Circulation, Vol 90, 1252-1261, Copyright © 1994 by American Heart Association
H Mudra, V Klauss, R Blasini, M Kroetz, J Rieber, E Regar and K Theisen
BACKGROUND: Coronary stenting in conjunction with coronary angioplasty is a
valuable tool for treatment of severe coronary dissection and is effective
in reducing the frequency of restenoses. Evidence is increasing that the
lumen gain within the stent is negatively correlated with the rate of
subacute closures and restenoses. Since the assessment of radiolucent
coronary stents and complex lumen morphologies by angiography is limited,
we hypothesized that the use of a balloon catheter with integrated
intravascular ultrasound (IVUS) facility for stent deployment and guidance
of its expansion could improve the acute lumen gain without relevant
procedural prolongation. METHODS AND RESULTS: Deployment of a single
Palmaz-Schatz coronary stent with the combined imaging balloon catheter
alone was successful in 18 of 20 patients eligible for this study.
Corresponding measurements of minimal lumen diameter (MLD) by angiography
and IVUS could be performed in 16 patients, revealing a close correlation
between the two methods within the reference segments (3.10 +/- 0.38 and
3.08 +/- 0.43 mm, r = .79). Despite an adequate angiographic result in most
patients after stent deployment, IVUS showed smaller MLD within the stented
segment (2.15 +/- 0.23 mm) compared with angiography (2.63 +/- 0.26 mm, P
< .0001) with a poor correlation (r = .27). To achieve IVUS criteria for
optimal stent expansion (ratio of 0.9 between IVUS- assessed
cross-sectional area of stent and reference segment), an average of three
additional balloon inflations with higher pressure and/or a larger balloon
diameter were performed without adverse effects in 15 of 16 patients who
initially did not fulfill these criteria. This resulted in a significant
increase in stent MLD to 2.63 +/- 0.27 mm (IVUS, P < .0001 versus
initial MLD) and 2.89 +/- 0.32 mm (angiography, P < .0002 versus initial
MLD) and a better correlation between the two methods (r = .60). The IVUS
guidance led to a 40 +/- 15% increase of the minimal stent cross-sectional
area with an additional time consumption of 21 minutes on average.
CONCLUSIONS: This study demonstrates the application of a combined imaging
balloon catheter for delivery and ultrasound-guided expansion of
Palmaz-Schatz coronary stents. IVUS offered a comprehensive insight into
the stented coronary segments, revealing a substantial overestimation of
stent dimensions by angiography. IVUS guidance led to a significant
improvement of stent expansion. This additional lumen gain, which was not
discernible by angiography in most patients, might result in a reduction of
subacute stent thromboses as well as restenoses.
ARTICLES
Ultrasound guidance of Palmaz-Schatz intracoronary stenting with a combined intravascular ultrasound balloon catheter
Department of Medicine, Klinikum Innenstadt, University of Munich, Germany.
This article has been cited by other articles:
 |
|
 |
|
  E. Romagnoli, G. M. Sangiorgi, J. Cosgrave, E. Guillet, and A. Colombo Drug-eluting stenting the case for post-dilation. J. Am. Coll. Cardiol. Intv., February 1, 2008; 1(1): 22 - 31. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. J. Kim, B. H. Lee, D. I. Kim, W. H. Shim, P. Jeon, and T. H. Lee Stent-Assisted Angioplasty of Symptomatic Intracranial Vertebrobasilar Artery Stenosis: Feasibility and Follow-up Results AJNR Am. J. Neuroradiol., June 1, 2005; 26(6): 1381 - 1388. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. L. Packer, C. L. Stevens, M. G. Curley, C. J. Bruce, F. A. Miller, B. K. Khandheria, J. K. Oh, L. J. Sinak, and J. B. Seward Intracardiac phased-array imaging: methods and initial clinical experience with high resolution, under blood visualization: Initial experience with intracardiac phased-array ultrasound J. Am. Coll. Cardiol., February 6, 2002; 39(3): 509 - 516. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Mudra, C. di Mario, P. de Jaegere, H. R. Figulla, C. Macaya, R. Zahn, B. Wennerblom, W. Rutsch, V. Voudris, E. Regar, et al. Randomized Comparison of Coronary Stent Implantation Under Ultrasound or Angiographic Guidance to Reduce Stent Restenosis (OPTICUS Study) Circulation, September 18, 2001; 104(12): 1343 - 1349. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. C. Smith Jr, J. T. Dove, A. K. Jacobs, J. Ward Kennedy, D. Kereiakes, M. J. Kern, R. E. Kuntz, J. J. Popma, H. V. Schaff, D. O. Williams, et al. ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines): A report of the American College of Cardiology/ American Heart Association Task Force on practice guidelines (Committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty) endorsed by the Society for Cardiac Angiography and Interventions J. Am. Coll. Cardiol., June 15, 2001; 37(8): 2239 - 2239. [Full Text] [PDF]
|
|
|
|
|
|
P. Angerer, U. Siebert, W. Kothny, D. Muhlbauer, H. Mudra, and C. von Schacky Impact of social support, cynical hostility and anger expression on progression of coronary atherosclerosis J. Am. Coll. Cardiol., November 15, 2000; 36(6): 1781 - 1788. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. M. Lincoff Stent Scrutiny JAMA, October 11, 2000; 284(14): 1839 - 1841. [Full Text] [PDF]
|
|
|
|
|
|
P. J. de Feyter, P. Kay, C. Disco, and P. W. Serruys Reference Chart Derived From Post-Stent-Implantation Intravascular Ultrasound Predictors of 6-Month Expected Restenosis on Quantitative Coronary Angiography Circulation, October 26, 1999; 100(17): 1777 - 1783. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J G Fujimoto, S A Boppart, G J Tearney, B E Bouma, C Pitris, and M E Brezinski High resolution in vivo intra-arterial imaging with optical coherence tomography Heart, August 1, 1999; 82(2): 128 - 133. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. von Schacky, P. Angerer, W. Kothny, K. Theisen, and H. Mudra The Effect of Dietary {omega}-3 Fatty Acids on Coronary Atherosclerosis: A Randomized, Double-Blind, Placebo-Controlled Trial Ann Intern Med, April 6, 1999; 130(7): 554 - 562. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P B M Clarkson, M Halim, K K Ray, S Doshi, M Been, H Singh, and M F Shiu Coronary artery stenting in unstable angina pectoris: a comparison with stable angina pectoris Heart, April 1, 1999; 81(4): 393 - 397. [Abstract] [Full Text]
|
|
|
|
 |
|
 R. Erbel, M. Haude, H. W. Hopp, D. Franzen, H. J. Rupprecht, B. Heublein, K. Fischer, P. de Jaegere, P. Serruys, W. Rutsch, et al. Coronary-Artery Stenting Compared with Balloon Angioplasty for Restenosis after Initial Balloon Angioplasty N. Engl. J. Med., December 3, 1998; 339(23): 1672 - 1678. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Oshima, D. Itchhaporia, and P. Fitzgerald New developments in intravascular ultrasound Vascular Medicine, November 1, 1998; 3(4): 281 - 290. [Abstract] [PDF]
|
|
|
|
|
|
F. Schiele, N. Meneveau, A. Vuillemenot, D. D. Zhang, S. Gupta, M. Mercier, N. Danchin, B. Bertrand, J.-P. Bassand, and on behalf of the RESIST Study Group Impact of intravascular ultrasound guidance in stent deployment on 6-month restenosis rate: a multicenter, randomized study comparing two strategies--with and without intravascular ultrasound guidance J. Am. Coll. Cardiol., August 1, 1998; 32(2): 320 - 328. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Mudra, E. Regar, V. Klauss, F. Werner, K.-H. Henneke, E. Sbarouni, and K. Theisen Serial Follow-up After Optimized Ultrasound-Guided Deployment of Palmaz-Schatz Stents: In-Stent Neointimal Proliferation Without Significant Reference Segment Response Circulation, January 21, 1997; 95(2): 363 - 370. [Abstract] [Full Text]
|
|
|
|
|
|
P. W. Serruys and C. Di Mario Who Was Thrombogenic: The Stent or the Doctor? Circulation, March 15, 1995; 91(6): 1891 - 1893. [Full Text]
|
|