IVUS-CTO: Intravascular Ultrasound-Guided vs. Angiography-Guided DES Intervention in Coronary CTO
Intravascular ultrasound (IVUS)-guided chronic total occlusion (CTO) intervention significantly improves clinical outcomes during the 12 months following new generation drug-eluting stent (DES) implantation, as compared to conventional angiography-guided CTO intervention, according to results from the IVUS-CTO trial presented Sept. 14 at TCT 2014.
The trial was led by Yangsoo Jang, MD, PhD, FACC, Division of Cardiology, Severance Cardiovascular Hospital Yonsei University College of Medicine, Seoul, Korea, and was the first randomized trial to look at the clinical benefits of IVUS guidance for CTO intervention “after successful guidewire crossing in the era of new generation DES.”
Enrolling 402 patients, subjects of Jang et al.’s trial were divided randomly into an IVUS-guided group (n=201) and a angiography-guided group (n=201). With a primary endpoint as a composite of cardiac death, myocardial infarction and target vessel revascularization at 12 months, the percentage of cumulative incidence in that timeframe was 7.1 percent (14 incidences; four cardiac death or myocardial infarction, and 10 target vessel revascularization) for the angiography-guided group and 2.6 percent (five incidences; 0 cardiac death or myocardial infarction, and five target vessel revascularization) for the IVUS-guided group.
In addition to significantly improving clinical outcomes after DES implantation, the trial also demonstrates that as compared to conventional angiography-guided CTO intervention, IVUS-guided CTO intervention causes a more frequent use of high-pressure post-dilation and a larger post-procedural minimal lumen diameter.
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