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 - RESIST
RESIST is a randomized study comparing IVUS (intravascular ultrasound) guided coronary stent deployment with standard stent deployment on 6-month restenosis rate.
IVUS-guided stent deployment may improve the 6-month rate of coronary restenosis.
Patients Enrolled: 155
Mean Follow Up: 6 months
Mean Patient Age: Mean of 56 in non-IVUS group and 57 in IVUS group
Mean Ejection Fraction: Mean of 51% and 53% in the non-IVUS and IVUS group, respectively
- Symptomatic Coronary Artery Disease and Single-Vessel or Native Multivessel disease with >70% stenosis of the target lesion
- Single <20 mm stent deployment
- Balloon/Artery Ratio of 1.0-1.2
- Ballon inflation pressure >12 atm for Palmaz-Schatz or NIR stent and >9 atm for premounted AVE or Freedom stent
- Optimal angiographic result after stent implantation without dissection or residual stenosis
- Vessel diameter <3.0 mm
- Coronary lesion >15mm in length
- Previous bypass surgery
- Contraindication to antiplatelet therapy
- Treatment of acute or chronic total occlusion
- Saphenous vein graft stenosis
- Recent (<7 days) acute coronary syndrome
6-month restenosis rate (>50% narrowing at the stent site) or restenosis 5 mm from either end of the stent
6-month angiographic mean luminal diameter and 6-month lumen cross-sectional area by IVUS.
Patients were randomized to stent deployment without intravascular ultrasound compared with stent deployment with additional balloon dilation until achievement of IVUS criterion for stent expansion.
- Heparin (discontinued within 24 hours of angioplasty)
- Aspirin 250 mg
- Ticlid 500 mg for 1 month
- The use of IVUS guided stent dilation was not associated with a difference in mean luminal diameter or average percent stenosis at 6-month follow-up
- 6-month cross-sectional area was 5.36±2.81 in the IVUS group and 4.47± 2.59 in the non-IVUS group (p=0.03) Restenosis rate did not differ by treatment group (22.5% in the IVUS group and 28.8% in the non-IVUS group (p=0.25), nor did minimum lumen diameter (1.70 mm vs 1.60 mm, p=0.20)
Among patients with symptomatic coronary artery disease without recent acute coronary syndrome IVUS-guided stent deployment was not associated with significant differences in 6-month mean luminal diameter but was associated with a significant increase in lumen cross-sectional area.
Schiele F, et al. 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. JACC 1998; 32:320-8.
Clinical Topics: Acute Coronary Syndromes, Invasive Cardiovascular Angiography and Intervention, Stable Ischemic Heart Disease, Atherosclerotic Disease (CAD/PAD), Interventions and ACS, Interventions and Coronary Artery Disease, Chronic Angina
Keywords: Coronary Artery Disease, Acute Coronary Syndrome, Follow-Up Studies, Coronary Restenosis, Cross-Sectional Studies, Constriction, Pathologic, Stents
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