Intravascular Imaging During PCI: Difference between revisions
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*Due to [[angiography]] limitations, intra-[[coronary]] imaging can be used to guide [[coronary]] [[stent]] implantation, especially in [[patients]] with [[left main coronary artery]] involvement or complex [[lesions]].<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref> | *Due to [[angiography]] limitations, intra-[[coronary]] imaging can be used to guide [[coronary]] [[stent]] implantation, especially in [[patients]] with [[left main coronary artery]] involvement or complex [[lesions]].<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref> | ||
*[[Intravascular ultrasound]] ([[IVUS]]) and [[optical coherence tomography]] ([[optical coherence tomography|OCT]] are two imaging methods that can be used to assess [[vasculature]] conditions before and after [[PCI]]. | |||
*Both imaging methods can assist in evaluating the need for [[lesion]] preparation, [[stent]] sizing, diminishing geographic-related errors, confirming [[stent]] expansion, identifying [[complications]], and causes of [[stent]] failure.<ref name="pmid29216976">{{cite journal| author=Maehara A, Matsumura M, Ali ZA, Mintz GS, Stone GW| title=IVUS-Guided Versus OCT-Guided Coronary Stent Implantation: A Critical Appraisal. | journal=JACC Cardiovasc Imaging | year= 2017 | volume= 10 | issue= 12 | pages= 1487-1503 | pmid=29216976 | doi=10.1016/j.jcmg.2017.09.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29216976 }} </ref> | |||
==ACA 2021 Revascularization Guideline== | |||
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| colspan="1" style="text-align:center; background:LightGreen"|Class 2a Recommendation, Level of Evidence: B-R<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref> | |||
|- | |||
| bgcolor="LightGreen"|1.[[Intravascular ultrasound]] ([[Intravascular ultrasound|IVUS]]) can be used as a procedural guidance in [[patients]] undergoing [[stent|coronary stent implantation]], particularly in those with [[Left main coronary artery|left main]] or complex [[coronary artery]] [[stent|stenting]] in order to diminish [[ischemia|ischemic events]]. | |||
2.[[Optical coherence tomography]] ([[Optical coherence tomography|OCT]] is a reasonable alternative to [[Intravascular ultrasound|IVUS]] as an procedural guidance in [[patients]] undergoing [[stent|coronary stent implantation]], except in those with [[Left main coronary artery|ostial left main disease]]. | |||
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{|class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:yellow"|Class 2a Recommendation, Level of Evidence: C-LD<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref> | |||
|- | |||
| bgcolor="yellow"|If [[stent]] failure occurs, both [[Intravascular ultrasound|IVUS]] and [[Optical coherence tomography|OCT]] can be used to determine the mechanism of [[stent]] failure. | |||
|} | |||
==Intravenous Ultrasound== | |||
*Multiple [[meta-analyses]] have shown that [[intravascular ultrasound]]-guided [[PCI]] is more successful in reducing major adverse cardiovascular events (MACE) compared to [[PCI|angiographic-guided PCI]].<ref name="pmid29153502">{{cite journal| author=Buccheri S, Franchina G, Romano S, Puglisi S, Venuti G, D'Arrigo P | display-authors=etal| title=Clinical Outcomes Following Intravascular Imaging-Guided Versus Coronary Angiography-Guided Percutaneous Coronary Intervention With Stent Implantation: A Systematic Review and Bayesian Network Meta-Analysis of 31 Studies and 17,882 Patients. | journal=JACC Cardiovasc Interv | year= 2017 | volume= 10 | issue= 24 | pages= 2488-2498 | pmid=29153502 | doi=10.1016/j.jcin.2017.08.051 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29153502 }} </ref><ref name="pmid26980883">{{cite journal| author=Elgendy IY, Mahmoud AN, Elgendy AY, Bavry AA| title=Outcomes With Intravascular Ultrasound-Guided Stent Implantation: A Meta-Analysis of Randomized Trials in the Era of Drug-Eluting Stents. | journal=Circ Cardiovasc Interv | year= 2016 | volume= 9 | issue= 4 | pages= e003700 | pmid=26980883 | doi=10.1161/CIRCINTERVENTIONS.116.003700 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26980883 }} </ref><ref name="pmid26577590">{{cite journal| author=Zhang YJ, Pang S, Chen XY, Bourantas CV, Pan DR, Dong SJ | display-authors=etal| title=Comparison of intravascular ultrasound guided versus angiography guided drug eluting stent implantation: a systematic review and meta-analysis. | journal=BMC Cardiovasc Disord | year= 2015 | volume= 15 | issue= | pages= 153 | pmid=26577590 | doi=10.1186/s12872-015-0144-8 | pmc=4647753 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26577590 }} </ref><ref name="pmid27840327">{{cite journal| author=Nerlekar N, Cheshire CJ, Verma KP, Ihdayhid AR, McCormick LM, Cameron JD | display-authors=etal| title=Intravascular ultrasound guidance improves clinical outcomes during implantation of both first- and second-generation drug-eluting stents: a meta-analysis. | journal=EuroIntervention | year= 2017 | volume= 12 | issue= 13 | pages= 1632-1642 | pmid=27840327 | doi=10.4244/EIJ-D-16-00769 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27840327 }} </ref><ref name="pmid24685326">{{cite journal| author=Ahn JM, Kang SJ, Yoon SH, Park HW, Kang SM, Lee JY | display-authors=etal| title=Meta-analysis of outcomes after intravascular ultrasound-guided versus angiography-guided drug-eluting stent implantation in 26,503 patients enrolled in three randomized trials and 14 observational studies. | journal=Am J Cardiol | year= 2014 | volume= 113 | issue= 8 | pages= 1338-47 | pmid=24685326 | doi=10.1016/j.amjcard.2013.12.043 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24685326 }} </ref> | |||
*Furthermore, based on a trial named ULTIMATE (Intravascular Ultrasound Guided Drug Eluting Stents Implantation in “All-Comers” Coronary Lesions), [[intravascular ultrasound]]-guided [[PCI]] is more successful in reducing target-[[vessel]] failure compared to [[PCI|angiographic-guided PCI]].<ref name="pmid30261237">{{cite journal| author=Zhang J, Gao X, Kan J, Ge Z, Han L, Lu S | display-authors=etal| title=Intravascular Ultrasound Versus Angiography-Guided Drug-Eluting Stent Implantation: The ULTIMATE Trial. | journal=J Am Coll Cardiol | year= 2018 | volume= 72 | issue= 24 | pages= 3126-3137 | pmid=30261237 | doi=10.1016/j.jacc.2018.09.013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30261237 }} </ref> | |||
*The following are the list of pre-[[PCI]] evaluations that can be done with [[intravascular ultrasound]]:<ref name="pmid20488404">{{cite journal| author=Steinberg DH, Mintz GS, Mandinov L, Yu A, Ellis SG, Grube E | display-authors=etal| title=Long-term impact of routinely detected early and late incomplete stent apposition: an integrated intravascular ultrasound analysis of the TAXUS IV, V, and VI and TAXUS ATLAS workhorse, long lesion, and direct stent studies. | journal=JACC Cardiovasc Interv | year= 2010 | volume= 3 | issue= 5 | pages= 486-94 | pmid=20488404 | doi=10.1016/j.jcin.2010.03.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20488404 }} </ref><ref name="pmid27402854">{{cite journal| author=Kobayashi N, Mintz GS, Witzenbichler B, Metzger DC, Rinaldi MJ, Duffy PL | display-authors=etal| title=Prevalence, Features, and Prognostic Importance of Edge Dissection After Drug-Eluting Stent Implantation: An ADAPT-DES Intravascular Ultrasound Substudy. | journal=Circ Cardiovasc Interv | year= 2016 | volume= 9 | issue= 7 | pages= e003553 | pmid=27402854 | doi=10.1161/CIRCINTERVENTIONS.115.003553 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27402854 }} </ref> | *The following are the list of pre-[[PCI]] evaluations that can be done with [[intravascular ultrasound]]:<ref name="pmid20488404">{{cite journal| author=Steinberg DH, Mintz GS, Mandinov L, Yu A, Ellis SG, Grube E | display-authors=etal| title=Long-term impact of routinely detected early and late incomplete stent apposition: an integrated intravascular ultrasound analysis of the TAXUS IV, V, and VI and TAXUS ATLAS workhorse, long lesion, and direct stent studies. | journal=JACC Cardiovasc Interv | year= 2010 | volume= 3 | issue= 5 | pages= 486-94 | pmid=20488404 | doi=10.1016/j.jcin.2010.03.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20488404 }} </ref><ref name="pmid27402854">{{cite journal| author=Kobayashi N, Mintz GS, Witzenbichler B, Metzger DC, Rinaldi MJ, Duffy PL | display-authors=etal| title=Prevalence, Features, and Prognostic Importance of Edge Dissection After Drug-Eluting Stent Implantation: An ADAPT-DES Intravascular Ultrasound Substudy. | journal=Circ Cardiovasc Interv | year= 2016 | volume= 9 | issue= 7 | pages= e003553 | pmid=27402854 | doi=10.1161/CIRCINTERVENTIONS.115.003553 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27402854 }} </ref> | ||
**Full-thickness evaluation of the [[vessel wall]] | **Full-thickness evaluation of the [[vessel wall]] | ||
| Line 13: | Line 35: | ||
**[[Tissue]] protrusion | **[[Tissue]] protrusion | ||
**Edge [[disease]] and [[dissection]] | **Edge [[disease]] and [[dissection]] | ||
==Optical Coherence Tomography== | |||
*[[Optical coherence tomography]] ([[Optical coherence tomography|OCT]]) is capable of generating high-resolution images of [[vessel walls]] by using infrared light. This imaging method has particular advantages in the evaluation of the following:<ref name="pmid29216976">{{cite journal| author=Maehara A, Matsumura M, Ali ZA, Mintz GS, Stone GW| title=IVUS-Guided Versus OCT-Guided Coronary Stent Implantation: A Critical Appraisal. | journal=JACC Cardiovasc Imaging | year= 2017 | volume= 10 | issue= 12 | pages= 1487-1503 | pmid=29216976 | doi=10.1016/j.jcmg.2017.09.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29216976 }} </ref> | |||
**[[Calcium]] thickness | |||
**[[Lipid]], [[thrombus]], [[Atheroma|fibroatheroma]], and [[plaque]] rupture | |||
**[[Stent]] strut neointimal thickness | |||
**[[Stent]] malposition | |||
**Edge [[dissections]] | |||
*The following are some of the limitations of [[optical coherence tomography]] ([[Optical coherence tomography|OCT]]):<ref name="pmid34895950">{{cite journal| author=Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM | display-authors=etal| title=2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=J Am Coll Cardiol | year= 2022 | volume= 79 | issue= 2 | pages= e21-e129 | pmid=34895950 | doi=10.1016/j.jacc.2021.09.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34895950 }} </ref> | |||
**Limited depth of imaging | |||
**Usage of [[Optical coherence tomography|OCT]] is limited in [[Left main coronary artery|ostial left main disease]] since [[blood]] clearance through the use of [[contrast]] [[injection]] is necessary for performing [[Optical coherence tomography|OCT]] | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Latest revision as of 09:51, 23 June 2022
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2]
- Due to angiography limitations, intra-coronary imaging can be used to guide coronary stent implantation, especially in patients with left main coronary artery involvement or complex lesions.[1]
- Intravascular ultrasound (IVUS) and optical coherence tomography (OCT are two imaging methods that can be used to assess vasculature conditions before and after PCI.
- Both imaging methods can assist in evaluating the need for lesion preparation, stent sizing, diminishing geographic-related errors, confirming stent expansion, identifying complications, and causes of stent failure.[2]
ACA 2021 Revascularization Guideline
| Class 2a Recommendation, Level of Evidence: B-R[1] |
| 1.Intravascular ultrasound (IVUS) can be used as a procedural guidance in patients undergoing coronary stent implantation, particularly in those with left main or complex coronary artery stenting in order to diminish ischemic events.
2.Optical coherence tomography (OCT is a reasonable alternative to IVUS as an procedural guidance in patients undergoing coronary stent implantation, except in those with ostial left main disease. |
| Class 2a Recommendation, Level of Evidence: C-LD[1] |
| If stent failure occurs, both IVUS and OCT can be used to determine the mechanism of stent failure. |
Intravenous Ultrasound
- Multiple meta-analyses have shown that intravascular ultrasound-guided PCI is more successful in reducing major adverse cardiovascular events (MACE) compared to angiographic-guided PCI.[3][4][5][6][7]
- Furthermore, based on a trial named ULTIMATE (Intravascular Ultrasound Guided Drug Eluting Stents Implantation in “All-Comers” Coronary Lesions), intravascular ultrasound-guided PCI is more successful in reducing target-vessel failure compared to angiographic-guided PCI.[8]
- The following are the list of pre-PCI evaluations that can be done with intravascular ultrasound:[9][10]
- Full-thickness evaluation of the vessel wall
- Plaque burden
- Calcification extent
- Length of lesion
- External elastic lamina diameter for stent sizing
- The following are the list of post-PCI evaluations that can be done with intravascular ultrasound:[9][10]
Optical Coherence Tomography
- Optical coherence tomography (OCT) is capable of generating high-resolution images of vessel walls by using infrared light. This imaging method has particular advantages in the evaluation of the following:[2]
- Calcium thickness
- Lipid, thrombus, fibroatheroma, and plaque rupture
- Stent strut neointimal thickness
- Stent malposition
- Edge dissections
- The following are some of the limitations of optical coherence tomography (OCT):[1]
References
- ↑ 1.0 1.1 1.2 1.3 Writing Committee Members. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM; et al. (2022). "2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". J Am Coll Cardiol. 79 (2): e21–e129. doi:10.1016/j.jacc.2021.09.006. PMID 34895950 Check
|pmid=value (help). - ↑ 2.0 2.1 Maehara A, Matsumura M, Ali ZA, Mintz GS, Stone GW (2017). "IVUS-Guided Versus OCT-Guided Coronary Stent Implantation: A Critical Appraisal". JACC Cardiovasc Imaging. 10 (12): 1487–1503. doi:10.1016/j.jcmg.2017.09.008. PMID 29216976.
- ↑ Buccheri S, Franchina G, Romano S, Puglisi S, Venuti G, D'Arrigo P; et al. (2017). "Clinical Outcomes Following Intravascular Imaging-Guided Versus Coronary Angiography-Guided Percutaneous Coronary Intervention With Stent Implantation: A Systematic Review and Bayesian Network Meta-Analysis of 31 Studies and 17,882 Patients". JACC Cardiovasc Interv. 10 (24): 2488–2498. doi:10.1016/j.jcin.2017.08.051. PMID 29153502.
- ↑ Elgendy IY, Mahmoud AN, Elgendy AY, Bavry AA (2016). "Outcomes With Intravascular Ultrasound-Guided Stent Implantation: A Meta-Analysis of Randomized Trials in the Era of Drug-Eluting Stents". Circ Cardiovasc Interv. 9 (4): e003700. doi:10.1161/CIRCINTERVENTIONS.116.003700. PMID 26980883.
- ↑ Zhang YJ, Pang S, Chen XY, Bourantas CV, Pan DR, Dong SJ; et al. (2015). "Comparison of intravascular ultrasound guided versus angiography guided drug eluting stent implantation: a systematic review and meta-analysis". BMC Cardiovasc Disord. 15: 153. doi:10.1186/s12872-015-0144-8. PMC 4647753. PMID 26577590.
- ↑ Nerlekar N, Cheshire CJ, Verma KP, Ihdayhid AR, McCormick LM, Cameron JD; et al. (2017). "Intravascular ultrasound guidance improves clinical outcomes during implantation of both first- and second-generation drug-eluting stents: a meta-analysis". EuroIntervention. 12 (13): 1632–1642. doi:10.4244/EIJ-D-16-00769. PMID 27840327.
- ↑ Ahn JM, Kang SJ, Yoon SH, Park HW, Kang SM, Lee JY; et al. (2014). "Meta-analysis of outcomes after intravascular ultrasound-guided versus angiography-guided drug-eluting stent implantation in 26,503 patients enrolled in three randomized trials and 14 observational studies". Am J Cardiol. 113 (8): 1338–47. doi:10.1016/j.amjcard.2013.12.043. PMID 24685326.
- ↑ Zhang J, Gao X, Kan J, Ge Z, Han L, Lu S; et al. (2018). "Intravascular Ultrasound Versus Angiography-Guided Drug-Eluting Stent Implantation: The ULTIMATE Trial". J Am Coll Cardiol. 72 (24): 3126–3137. doi:10.1016/j.jacc.2018.09.013. PMID 30261237.
- ↑ 9.0 9.1 Steinberg DH, Mintz GS, Mandinov L, Yu A, Ellis SG, Grube E; et al. (2010). "Long-term impact of routinely detected early and late incomplete stent apposition: an integrated intravascular ultrasound analysis of the TAXUS IV, V, and VI and TAXUS ATLAS workhorse, long lesion, and direct stent studies". JACC Cardiovasc Interv. 3 (5): 486–94. doi:10.1016/j.jcin.2010.03.007. PMID 20488404.
- ↑ 10.0 10.1 Kobayashi N, Mintz GS, Witzenbichler B, Metzger DC, Rinaldi MJ, Duffy PL; et al. (2016). "Prevalence, Features, and Prognostic Importance of Edge Dissection After Drug-Eluting Stent Implantation: An ADAPT-DES Intravascular Ultrasound Substudy". Circ Cardiovasc Interv. 9 (7): e003553. doi:10.1161/CIRCINTERVENTIONS.115.003553. PMID 27402854.