The clinical and angiographic impact of intravascular ultrasound guided stenting of unprotected left main and proximal left anterior descending coronary artery. A prospective randomized controlled study in Egypt

Abstract

Background: Coronary angiography has some limitations in the proper assessment of coronary artery lesions. Intravascular ultrasound (IVUS) before percutaneous coronary intervention (PCI) can identify significant stenosis, select the appropriate stent and detect complications. The study aimed to evaluate the impact of intravascular ultrasound on clinical and angiographic outcomes after revascularization by stenting for patients with unprotected left main (ULM) or proximal left anterior descending (LAD) coronary artery disease (CAD). Materials and methods: A prospective randomized controlled study that was carried on sixty patients presented with stable angina or non-ST elevation acute coronary syndrome. Coronary angiography that was carried out at cardiac catheterization laboratory at the National Heart Institute in Egypt revealed significant left main or proximal LAD coronary artery disease. Patients were scheduled for revascularization by PCI. Percutaneous coronary intervention guided by coronary IVUS was done in thirty patients (Group A). Whereas, Group B included 30 patients in which PCI was not guided by IVUS. The patients were followed for six months to detect any primary or secondary endpoints. Results: IVUS guidance was associated with a significant higher post-stent minimal lumen diameter as found by quantitative coronary angiography (QCA) (p = 0.001), stent diameter (p = 0.001), and adjunct post-dilatation (p = 0.02). By comparing both study groups it was found that IVUS guidance was associated with significant lower rates of stent thrombosis in target lesions, non-fatal myocardial infarction related to target lesions, target lesion revascularization and all cause major adverse cardiac events (MACE) within 6 months of follow-up (p-value 0.038, for all). Conclusions: IVUS guided PCI during ULM and proximal LAD coronary artery stenting improves clinical outcome with significant lower rates of MACE at 6 months which is due to significant lower risk of target lesion revascularization and stent thrombosis. We recommended routine use of IVUS during revascularization by stenting in cases of ULM or proximal LAD CAD.