Читать книгу Interventional Cardiology - Группа авторов - Страница 225

The two main uses of IVUS are to insure optimal stent expansion (stent CSA) and full coverage of the lesion. Stent underexpansion is a powerful predictor of early stent thrombosis and restenosis after DES implantation according to numerous IVUS studies [4,5,42–49]. In almost every meta‐analyses, IVUS guidance was associated with a reduction in death (primarily cardiovascular mortality) as well as other hard end points of myocardial infarction and stent thrombosis. Of note, the beneft of IVUS guidance in reducing events after DES implantation was greater in meta‐analyses of randomized trials of IVUS vs angiographic guidance compared to meta‐analyses of registries, and it tended to be greater in high‐risk patient and complex lesion subsets than in “all comers” populations [46].

A meta‐analysis of outcomes after IVUS‐guided vs. angiography‐guided DES implantation in 26 503 patients enrolled in three randomized trials and 14 observational studies, demonstrated that IVUS‐guided PCI was associated with a significantly lower risk of TLR (OR 0.81; p = 0.046). In addition, the risk of death (OR 0.61; p <0.001), MI (OR 0.57; p <0.001), and stent thrombosis (OR; p <0.001) were also decreased [47]. A recent metanalysis of 10 RCTs (5007 participants, which include the largest RCTs IVUS‐XPL and ULTIMATE Trial) including patients with CTO, stable ischemic heart disease or presented as ACS showed that routine use of IVUS was effective in reducing TLR (RR 0.59; p < 0.01), TVR (RR 0.59; p < 0.01), and MACE (RR 0.63; p < 0.01). Cardiovascular mortality was also significantly reduced (RR 0.51; p = 0.04) [48].