Intravascular Imaging During PCI
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2]
- Due to angiography limitations, intra-coronary imaging can be used to guide coronary stent implantation, especially in patients with left main coronary artery involvement or complex lesions.[1]
- Intravascular ultrasound (IVUS) and optical coherence tomography (OCT are two imaging methods that can be used to assess vasculature conditions before and after PCI.
- Both imaging methods can assist in evaluating the need for lesion preparation, stent sizing, diminishing geographic-related errors, confirming stent expansion, identifying complications, and causes of stent failure.[2]
ACA 2021 Revascularization Guideline
| Class 2a Recommendation, Level of Evidence: B-R[1] |
| 1.Intravascular ultrasound (IVUS) can be used as a procedural guidance in patients undergoing coronary stent implantation, particularly in those with left main or complex coronary artery stenting in order to diminish ischemic events.
2.Optical coherence tomography (OCT is a reasonable alternative to IVUS as an procedural guidance in patients undergoing coronary stent implantation, except in those with ostial left main disease. |
| Class 2a Recommendation, Level of Evidence: C-LD[1] |
| If stent failure occurs, both IVUS and OCT can be used to determine the mechanism of stent failure. |
Intravenous Ultrasound
- Multiple meta-analyses have shown that intravascular ultrasound-guided PCI is more successful in reducing major adverse cardiovascular events (MACE) compared to angiographic-guided PCI.[3][4][5][6][7]
- Furthermore, based on a trial named ULTIMATE (Intravascular Ultrasound Guided Drug Eluting Stents Implantation in “All-Comers” Coronary Lesions), intravascular ultrasound-guided PCI is more successful in reducing target-vessel failure compared to angiographic-guided PCI.[8]
- The following are the list of pre-PCI evaluations that can be done with intravascular ultrasound:[9][10]
- Full-thickness evaluation of the vessel wall
- Plaque burden
- Calcification extent
- Length of lesion
- External elastic lamina diameter for stent sizing
- The following are the list of post-PCI evaluations that can be done with intravascular ultrasound:[9][10]
Optical Coherence Tomography
- Optical coherence tomography (OCT) is capable of generating high-resolution images of vessel walls by using infrared light. This imaging method has particular advantages in the evaluation of the following:[2]
- Calcium thickness
- Lipid, thrombus, fibroatheroma, and plaque rupture
- Stent strut neointimal thickness
- Stent malposition
- Edge dissections
- The following are some of the limitations of optical coherence tomography (OCT):[1]
References
- ↑ 1.0 1.1 1.2 1.3 Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM; et al. (2022). "2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". J Am Coll Cardiol. 79 (2): e21–e129. doi:10.1016/j.jacc.2021.09.006. PMID 34895950 Check
|pmid=value (help). - ↑ 2.0 2.1 Maehara A, Matsumura M, Ali ZA, Mintz GS, Stone GW (2017). "IVUS-Guided Versus OCT-Guided Coronary Stent Implantation: A Critical Appraisal". JACC Cardiovasc Imaging. 10 (12): 1487–1503. doi:10.1016/j.jcmg.2017.09.008. PMID 29216976.
- ↑ Buccheri S, Franchina G, Romano S, Puglisi S, Venuti G, D'Arrigo P; et al. (2017). "Clinical Outcomes Following Intravascular Imaging-Guided Versus Coronary Angiography-Guided Percutaneous Coronary Intervention With Stent Implantation: A Systematic Review and Bayesian Network Meta-Analysis of 31 Studies and 17,882 Patients". JACC Cardiovasc Interv. 10 (24): 2488–2498. doi:10.1016/j.jcin.2017.08.051. PMID 29153502.
- ↑ Elgendy IY, Mahmoud AN, Elgendy AY, Bavry AA (2016). "Outcomes With Intravascular Ultrasound-Guided Stent Implantation: A Meta-Analysis of Randomized Trials in the Era of Drug-Eluting Stents". Circ Cardiovasc Interv. 9 (4): e003700. doi:10.1161/CIRCINTERVENTIONS.116.003700. PMID 26980883.
- ↑ Zhang YJ, Pang S, Chen XY, Bourantas CV, Pan DR, Dong SJ; et al. (2015). "Comparison of intravascular ultrasound guided versus angiography guided drug eluting stent implantation: a systematic review and meta-analysis". BMC Cardiovasc Disord. 15: 153. doi:10.1186/s12872-015-0144-8. PMC 4647753. PMID 26577590.
- ↑ Nerlekar N, Cheshire CJ, Verma KP, Ihdayhid AR, McCormick LM, Cameron JD; et al. (2017). "Intravascular ultrasound guidance improves clinical outcomes during implantation of both first- and second-generation drug-eluting stents: a meta-analysis". EuroIntervention. 12 (13): 1632–1642. doi:10.4244/EIJ-D-16-00769. PMID 27840327.
- ↑ Ahn JM, Kang SJ, Yoon SH, Park HW, Kang SM, Lee JY; et al. (2014). "Meta-analysis of outcomes after intravascular ultrasound-guided versus angiography-guided drug-eluting stent implantation in 26,503 patients enrolled in three randomized trials and 14 observational studies". Am J Cardiol. 113 (8): 1338–47. doi:10.1016/j.amjcard.2013.12.043. PMID 24685326.
- ↑ Zhang J, Gao X, Kan J, Ge Z, Han L, Lu S; et al. (2018). "Intravascular Ultrasound Versus Angiography-Guided Drug-Eluting Stent Implantation: The ULTIMATE Trial". J Am Coll Cardiol. 72 (24): 3126–3137. doi:10.1016/j.jacc.2018.09.013. PMID 30261237.
- ↑ 9.0 9.1 Steinberg DH, Mintz GS, Mandinov L, Yu A, Ellis SG, Grube E; et al. (2010). "Long-term impact of routinely detected early and late incomplete stent apposition: an integrated intravascular ultrasound analysis of the TAXUS IV, V, and VI and TAXUS ATLAS workhorse, long lesion, and direct stent studies". JACC Cardiovasc Interv. 3 (5): 486–94. doi:10.1016/j.jcin.2010.03.007. PMID 20488404.
- ↑ 10.0 10.1 Kobayashi N, Mintz GS, Witzenbichler B, Metzger DC, Rinaldi MJ, Duffy PL; et al. (2016). "Prevalence, Features, and Prognostic Importance of Edge Dissection After Drug-Eluting Stent Implantation: An ADAPT-DES Intravascular Ultrasound Substudy". Circ Cardiovasc Interv. 9 (7): e003553. doi:10.1161/CIRCINTERVENTIONS.115.003553. PMID 27402854.