Final results of the Can Routine Ultrasound Influence Stent Expansion (CRUISE) study

Background-Intravascular ultrasound (IVUS) can assess stent geometry more a ccurately than angiography, Several studies have demonstrated that the degr ee of stent expansion as measured by IVUS directly correlated to clinical o utcome. However, it is unclear if routine ultrasound guidance of stent impl antation improves clinical outcome as compared with angiographic guidance a lone. Methods and Results-The CRUISE (Can Routine Ultrasound Influence Stent Expa nsion) study, a multicenter study IVUS substudy of the Stent Anti-thromboti c Regimen Study, was designed to assess the impact of IVUS on stent deploym ent in the high-pressure era. Nine centers were prospectively assigned to s tent deployment with the use of ultrasound guidance and 7 centers to angiog raphic guidance alone with documentary (blinded) IVUS at the conclusion of the procedure. A total of 525 patients were enrolled with completed quantit ative coronary angiography, quantitative coronary ultrasound, and clinical events adjudicated at 9 months for 499 patients. The IVUS-guided group had a larger minimal lumen diameter (2.9+/-0.4 versus 2.7+/-0.5 mm, P<0.001) by quantitative coronary angiography and a larger minimal stent area (7.78+/- 1.72 versus 7.06+/-2.13 mm(2), P<0.001) by quantitative coronary ultrasound . Target vessel revascularization, defined as clinically driven repeat inte rventional or surgical therapy of the index vessel at 9 month-follow-up, oc curred significantly less frequently in the IVUS-guided group (8.5% versus 15.3%, P<0.05; relative reduction of 44%), Conclusions-These data suggest that ultrasound guidance of stent implantati on may result in more effective stent expansion compared with angiographic guidance alone.