Intravascular ultrasound-guided optimization for chronic total occlusion-percutaneous coronary intervention with multiple drug-eluting stents

Abstract Background Multiple stenting in the chronic total occlusion (CTO) lesions is frequently required, however associated with poorer clinical outcomes. It demonstrated that intravascular ultrasound (IVUS)-guided CTO-percutaneous coronary intervention (PCI) related to a lower risk of adverse events. Purpose We aimed evaluate impact stent optimization under IVUS guidance for multiple stenting, comparing single stenting. Methods A 916 patients receiving drug-eluting (DES) were classified into two groups (stent and non-optimization) according criteria (an absolute expansion criteria; minimal area ≥4.9 mm2 relative 80% mean reference lumen area). Of population, 314 (34.3%) treated 575 (62.7%) stents, respectively. Ischemic-driven target-lesion revascularization (TLR)/reocclusion was evaluated. Results Under guidance, 316 (34.5%) met The achieving rates 53% group 24% stents group, respectively, (p<0.001). During median 4.7 years, showed significantly higher TLR/reocclusion rate, compared (12.8% vs. 5.2%, adjusted hazard ratio [HR] 2.51, 95% confidence interval [CI] 1.20–5.25, p=0.01). (Figure 1) Meeting both low rate (12.5% HR 0.34, CI: 0.15–0.79, IVUS-guidance, there no significant difference between case (6.5% 4.2%, p=0.11), whereas non-optimization TLR/reocclusion, IVUS-optimization (14.5% p=0.002). 2) Conclusions In CTO-PCI DES, increased TLR/reocclusion. IVUS-guided comparable long-term optimization. Hence, may help reduce DES overlapping. Funding Acknowledgement Type funding sources: None.