Impact of intravascular ultrasound on chronic total occlusion percutaneous revascularization

Kalogeropoulos, Andreas S. and Alsanjari, Osama and Davies, John R. and Keeble, Thomas R. and Tang, Kare H. and Konstantinou, Kilo and Vardas, Panagiotis and Werner, Gerald S. and Kelly, Paul A. and Karamasis, Grigoris V. (2021) Impact of intravascular ultrasound on chronic total occlusion percutaneous revascularization. Cardiovascular Revascularization Medicine. ISSN 1878-0938

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Aim: We sought to investigate the impact of IVUS use on chronic total occlusion (CTO) PCI using data from a contemporary registry of consecutive patients and applying a propensity score matching analysis. Methods and results: We evaluated 514 successful CTO-PCIs, median age: 67 years (IQR: 58–73), 83.5% males. IVUS-guided PCI was performed in 184 (35.8%) of cases. After using 1:1 propensity matching score analysis, two groups of 182 patients each (IVUS-guided vs. angiography-guided CTO-PCI group) were produced to form the study population. In the IVUS-guided group the median maximum stent diameter was larger and the median total stented segment was longer compared to the angiography-guided group [(3.5 mm, IQR: 3.0–4.0 vs. 3.2 mm, IQR: 3.0–3.5, p < 0.001) and (60.0 mm, IQR: 38.0–91.3 vs. 38.0 mm, IQR: 32.0–70.5, p < 0.001), respectively]. In the IVUS-guided group, retrograde recanalization was more frequently encountered compared to the angiography-guided PCI group (30.2% vs. 20.9%, p = 0.04). Procedural time was significantly longer in the IVUS-guided group, without any difference in fluoroscopy time, radiation dose and contrast volume. Multivariate linear regression analysis showed that IVUS use was the strongest independent factor associated with larger maximum diameter stents (p < 0.001) and a strong independent predictor for total stented segment length during CTO-PCI (p < 0.001). Up to 8 years follow-up, there was no difference in the incidence of the composite endpoint of all-cause death, cardiac death, myocardial infarction and target vessel revascularization between the IVUS-guided PCI and the angiography-guided PCI groups (hazard ratio: 13.7% vs. 15.9%, respectively, log-rank: p = 0.67, median follow-up time: 49.0 months, IQR: 33.0–67.0). Conclusions: Use of IVUS in CTO-PCI was associated with larger stent diameter and longer stented segments. Despite more frequent use of IVUS in retrograde CTO-PCI, there was no difference in long-term adverse events between IVUS and angiography CTO-PCI groups; nevertheless, the study was not powered to assess clinical outcomes.

Item Type: Journal Article
Keywords: Chronic total occlusions, Complex PCI, IVUS, Intravascular imaging, Drug eluting stents
Faculty: Faculty of Health, Education, Medicine & Social Care
Depositing User: Ian Walker
Date Deposited: 11 Jan 2021 16:04
Last Modified: 20 Jan 2021 11:33

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