar 31;43(13):1307-1316. doi: 10.1093/eurheartj/ehab703. PMID: 34617993; PMCID: PMC8970987.
2. Maehara A, Mintz GS, et al. Relationship Between Intravascular Ultrasound Guidance and Clinical Outcomes After Drug-Eluting Stents. Circ Cardiovasc Interv. 2018 Nov;11(11):e006243. doi: 10.1161/CIRCINTERVENTIONS.117.006243. PMID: 30571206.
3. Fujino A, Maehara A, Mintz G, et al. PREDICTORS OF LEFT MAIN CORONARY ARTERY STENT DIMENSIONS: AN EXCEL TRIAL INTRAVASCULAR ULTRASOUND SUBSTUDY. J Am Coll Cardiol. 2018 Mar, 71 (11_Supplement) A1451. https://doi.org/10.1016/S0735-1097(18)31992-2
4. Gao X, Ge Z, Kong X, et al. 3-Year Outcomes of the ULTIMATE Trial Comparing Intravascular Ultrasound Versus Angiography-Guided Drug-Eluting Stent Implantation. J Am Coll Cardiol Intv. 2021 Feb, 14 (3) 247–257. https://doi.org/10.1016/j.jcin.2020.10.001
5. Lee JM, Choi KH, Song YB, et al., on behalf of the RENOVATE-COMPLEX-PCI Investigators. Intravascular Imaging– Guided or Angiography-Guided Complex PCI. N Engl J Med 2023; 388:1668-79.
6. Hong S, Mintz G, Ahn C, et al. Effect of Intravascular Ultrasound–Guided Drug-Eluting Stent Implantation. J Am Coll Cardiol Intv. 2020 Jan, 13 (1) 62–71. https://doi.org/10.1016/j.jcin.2019.09.033
7. Lee JM, Choi KH, Song YB, et al., on behalf of the RENOVATE-COMPLEX-PCI Investigators. Intravascular Imaging– Guided or Angiography-Guided Complex PCI. N Engl J Med 2023; 388:1668-79.
8. Stone GW. Intravascular imaging guidance for PCI: a “real-time” updated network meta-analysis. Presented at: ESC 2023. August 27, 2023. Amsterdam, the Netherlands.