Use of intravascular ultrasound for optimal vessel sizing in chronic total occlusion percutaneous coronary intervention

Recha Blessing; Andrea Buono; Majid Ahoopai; Martin Geyer; Maike Knorr; Moritz Brandt; Sebastian Steven; Ioannis Drosos; Thomas Muenzel; Philip Wenzel; Tommaso Gori; Zisis Dimitriadis

doi:10.3389/fcvm.2022.922366

Use of intravascular ultrasound for optimal vessel sizing in chronic total occlusion percutaneous coronary intervention

Front Cardiovasc Med. 2022 Aug 3:9:922366. doi: 10.3389/fcvm.2022.922366. eCollection 2022.

Authors

Recha Blessing¹, Andrea Buono², Majid Ahoopai¹, Martin Geyer¹, Maike Knorr¹, Moritz Brandt^{1

3}, Sebastian Steven^{1

3

4}, Ioannis Drosos⁵, Thomas Muenzel^{1

4}, Philip Wenzel^{1

3

4}, Tommaso Gori^{1

4}, Zisis Dimitriadis⁵

Affiliations

¹ University Medical Center Mainz, Center of Cardiology, Johannes Gutenberg University, Mainz, Germany.
² Interventional Cardiology Unit, Fondazione Poliambulanza, Brescia, Italy.
³ Center for Thrombosis and Hemostasis, Johannes Gutenberg University, Mainz, Germany.
⁴ German Center for Cardiovascular Research (DZHK), Mainz Partner Site Rhine-Main, Mainz, Germany.
⁵ Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany.

Abstract

Aim: The aim of this study is to provide evidence on how use of standardized intravascular ultrasound (IVUS) use impacts stent size choice in the setting of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) compared to visual estimation.

Methods and results: Data of 82 consecutive patients who had successfully undergone IVUS-guided revascularization of CTO at the University Medical Center Mainz were analyzed. Angiography-based stent size prediction for the proximal and distal vessels was compared to the implanted stent diameter after IVUS assessment. Angiography-based stent size prediction for the proximal vessel was 3.09 ± 0.41, whereas IVUS use demonstrated larger vessel diameter, resulting in larger implanted stent diameter (3.24 ± 0.45, p < 0.001). Proximal vessel stent size prediction was underestimated in the majority of patients by angiographic estimation. Angiography-based stent size prediction for the distal vessel was 2.79 ± 0.38, whereas IVUS use demonstrated larger vessel diameter, resulting in larger implanted stent diameter (2.92 ± 0.39, p < 0.001).

Conclusion: Pre-stent IVUS assessment in CTO PCI provides important information on vessel morphology and size. Angiography-based stent size prediction for the proximal and distal vessels was frequently underestimated, IVUS use demonstrated larger vessel diameter, resulting in significantly larger implanted stent diameter.

Keywords: CTO percutaneous coronary intervention; complex PCI; coronary artery disease; intravascular ultrasound (IVUS); percutaneous coronary intervention (PCI).