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ercutaneous coronary intervention (PCI) is an integral part of treatment of ischemic heart disease. The use of coronary catheterization in appropriate patients reduces morbidity and mortality. (1,2)
Intravascular ultrasound (IVUS) is a reliable imaging tool to guide percutaneous coronary intervention. There has been increasing evidence supporting the clinical utility of IVUS-guided stent implantation. IVUS provides cross-sectional views of the coronary artery wall, and allows us to assess stenosis severity, identify plaque morphology, optimize stent implantation, and understand mechanism of stent failure. IVUS guidance can increase stent efficacy and decrease clinical adverse events. (4)
Coronary computed tomography angiography has been gaining popularity due to its ability to identify coronary artery disease, give information about coronary anatomy, plaque morphology and length, and its calcium content. (5)
Not only it can help in identification of the coronary artery disease and indentify plaques, but also it can help planning coronary intervention, especially the complex ones. (6)
The study was conducted on 90 patients having coronary artery disease, planned for elective PCI at the department of Cardiology, Ain Shams University Hospitals.
After obtaining a written informed consent from the patients, and after the approval of the Ethical Committee of the department of Cardiology, Ain Shams University, the patients were divided into three equal groups. group A, underwent IVUS guided PCI, group B, underwent planned PCI after multi-slice CT coronary angiography and group C underwent conventional coronary angiography followed by PCI.
Most of the patients in this study were males, (84.4%, 76 patients) 27 of them were in group B. Patients’ age ranged from 36 to 74 years with a mean of 55 years. Gender and age were not significantly different between the three groups.
Most of the patients (85 patients - 94.4%) had the procedure done through the femoral approach, while only 5 patients (6.6%) through the radial approach.
Target vessels varied between LM, LAD, LCX and RCA, with the predominance of LAD, 55.5% of all patients. There was no significant difference between the three groups regarding the target vessel (P = 0.397).
Most of the patients had single stent implantation (69.6%). Only 23.3% and 5.53% of all patients had 2 and 3 stents implantation respectively. group B showed a single patient that didn’t have any stents implanted as the lesion was non-significant angiographically.
Regarding contrast use, group B was significantly higher regarding the amount of contrast used during the procedure. Post-hoc analysis showed that comparison between group B, and both groups A and C, was significant with a P value of 0.024 and 0.034 respectively.
Regarding stent diameter, no significant difference was found between the three groups regarding the stent diameter, in contrast to stent length which was significantly longer in group B. Post-hoc analysis showed comparison between group B, and both group A and C was significant, with a P value of 0.002 and 0.036 respectively.
Regarding the use of non-compliant balloons, group A had a significant number of patients who needed post-stenting balloon dilatation (28 patients, 93.34%). Comparison between group A and group C was highly significant, with a P value of 0.007. Also comparison between group A and group B was significant, with a P value of 0.042.
Most of the patient had satisfactory results with TIMI 3 flow (84 patients, 94.37%). Only one patient had access site complication (1.1%) and 6 patients had distal edge dissection (6 patients, 6.67%), 4 of them in group A.
No MACCES were detected during the hospital stay.
At one month follow up, there was no significant difference between the 3 groups regarding MACCES although group B showed one patient who died 18 days after a successful procedure.
Also in group B, a patient developed CIN 3 days after the procedure.
In conclusion, IVUS is the most accurate tool to assess the need of post-stenting balloon dilatation in PCI and also the early detection of intra-coronary complications.
Multi-slice CT coronary angiography is associated with larger amount of contrast use, longer lesion detection with the subsequent longer stent deployment in comparison to IVUS and angiography alone. This should be further studied for weighing its benefits against the risk of longer metal load.
The results of our study doesn’t support the routine use of MSCT or IVUS in all cases undergoing PCI.
In view of the small number of patients, lack of long-term follow-up data, further studies including larger number of patients with a longer follow up of the clinical outcome is recommended.