A Randomized Controlled Trial of Angiography Versus Intravascular Ultrasound-Directed Bare-Metal Coronary Stent Placement (The AVID Trial)

作者：Russo Robert J^*; Silva Patricia D; Teirstein Paul S; Attubato Michael J; Davidson Charles J; DeFranco Anthony C; Fitzgerald Peter J; Goldberg Steven L; Hermiller James B; Leon Martin B; Ling Frederick S; Lucisano Jennifer E; Schatz Richard A; Wong S Chiu; Weissman Neil J; Zientek David M

来源：Circulation: Cardiovascular Interventions , 2009, 2(2): 113-U56.

DOI：10.1161/CIRCINTERVENTIONS.108.778647

• angiography
• intravascular ultrasound
• randomized controlled trial
• restenosis
• stents

Background-AVID (Angiography Versus Intravascular ultrasound-Directed stent placement) is a multicenter, randomized controlled trial designed to assess the effect of intravascular ultrasound (IVUS)-directed stent placement on the 12-month rate of target lesion revascularization (TLR).
Methods and Results-After elective coronary stent placement and an optimal angiographic result (<10% stenosis), 800 patients were randomized to Angiography-or IVUS-directed therapy. Blinded IVUS was performed in the Angiography group without further therapy. In the IVUS group, IVUS criteria for optimal stent placement (<10% area stenosis, apposition, and absence of dissection) were applied. Final minimum stent area was 6.90 +/- 2.43 mm(2) in the Angiography group and 7.55 +/- 2.82 mm(2) in the IVUS group (P=0.001). In the IVUS group, only 37% with inadequate expansion (<90%) received further therapy. The 12-month TLR rate was 12.0% in the Angiography group and 8.1% in the IVUS group (P=0.08, 95% confidence level [CI], [-8.3% to 0.5%]). When vessels with a distal reference diameter <2.5 mm by core laboratory angiography measurement were excluded from analysis, the 12-month TLR rate was 10.1% in the Angiography group and 4.3% in the IVUS group (P=0.01, 95% CI, [-10.6% to -1.2%]). With a prestent angiographic stenosis of >= 70%, the TLR rate was lower in the IVUS group compared with the Angiography group (3.1% versus 14.2%; P=0.002; 95% CI, [-18.4% to -4.2%]).
Conclusions-IVUS-directed bare-metal stent placement results in larger acute stent dimensions without an increase in complications and a significantly lower 12-month TLR rate for vessels >= 2.5 mm by angiography and for vessels with high-grade prestent stenosis. However, for the entire sample analyzed on an intention-to-treat basis, IVUS-directed bare-metal stent placement does not significantly reduce the 12-month TLR rate when compared with stent placement guided by angiography alone. In addition, IVUS evaluation of adequate stent expansion is underutilized by experienced operators. (Circ Cardiovasc Intervent. 2009; 2: 113-123.)

• 出版日期2009-4
• 单位西北大学