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IVUS Guidance Elevates Coronary Outcomes

Intravascular ultrasound (IVUS) is a core tenet of the SYNTAX II methodology for state-of-the-art PCI. The study’s five-year outcomes, along with several other highly-regarded trials, demonstrate that IVUS visualization optimizes long-term outcomes by enabling more comprehensive procedure planning, execution, and assessment.

SYNTAX II
Physiological Assessment
Tools & Techniques
 
 

Visualize Better Outcomes with IVUS

Procedural Planning

Using IVUS to inform treatment planning and guide DES implantation.

The ADAPT-DES1 study evaluated outcomes in patients undergoing PCI with IVUS use versus no IVUS use. IVUS guidance led to the use of larger stents or balloons, more post-dilatation, additional stents, or higher pressures in 74% of patients. The IVUS use group reported a significant reduction in MI (38%), ST (53%), MACE (35%), and TLR (20%). IVUS use was identified as an independent predictor of lower ST incidence.

IVUS reduction
A change in treatment plan for 74% of patients
 
 

Optimal Stent Placement

Utilization of IVUS vs angiography alone leads to a statistically significant difference in major adverse cardiac events (MACE*) three years post procedure.

 

The ULTIMATE Trial2 had IVUS-defined criteria for optimal stent deployment.

Trial Design

IVUS-Defined Criteria for the Optimal Stent Deployment

  • Minimum lumen area in the stented segment more than 5.00mm or 90% of the minimal lumen area at the distal reference segments
  • Plaque burden 5mm proximal or distal to the stent edge <50%
  • No edge dissection involving the media with length more than 3mm
1448 All-comers patients, Randomized 1:1 to IVUS guided PCI or angiographic guided PCI
 

Results

The study found that utilizing IVUS to asses this criteria leads to superior outcomes versus utilizing angiography alone.
Target Vessel Failure (TVF)
 

IVUS guidance to assess lesion morphology during stent implantation will improve both immediate and long-term clinical outcomes.

The IVUS-XPL3 Study found that, among patients with long coronary lesions (defined as greater than 28mm), IVUS- versus angiography-guided stent implantation led to an immediate divergence of clinical events at stent implantation that continued out to five years post procedure.

 
IVUS Use Group Showed 48% Lower MACE
Post-PCI QCA Data
 
 

Identifying Stent Deformation

PCI procedures have significantly worse outcomes when stent strength is compromised.

The IVUS sub study of the EXCEL trial4, found that stent deformation was present in nearly 7% of all patients, and stent deformation detected by IVUS was strongly associated with LM-related MACE during 3-year follow-up.

  • Statistically higher MACE rates when stent deformation occurred 
  • Stent deformation at 3 years: 28% MACE 
  • No stent deformation at 3 years: 13% MACE
 
 

Peace of Mind Post Procedure

IVUS is a cornerstone of the SYNTAX II study design and was used 84.1% of the time. This trial demonstrates the importance of IVUS use to ensure the effectiveness of PCI.5

Adequate stent expansion and apposition

IVUS usage post stent implantation led to further optimization of the stented lesion in 30.2% of lesions, predominantly further post-dilatation.

30.2%

Visualization of a larger minimal stent area

Larger post-procedural MSA, evaluated by IVUS, was independently associated with the lower rate of Target Lesion Revascularization (TLR) at 2 years.

TLR down arrow
 

Controlling Coronary Procedure Costs

Studies show that IVUS-guided PCI is more cost-effective than angio-guided PCI.

Evidence suggests that IVUS reduces the rate of severe cardiac events at 30 days, which may result in fewer MI related readmissions.6 Over the lifetime of a CAD patient, IVUS could potentially save a total of $2,142 as compared to angiography alone.7 The potential savings are even higher ($2,997, $2,879, and $3,257) when modeling patients with diabetes, ACS, and impaired renal function.7

Cost Incurred to Treat a Patient
 

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