Optimal Morphological Criteria Evaluated by Intravascular Ultrasound to Predict Future Clinical Outcomes in the Complex Percutaneous Coronary Intervention Lesions

Background: Intravascular ultrasound (IVUS) guidance of stent implantation can help optimal stent deployment in comparison to angiographic guidance alone. Thus, IVUS guidance might enhance short and long-term clinical outcomes of cases performing percutaneous coronary intervention (PCI). The purpose of this work was to investigate the optimal morphological criteria evaluated by IVUS to predict the clinical outcomes in PCI of complex lesions.

Methods: This observational prospective study was carried out on 56 patients who underwent PCI for complex coronary lesions guided by IVUS. All patients were subjected to standard 12- lead electrocardiogram (ECG), routine laboratory examinations [complete blood count (CBC), blood urea and serum creatinine, prothrombin time, and international normalized ratio (INR)], echocardiography, coronary angiography, PCI and IVUS guidance (both pre and post stenting).

Results: 7 of 45 cases with coronary bifurcation lesion (CBL) were treated with a two-stent technique that was planned upfront in 5 of them and was applied as a bail-out strategy in 2 cases. Whereas, in the remaining 38 cases, provisional stenting strategy was adopted and ended up with one-stent technique that went smooth and uneventful as guided and optimized by adjunctive IVUS. Only one patient (2%) had a non-fatal myocardial infarction 4 months post-index procedure. No incidence of other composite endpoint was encountered during the 6 months follow-up period of the study.

Conclusions: Intravascular ultrasound (IVUS) guidance is associated with favourable procedural and clinical results for cases undergoing complex PCI procedures. This well-established evident role of IVUS in complex PCI procedures is driven mainly by the insights it offers that help better upfront procedural planning in addition to acute procedural result optimization.