Angiographic and clinical comparisons of intravascular ultrasound- versus angiography-guided drug-eluting stent implantation for patients with chronic total occlusion lesions: two-year results from a randomised AIR-CTO study

作者：Tian, Nai-Liang; Gami, Sandeep-Kumar; Ye, Fei; Zhang, Jun-Jie; Liu, Zhi-Zhong; Lin, Song; Ge, Zhen; Shan, Shou-Jie; You, Wei; Chen, Liang; Zhang, Yao-Jun; Mintz, Gary; Chen, Shao-Liang^*

来源：Eurointervention, 2015, 10(12): 1409-1417.

DOI：10.4244/EIJV10I12A245

• chronic total occlusion
• intravascular ultrasound
• late lumen loss
• minimal lumen diameter
• minimal stent cross-section area

Aims: This study sought to compare angiographic endpoints at one-year follow-up after a drug-cluting stein implantation guided by either intravascular ultrasound (IVUS) or angiography in patients with chronic total occlusion (CTO) lesions. @@@ Methods and results: Patients with at least one CTO lesion recanalised successfully were randomly assigned to the IVUS-guided or the angiography-guided group. The use of IVUS for penetration of the true lumen and optimisation of stent expansion was only done in the IVUS-guided group. The primary endpoint was in-stent late lumen loss (LLL) at one-year follow-up. A total of 230 patients with CTO lesions after successful recanalisation were enrolled and followed with office visits or telephone contact up to 24 months. In-stent LLL in the IVUS-guided group was significantly lower compared to the angiography-guided group at one-year follow-up (0.28 +/- 0.48 mm vs. 0.46 +/- 0.68 mm, p=0.025), with a significant difference in restenosis of the "in-true-lumen" stent between the two groups (3.9% vs. 13.7%, p=0.021). The minimal lumen diameter and minimal stent cross-section area significantly and negatively correlated with LLL (all p<0.001). The rates of adverse clinical events were comparable between the IVUS- and angiography-guided groups at two-year follow-up (21.7% vs. 25.2%, p=0.641). @@@ Conclusions: The IVUS-guided stenting of the CTO lesion was associated with less LLL and a lower incidence of "in-true-lumen" stent restenosis. Additional study is required to identify the clinical benefit of the IVUS-guided procedure for CTO lesions. [ChiCTR-TRC-10000996]

• 出版日期2015-4
• 单位南京医科大学