USEFULNESS OF ONLINE 3-DIMENSIONAL RECONSTRUCTION OF INTRACORONARY ULTRASOUND FOR GUIDANCE OF STENT DEPLOYMENT

The additional information provided by automated on-line 3-dimensional (3-D) reconstruction of intracoronary ultrasound (ICUS) was assessed in 42 patients (62 stents) who underwent stent deployment after achiev ing an optimal quantitative angiographic result. In 10 of 42 patients, 3-D ICUS was also performed before stenting, ICUS images of stents an d adjacent reference segments were acquired by using a motorized pullb ack at a constant speed (1 mm/s) and immediately processed in the cath eterization laboratory, Optimal stent expansion was detected by 3-D IC US in case of complete apposition of stent struts to the vessel wall. Furthermore, an attempt was made to maximize the intrastent lumen area to match lumen area of the reference segment and to cover with stents all the segments with residual significant lesions (plaque burden >50 %). Three-dimensional automated reconstruction of ICUS was successful in 8 of 10 patients (80%) before, and in 36 of 42 patients (86%) after stent deployment. In all 8 patients who underwent successful 3-D ICUS assessment before stent implantation, the selection of stent length w as facilitated by accurately measuring the lesion length. After stenti ng, 3-D ICUS modified the management strategy in 21 of 36 patients (58 %), triggering additional high-pressure dilatations in 13 patients (36 %) and additional stent deployment in 8 (22%). In conclusion, on-line 3-D ICUS facilitates stent selection and strongly modifies the revascu larization strategy by accurately detecting stent underexpansion and p resence of uncovered lesions.