Dec 16, 2021 by Philips
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Diffuse Disease
Approximately 20% of the coronary lesions treated today are long and diffuse.1,2
Clinical challenges
- Diffuse or long lesions are associated with decreased proceduralsuccess and are associated with higher rates of restenosis.
– Stent length is an independent predictor of in-stent restenosis and thrombosis.
– Stenting long segments with multiple and or overlapping stents may lead to injury to the vessel wall integrity.
- Angiography alone may not be able to identify the critical lesion.
– Diffuse CAD may be underestimated by evaluation with coronary angiography.
– Determining reference vessel sizing can be challenging when the vessel is diffusely diseased.
IVUS-guided vs. angiography-guided outcomes3
Advanced tools for optimal PCI outcomes
- Maps iFR physiological drops to identify critical stenoses.
- Creates length measurements without a pullback device, plan your procedure and see the physiologic impact of a virtual stent.
- Guides stenting of the most severely diseased areas, eliminating the need for implantation of long stents.
- Study data (IVUS-XPL) reported IVUS was associated with a 50% reduction in MACE at 5 year with Xience Prime stents ≥28 mm.4
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References
1. Xu B., Gao R. L., Zhang R. Y., et al. Efficacy and safety of FIREHAWK abluminal groove filled biodegradable polymer sirolimus-eluting stents for the treatment of long coronary lesions: nine-month angiographic and one-year clinical results from TARGET I trial long cohort. Chinese Medical Journal. 2013;126(6):1026–1032.
2. Ahn J. M., Park D. W., Kim Y. H., et al. Comparison of resolute zotarolimus-eluting stents and sirolimus-eluting stents in patients with de novo long coronary artery lesions a randomized LONG-DES IV trial. Circulation: Cardiovascular Interventions. 2012;5(5):633–640.
3. Costa JR, Mintz GS, Carlier SG, et al. Nonrandomized comparison of coronary stenting under intravascular ultrasound guidance of direct stenting without predilation versus conventional predilation with a semi-compliant balloon versus predilation with a new scoring balloon. Am J Cardiol. 2007;100:812-817.
4. Hong S-J, et al. “Effect of Intravascular Ultrasound-guided Drug-Eluting Stent Implantation: Five-Year Follow-Up of the IVUS-XPL Randomized Trial, JACC: Cardiovascular Interventions (2020), doi: www.doi.org/10.1016/j.jcin.2019.09.033.
5. Weisz, G., Metzger, D. C., Liberman, H. A., O'Shaughnessy, C. D., Douglas, J. S., Jr, Turco, M. A., Mehran, R., Gershony, G., Leon, M. B., & Moses, J. W. (2013). A provisional strategy for treating true bifurcation lesions employing a scoring balloon for the side branch: final results of the AGILITY trial. Catheterization and cardiovascular interventions: official journal of the Society for Cardiac Angiography & Interventions, 82(3), 352–359. https://doi.org/10.1002/ccd.24630.
