Application of Intravascular Ultrasound in Stent Implantation for Small Coronary Arteries

Aims: Recently, the final minimum luminal diameter (MLD) has been regarded as one of the most important determinants of restenosis. Our study was to evaluate if IVUS optimized DES implantation in small coronary artery lesions was superior to angiographic guidance alone in achieving a larger final MLD. Methods and Results: 84 non-diabetic coronary heart disease (CHD) patients with a single de novo lesion in a small vessel (diameter range ≥2.25 and ≤2.75 mm) were randomized as follows: 42 to the angiography group and 42 to the IVUS group. Primary study endpoint was postprocedure in lesion MLD. Secondary end points were combined major adverse cardiac events (MACE) at 1, 6, 9, and 12months. No significant differences were observed in the baseline patient demographic and lesion characteristics, between the angiography group and the IVUS group. The primary study end point post-procedure MLD and acute gain were larger in the IVUS group (2.77±0.19mm versus 2.53±0.21mm, P=0.000, and 1.87±0.28mm versus 1.63±0.27mm, P=0.000, respectively). Final stenosis was smaller in the IVUS group (6.72±2.56% versus 7.94±2.47%, P=0.029). At follow-up, there were no statistically significant differences between the IVUS group and angiography group with respect to MI, TVR, and Cardiac death. Conclusions: A benefit of IVUS optimized DES implantation was observed in a small vessel in the post-procedure minimal lumen diameter. No statistically significant difference was found in MACE up to 12 months (J clin invasive cardiol 2016;3:2-8).