الفهرس 
INTRAVASCULAR ULTRASOUND (IVUS)Only 14 pages are availabe for public view
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Abstract
Intravascular ultrasound (IVUS) was largely used to guide
percutaneous coronary interventions (PCIs). Because of its
ability to accurately measure lumen, plaque, and vessel
dimensions, it is possible that IVUS might serve as an adjuctive
tool to angiography in many steps during PCI, therefore it is
hypothesized that IVUS imaging during coronary angioplasty
may lead to a reduced use of contrast media.
Contrast-induced acute kidney injury (CI-AKI) is a
potential complication of diagnostic and therapeutic angiographic
procedures. Almost unanimously, previous studies have shown
that CI-AKI is associated with worse clinical outcomes. It
remains debatable, however, whether CI-AKI is solely a marker
for future morbidity and mortality or, conversely, it is also
causally implicated in the occurrence of adverse events.
Although the incidence of CI-AKI is modulated by
several clinical characteristics, the volume of iodine contrast
seems to be a major factor leading to CI-AKI, independently of
the baseline risk profile. Curiously, thus far, few approaches
have been described to reduce the primary cause of CI-AKI
after PCI, namely, the contrast agent dose.The aim of our study to evaluate the impact of
intravascular ultrasound guidance on the final volume of
contrast agent utilized in diabetic patients undergoing PCI for
chronic stable angina and its clinical implications.
Our study was conducted upon 100 Diabetic Egyptian
patients with chronic stable angina who were selected to
angiography-guided PCI (n= 50 patients) or IVUS-guided PCI
(n=50 patients) from June 2019 to January 2020.
All patients were subjected to full history taking and
clinical examination including diabetes mellitus, hypertension,
smoking and family history of IHD, thorough clinical
examination, surface Electrocardiogram (ECG) and laboratory
investigations as serum creatinine and glycated hemoglobin
(HbA1c). All patients signed the informed consent. Patients
with known allergy to contrast agents, unstable or unknown
renal function prior to PCI and anticipated technical
impossibility for intravascular ultrasound (Extreme
calcifications) were excluded from the study.
The interventional plan was left to the discretion of the
operator, but regardless of the allocated arm, operators was
strongly recommended to follow strict strategies to reduce the
total volume of contrast for all patient.
All percutaneous procedures were performed using nonionic, low-osmolar or iso-osmolar, iodine-based contrast media
(iopromide [Ultravist®
; Bayer Pharma AG, Berlin, Germany] or
iodixanol [Visipaque™; GE Healthcare Ireland, Cork, Ireland]).For those allocated to the IVUS-guided group,
intravascular ultrasound was performed with the Eagle Eye
Plantium ST Pro Imaging Catheter 40 MHz connected to
VOLCANO Ultrasound Imaging System by PHILLIPS.
Analysis of baseline characteristics of our study population
showed that mean age(years) was 60.20±10.33 (conventional PCI
group ) and 59.58 ± 8.29 ( IVUS group), Mean weight(Kg)
was77.78 ± 6.09 (conventionl PCI group) and 81.50 ± 8.61
(IVUS group), 14 (28.0%) were females and 36 (72.0 %) were
males (conventional PCI group), 13 (26.0%) were females and 37
(74.0%) were males (IVUS group), 24 (48.0%) were hypertensive
(conventional PCI group) and 26 (52.0%) were hypertensive
(IVUS group) and all patients were diabetic in both groups
It was found in our study that the median total volume of
contrast was 111.65 ml (interquartile range [IQR] 170.40 ±
52.91ml, range from 100 ml to 300 ml) in angiography-guided
group vs. 56.99 ml (IQR 94.70 ± 19.28ml, range from 70 ml to
180 ml) in IVUS-guided group (p<0.001).
The present study concluded that thoughtful and
extensive utilization of IVUS as the primary imaging tool to
guide percutaneous coronary intervention is safe and markedly
reduces the volume of iodine contrast, compared to
angiography-alone guidance.