The study goal was to determine whether the long-term clinical outcomes with IVUS-guided DES implantation are superior to those with angiography-guided implantation in patients with long coronary lesions (≥ 28 mm). The IVUS-XPL Study is the largest randomized, multi-center clinical trial for IVUS-guided vs. angio-guided stenting to date.
- IVUS group showed 48% lower MACE compared to angio-guided group (2.9% vs. 5.8%) at 1-year
- Higher percentage of post dilatation in IVUS group (76% vs. 54%, P < 0.001)
- Larger MLA post PCI in IVUS group
The study goal was to investigate the clinical impact of the use of IVUS during revascularization of patients with LM CAD using DES with drug-eluting stents (DES). The IVUS Guidance in Left Main Study pooled analysis of four registries involving 1,670 patients with LM disease. 505 patients who underwent IVUS-guided PCI compared to 505 propensity-matched patients where IVUS-guidance was not performed.
- MACE at 3-years was significantly lower in IVUS-guided group for both LM overall population (P = 0.04) and LM subgroups with distal lesions (P = 0.03)
- IVUS use was an independent predictor for fewer adverse events
- Further incremental benefit was shown in distal lesion subgroup receiving two stents
- Definite and Probable ST was significantly lower in the IVUS-guided group (P = 0.04)
1. Maehara A. ADAPT-DES IVUS Substudy: Utility of IVUS in Delineating the Mechanism of and Preventing Stent Thrombosis. Cardiovascular Research Foundation/Columbia University Medical Center, NY.
2. Hong SJ, Kim BK, Shin DH, et al. Effect of intravascular ultrasound-guided vs angiography-guided everolimus-eluting stent implantation: the IVUS-XPL randomized clinical trial. JAMA. 2015;314(20):2155-2163.
3. Hernandez JM, Alonso JA, Hospital JA, et al. Clinical Impact of Intravascular Ultrasound Guidance in Drug-Eluting Stent Implantation for Unprotected Left Main Coronary Disease. J Am Coll Cardiol Intv. 2014;7:244-254.
* MACE includes cardiac death, target lesion-related MI, and ischemia-driven TLR.