The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Clinical Outcomes of Post-Stent Intravascular Ultrasound Examination for Chronic Total Occlusion Intervention with Drug-Eluting Stents

DOI: 10.4244/EIJ-D-20-00941

1. Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea, Korea, Republic of
2. Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
3. Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
4. Division of Cardiology, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
5. Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea
6. Division of Cardiology, Department of Internal Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea

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Background: Few studies have evaluated intravascular ultrasound (IVUS) use in chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

Aims: In CTO-PCI, we aimed to (1) evaluate the clinical benefits of performing post-stent IVUS in preventing adverse clinical events, and (2) identify IVUS parameters and cut-off values for prediction of target-lesion revascularization (TLR)/reocclusion.

Methods: A total of 1,077 patients with 1077 CTO lesions treated with drug-eluting stents (DES) were included. Clinical outcomes during a median follow-up of 6.3 years were compared between subjects with or without post-stent IVUS using the inverse probability weighting method. 

Results: Of 1,077 patients, post-stent IVUS was performed in 838 (77.8%) cases while the remaining 239 (22.2%) cases did not undergo. In the weighted population, the risk of TLR/reocclusion was significantly lower in subjects with post-stent IVUS (9.6% vs. 18.9%, hazard ratio [HR], 0.54; 95% confidence interval [CI], 0.34-0.86, P=0.01), compared with those without post-stent IVUS. Cox-regression analysis showed that minimal stent area (MSA) measured by IVUS was the only parameter independently associated with TLR/reocculsion (HR, 0.78; 95% CI 0.64-0.95; P=0.01) and the optimal MSA cut-off value was 4.9 mm2 for prediction of TLR/reocclusion (area under the curve=0.632, P=0.001).

Conclusions: In CTO-PCI with DES, post-stent IVUS evaluation was associated with a lower risk of TLR/reocclusion. The final MSA was independently associated with TLR/reocclusion with a cut-off value of 4.9 mm2.

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