Употреба на интраваскуларен ултразвук во оптимизација на резултати при стентирање на долги лезии

Abstract

Introduction: Several clinical studies have shown that Intravascular Ultrasound (IVUS) guided Percutaneous Coronary Interventions (PCIs) improved short and long term clinical outcomes compared to angiographically guided PCIs. Objectives: To compare the clinical outcomes of IVUS guided PCI of long coronary lesions, in relation with angiographic-guided interventions, as well as to stimulate the use of IVUS in catheterization laboratories in the Republic of Macedonia in order to improve coronary results. Material and methods: We observed 60 patients with angiographically proven long coronary lesion (>20mm), stenosis diameter over 70% and clinical symptoms, divided into two groups: group with angiographic guided coronary artery stenting (n=30), and IVUS guided coronary artery stenting (n=30). Zotarolimus eluted stents (ZES) are used in both groups. In patients with angiographic-guided stenting, procedural success was defined as <30% diameter stenosis compared to the distal reference lumen and the absence of angiographically evident dissection. AVID criteria were used for stent optimization in IVUS guided group. The primary end point wаs composite of Major Adverse Cardiac Events (MACE): death,myocardial infarction, and ischemia-guided revascularization of the target lesion (TLR). Secondary end points includes: cardiac death, myocardial infarction associated with treated coronary artery (MI), stent thrombosis (ST), target vesel revascularization (TVR), target lesion revascularization (TLR). Clinical follow-up of patients included:interview, physical examination, electrocardiography (ECG) at 30 days, 6 months and 12 months after the intervention. Results: In both groups follow up was completed at one, six and twelve months in all 60 patients ( 30 in each group). After one and six months follow up of MACE no statistically significant differences between the two groups were found. Twelve months follow up showed significant MACE reduction in IVUS guided group, compared to angiographic guided group (3.30% vs 26.70%, p= 0.03). After 12 months there was no significant difference in death (3.30% vs 6.70, p=1.00), myocardial infarction (0.00% vs 6.70%, p=0.49), and TLR (0.00% vs 6.70%,p= 0.49) between angiographic and IVUS guided group. Conclusion: IVUS guided stenting of long coronary lesions significantly reduces the rate of 12- month composite of major adverse cardiac events (MACE) compare to angiographic-guided stenting. IVUS guided stenting has lower mortality rate, myocardial infarction, stent thrombosis, and TLR compared to angiographic guided stenting, but statistically insignificant. The results of the study will encourage the use of IVUS in the catheterization laboratories in the Republic of Macedonia in order to improve the results of coronary stenting.