Clinical Outcome of Intravascular Ultrasound Guided Percutaneous Coronary Intervention of Isolated Ostial Left Anterior Descending Artery Lesions
DOI:
https://doi.org/10.47672/ejhs.1326Keywords:
PCI, left main coronary disease, ostial disease, CABG, IVUSAbstract
Purpose: Despite recent advances in interventional cardiology procedures, isolated ostial left anterior descending (LAD) lesions remain a challenge in cardiology. Due to the probability of left main (LM) affection, an LM bifurcation stenting technique may be required in certain individuals. So we evaluated result of Intravascular Ultrasound (IVUS) guided percutaneous coronary intervention (PCI) in isolated LAD coronary artery lesions, either by crossing over the ostium or not, with a focus on major adverse cardiovascular events (MACE).
Methodology: Our prospective study from January2021 to November 2022 included 79 isolated ostial LAD patients with Ostial LAD stenting (OS) or LM to LAD cross-over (CO) stenting at the National Heart Institute. As per the recommended guidelines, the participants were divided into two groups: the first one had IVUS guided PCI and Group (2) had Angiography guided PCI. The data was collected and statistically analyzed with SPSS 23.0 program.
Findings: No statistically significant difference was present between the groups regarding socio-demographic or clinical data (P-value > 0.05). It was discovered that an increase in Rotablator use, a decrease in Fluoroscopy time (min), a decrease in Contrast volume (ml), and a decrease in PCI duration (min) in patients who had IVUS guided PCI, with statistically significant difference when compared to other group who had Angiography guided PCI (P-value < 0.05). In addition, it was discovered that an increase in the necessity for a cross-over stenting method in group (1), with no statistically significant difference (P-value > 0.05). High prevalence of mortality and morbidity among IVUS guided PCI patients was present with statistical significance regarding TVR (P-value < 0.05).
Recommendations: IVUS can offer valuable information on vascular lumen, plaque features, stent deployment, & device failure causes. As a result, IVUS-guided PCI may enhance clinical impact among participants, particularly those with complicated coronary lesions & those at high risk. Further reduction in IVUS's cost, cardiologists' education and enhancing IVUS use at PCI should be adapted next.
Downloads
References
Park SJ, Lee CW, Hong MK, et al. Stent placement for ostial left anterior descending coronary artery stenosis: acute and long term (2-year) results. Catheter Cardiovasc Interv 2000;49:2 67-71.
Jaffery Z, Kowalski M, Weaver WD, et al. A meta-analysis of randomized control trials comparing minimally invasive direct coronary bypass grafting versus percutaneous coronary intervention for stenosis of the proximal left anterior descending artery. Eur J Cardiothorac Surg 2007;31:69 1-7.
Zheng X, Peng H, Zhao D, et al. Optimal revascularization strategy on medina 0,1,0 left main bifurcation lesions in type 2 diabetes. J Diabetes Res 2016; 2016: 1702454.
Li L, Dash D, Gai LY, et al. Intravascular ultrasound classification of plaque in angiographic true bifurcation lesions of the left main coronary artery. Chin Med J (Engl) 2016; 129: 1538-1543.
Hsieh IC, Chen CC, Chang SH, et al. Acute and long-term outcomes of drug-eluting stent implantations in aorto-ostial, left anterior descending artery-ostial, and nonostial lesions. Catheter Cardiovasc Interv 2013; 82: 727-734.
Kang SJ, Ahn JM, Kim WJ, et al. Intravascular ultrasound assessment of drug-eluting stent coverage of the coronary ostium and effect on outcomes. Am J Cardiol 2013; 111: 1401-1407.
Lee CH, Choi SW, Hwang J, et al. 5-year outcomes according to ffr of left circumflex coronary artery after left main crossover stenting. JACC Cardiovasc Interv 2019; 12: 847-855.
Rigatelli G, Zuin M, Baracca E, et al. Long-term clinical outcomes of isolated ostial left anterior descending disease treatment: Ostial stenting versus left main crossover stenting. Cardiovasc Revasc Med 2019; 20: 1058-1062.
Mintz GS, Lefèvre T, Lassen JF, et al. Intravascular ultrasound in the evaluation and treatment of left main coronary artery disease: a consensus statement from the European Bifurcation Club. EuroIntervention. 2018;14: e467-e474.
De la Torre Hernández JM, GarcÃa Camarero T, Baz Alonso JA, et al. Outcomes of predefined optimisation criteria for intravascular ultrasound guidance of left main stenting. EuroIntervention. 2020;16:210-217.
Kang SJ, Ahn JM and KimWJ. Functional and morphological assessment of side branch after left main coronary artery bifurcation stenting with crossover technique. Catheter Cardiovasc Interv. 2014;83:545-552.
Stone GW, Kappetein AP, Sabik JF, et al. Five-Year Outcomes after PCI or CABG for Left Main Coronary Disease. N Engl J Med. 2019;381:1820-1830.
Sianos G, Morel MA, Kappetein AP, et al. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. Eurointervention 2005; 1: 219-27.
Medina A, Suarez de Lezo J and Pan M. A new classification of coronary bifurcation lesions. Rev EspCardiol 2006; 59: 183.
Kristian T, Joseph A, Allan J, et al. the Writing Group on behalf of the Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction. 2012; 125(21):2613-20.
Mehran R, Dangas G and Abizaid AS. Angiographic patterns of in-stent restenosis: Classification and implications for long-term outcome. Circulation 1999;100:1872-1878.
Kinnaird T, StrabileE, MintzG. et al. Incidence, predictors, and prognostic implications of bleeding and blood transfusion following percutaneous coronary intervention. Am J Cardiol 2003; 92(8):930-935.
Lakhal K, Ehrmann S, Chaari A, et al. Acute Kidney Injury Network definition of contrast-induced nephropathy in the critically ill: incidence and outcome. J Crit Care 2011; 26(6):593-9.
Lotfi A, Jeremias A, Fearon WF, et al. Expert consensus statement on the use of fractional flow reserve, intravascular ultrasound, and optical coherence tomography: a consensus statement of the society of cardiovascular angiography and interventions. Catheter CardiovascInterv 2014; 83: 509-518.
Kang SJ, Lee JY, Ahn JM, et al. Validation of intravascular ultrasound-derived parameters with fractional flow reserve for assessment of coronary stenosis severity. CircCardiovascInterv 2011; 4: 65-71.
Chieffo A, Latib A, Caussin C, et al. A prospective, randomized trial of intravascular ultrasound guided compared to angiography guided stent implantation in complexcoronary lesions: the AVIO trial. Am Heart J. 2013;165:65-72.
Mintz GS, Nissen SE, Anderson WD, et al. American College of Cardiology clinical expert consensus document on standards for acquisition, measurement and reporting of intravascular ultrasound studies (IVUS). A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2001;37:1478- 92.
Golmohamadi Z, Sokhanvar S, Aslanabadi N, et al. One-Year Outcomes After Everolimus-Eluting Stents Implantation in Ostial Lesions of Left Anterior Descending Coronary Arteries.Cardiol Res. 2013;4:192-198.
Gianluca R, Marco Z, Enrico B, et al. Long-Term Clinical Outcomes of Isolated Ostial
Left Anterior Descending Disease Treatment: Ostial Stenting versus Left Main Cross-Over Stenting. Cardiovascular Revascularization Medicine journal .2019;20: 1058-62.
Capranzano P, Sanfilippo A, Tagliareni F, et al. Long-term outcomes after drug-eluting stent for the treatment of ostial left anterior descending coronary artery lesions.Am Heart J. 2010;160:973-8.
Rigatelli G, Zuin M, Baracca E, et al. Long-term clinical outcomes of isolated ostial left anterior descending disease treatment: Ostial stenting versus left main crossover stenting. Cardiovasc Revasc Med 2019; 20: 1058-1062.
Elgendy IY, Mahmoud A, Elgendy AY, et al. Outcomes With Intravascular Ultrasound-Guided Stent Implantation: A Meta-Analysis of Randomized Trials in the Era of Drug-Eluting Stents. Circ Cardiovasc Interv 2016;9:e003700.
Medina A, MartÃn P, Suárez de Lezo J, et al. Vulnerable carina anatomy and ostial lesions in the left anterior descending coronary artery after floating-stent treatment.Rev EspCardiol. 2009;62:1240-9.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Hany Fayed, Khaled Elgendy, Ismail R Barrada
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution (CC-BY) 4.0 License that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
