Coronary Artery DiseaseDoes the specific intravascular ultrasound criterion used to optimize stent expansion have an impact on the probability of stent restenosis?
Section snippets
Patient population
From March 1993 until June 1995, 425 patients presented with 496 nonostial lesions in native coronary arteries and underwent angiographically successful Palmaz-Schatz stent implantation. All these patients underwent IVUS interrogation and had high quality images that allowed assessment of the stented segment and the proximal and distal reference. In all, 335 of 421 eligible patients (80%) with 390 of 490 lesions (80%) underwent angiographic follow-up at 5.3 ± 2.7 months. All eligible patients
Patient’s characteristics and factors associated with achieving various IVUS criteria
Patient’s clinical and angiographic characteristics are listed in Table I, Stenting indications were elective in 413 lesions (82%), suboptimal angioplasty in 60 lesions (12%), and threatened closure in 33 lesions (6%). The angiographic and procedural variables associated with each specific criterion are listed in Table II. and the IVUS measurements are listed in Table III. An ISMLCSA ≥9 mm2 and an ISMLCSA (≥9 mm2 and ≥80% of average reference lumen CSA) were achieved in a few patients with
Discussion
The major findings of this study are that (1) there is large variability in the frequency of achieving various IVUS criteria based on differences in vessel size, plaque burden, and balloon-to-artery ratio; (2) achieving an ISMLCSA ≥90% of reference lumen CSA (average or distal) did not lead to a reduction in restenosis; (3) achieving an ISMLCSA ≥9 mm2 was associated with a low restenosis rate, but this criterion was primarily achieved in large vessels; and (4) achieving an ISMLCSA ≥55% of
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