Stepwise intravascular ultrasound (IVUS) guidance of high-pressure coronary stenting does not result in an improved acute or long-term outcome: A randomized comparison to "final-look" IVUS assessment

The objective of this study was to evaluate the potential benefit of stepwi se intravascular ultrasound (IVUS)-guided coronary stent deployment compare d to angiographic stent implantation with final IVUS assessment only. Acute procedural success and B-month angiographic follow-up were compared in bot h groups. Intravascular ultrasound was performed using a 20- or 30-MHz mech anically rotated catheter in 85 patients who were prospectively randomized to group A (n = 42; IVUS-guided) and group a (n = 43; angiography + final I VUS assessment). There was no difference in the number of stents implanted (1.5 +/- 0.9 stents/lesion in group A and 1.3 +/- 0.6 stents/lesion in grou p B), the duration of the procedure, or the amount of contrast medium used. Defined criteria of optimal stent deployment (stent apposition, stent symm etry, complete coverage of dissections, >90% in-stent lumen area/reference lumen area) were achieved in 54.2% in group A and 56.6% in group B (NS). An giographic follow-up was 87.1% at 6 +/- 2 months, and clinical follow-up wa s 100% at 8 +/- 1 months, There was no significant difference in restenosis rate (33.3% vs. 34.9%) applying a binary >50% diameter stenosis criterion for both groups. There was no significant difference in minimal in-stent lu men area at both baseline (7.91 +/- 2.64 mm(2) vs. 7.76 +/- 2.21 mm(2)) and follow-up (5.84 +/- 2 mm(2) vs. 5.52 +/- 1.87 mm(2)). With regard to immed iate procedural lumen gain and rate of restenosis, multiple IVUS examinatio ns during the procedure showed no advantage compared to final IVUS assessme nt only. (C) 1999 Wiley-Liss, Inc.