Improved Procedural Results of Coronary Angioplasty With Intravascular Ultrasound–Guided Balloon Sizing

On average, plaque occupied 51.3±15.4% of the angiographically normal reference segments, virtually identical to the 50.7±12.7% reference segment plaque burden reported by Mintz et al.16

Gregg W. Stone; John M. Hodgson; Frederick G. St Goar; Axel Frey; Harald Mudra; Helen Sheehan; Thomas J. Linnemeier

2012

Scholarcy highlights

  • Indiscriminate use of balloons larger than the angiographic reference segment lumen results in high rates of ischemic complications after percutaneous transluminal coronary angioplasty
  • We hypothesized that angiographically unsuspected atheromatous remodeling with vessel expansion at and adjacent to PTCA target lesions would safely accommodate oversized balloons in selected patients undergoing PTCA with intravascular ultrasound guidance
  • After angiographically guided PTCA of 104 lesions in 102 patients, IVUS was performed, and if atheromatous remodeling was present, PTCA was repeated with larger balloons sized halfway between the lumen and external elastic membrane
  • Further balloon upsizing by 0.25 to 1.25 mm was performed in 76 lesions, increasing the nominal balloon-to-artery ratio from 1.12±0.15 after standard PTCA to 1.30±0.17 after IVUS-guided PTCA
  • The demonstration by IVUS of atheromatous remodeling permits the safe use of balloons traditionally considered oversized, resulting in significantly improved luminal dimensions without increased rates of dissection or ischemic complications
  • By the 50% DS criterion, PTCA was successful in 95.1% of lesions after standard optimal PTCA versus 99.0% after IVUS-guided upsized PTCA
  • No direct conclusions can be drawn about reduced restenosis rates from the improved acute procedural results of PTCA obtained by the IVUS strategy described here, it should be noted that the magnitude of luminal gain after IVUS-guided PTCA compared with standard dilatation in the present study is similar to that achieved after stenting compared with PTCA in the STRESS and BENESTENT trials
  • There has been a move away from percutaneous transluminal coronary angioplasty toward more complex and expensive technologies, such as coronary stenting, that reduce restenosis by achieving a larger initial lumen.67

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