Intensive use of intravascular ultrasound during coronary angioplasty. A six-month campaign

Background-Compared to coronary angiography, intravascular ultrasound (IVUS ) gives additional information important for the percutaneous transluminal coronary angioplasty (PTCA) procedure, but is time-consuming and may cause complications. Aim-To evaluate, during a period of intensive use of IVUS, the impact of IV US on the final decision on balloon/stent diameter, consumption of devices, time-consumption and IVUS-related complications. Method-During a 6-month period, IVUS was contemplated in all PTCA procedure s and the reason for not using IVUS was specified. We used CVIS during the first, and Endosonics during the last 3 months, and both periods started wi th 1 week of hands-on practice. All procedures were to be planned according to an initial quantitative coronary angiography (QCA), and the finally ach ieved result, material used and complications were registered. Results-The proportion of IVUS/PTCA was 37% during, 8% 6 months before and 12% 6 months after the study period. Three hundred and twenty-three patient s were included in the study (57% of all patients), 199 of them were subjec ted to IVUS. The indications for PTCA during the study period were stable a ngina (58%), unstable angina (32%) and acute myocardial infarction (10%). T he main reasons for not doing IVUS were use of 6F guiding catheter (13%), u rgent procedure (12%) and occluded vessel (11%). Initial QCA detected 253 s tenoses in 199 patients and 64 additional stenoses were treated, most of th em probably detected by IVUS. QCA systematically underestimated vessel size , particularly in small vessels. There was a non-significant trend to more accurate estimations towards the end of the study in small vessels. Dissect ion, probably due to IVUS, occurred in two cases (1%). There were no signif icant differences in the number of devices used in IVUS compared to non-IVU S patients. The procedural time was 24 min longer in IVUS than in non-IVUS cases and more stenoses were treated per procedure in the IVUS group. Conclusion-Coronary angiography often underestimated balloon/stent size but in an unpredictable way, with a substantial proportion of significant sten oses being undetected. IVUS had few serious complications, did not increase device consumption but prolonged procedural time.