Application of Intravascular Ultrasound During Percutaneous Coronary Interventions in Controversial Cases and Complex Atherosclerotic Lesions
The aim of the study is to present our own experience of using intravascular ultrasound (IVUS) for making a clinically informed decision to perform percutaneous coronary intervention (PCI) in a particular patient. Material and methods: A 65-year-old patient with angina pectoris and a positive exercise test, which revealed horizontal ST depression in the chest leads, underwent diagnostic coronary angiography, which diagnosed stenosis of up to 50 % of the trunk of the left coronary artery (LCA). In this connection, IVUS was performed to make a decision on the advisability of performing PCI. According to IVUS data, the area of narrowing of the LCA trunk was 60 %. There is a “torn” edge of the intima of the vessel with severe calcification in the largest segment of the narrowing, which indicates the “instability” of the atherosclerotic plaque. The patient underwent PCI with stenting of the LCA trunk with a transition to the proximal segment of the anterior descending artery (LAD) due to the spread of an atherosclerotic plaque at the mouth of the LAD. Conclusion: IVUS plays an important role in the decision to perform PCI in controversial cases and complex atherosclerotic lesions.
Molokhoev E.B., Gaisenok O.V., Zakaryan N.V. 2024. Application of Intravascular Ultrasound During Percutaneous Coronary Interventions in Controversial Cases and Complex Atherosclerotic Lesions. Challenges in Modern Medicine, 47(2): 182–191 (in Russian). DOI: 10.52575/2687-0940-2024-47-2-182-191
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Boudoulas K.D., Bittenbender P.M., Nagaraja H.N., Kahaly O., Dickerson J.A., Raman S.V., Mazzaferri E.L. Jr., Bush C.A. 2017. Factors Determining Left Main Coronary Artery Luminal Area. J. Invasive Cardiol.; 29(7): 246–249.
Case B.C., Torguson R., Mintz G.S., Di Mario C., Medranda G.A., Zhang C., Shea C., Garcia-Garcia H.M., Waksman R. 2023. Additive Effect of Multiple High-Risk Coronary Artery Segments on Patient Outcomes: LRP Study Sub-Analysis. Cardiovasc Revasc Med; 46: 38–43. doi: 10.1016/j.carrev.2022.08.008
Cheng J.M., Garcia-Garcia H.M., de Boer S.P., Kardys I., Heo J.H., Akkerhuis K.M., Oemrawsingh R.M., van Domburg R.T., Ligthart J., Witberg K.T., Regar E., Serruys P.W., van Geuns R.J., Boersma E. 2014. In Vivo Detection of High-Risk Coronary Plaques by Radiofrequency Intravascular Ultrasound and Cardiovascular Outcome: Results of the ATHEROREMO-IVUS Study. Eur. Heart. J; 35(10): 639–47. doi: 10.1093/eurheartj/eht484
Criqui M.H., Denenberg J.O., Ix J.H., McClelland R.L., Wassel C.L., Rifkin D.E., Carr J.J., Budoff M.J., Allison M.A. 2014. Calcium Density of Coronary Artery Plaque and Risk of Incident Cardiovascular Events. JAMA; 311(3): 271–8. doi: 10.1001/jama.2013.282535
Di Muro F.M., Di Mario C., Mattesini A. 2024. Hidden Vulnerable Plaques Make the Most Noise: Optical Coherence Tomography in Patients with ST Segment Elevation Myocardial Infarction and Multivessel Disease. Minerva Cardiol. Angiol. doi: 10.23736/S2724-5683.23.06508-0. Epub ahead of print.
Erlinge D., Maehara A., Ben-Yehuda O., Bøtker H.E., Maeng M., Kjøller-Hansen L., Engstrøm T., Matsumura M., Crowley A., Dressler O., Mintz G.S., Fröbert O., Persson J., Wiseth R., Larsen A.I., Okkels Jensen L., Nordrehaug J.E., Bleie Ø., Omerovic E., Held C., James S.K., Ali Z.A., Muller J.E., Stone G.W.; PROSPECT II Investigators. 2021. Identification of Vulnerable Plaques and Patients by Intracoronary Near-Infrared Spectroscopy and Ultrasound (PROSPECT II): a Prospective Natural History Study. Lancet; 397(10278): 985–995. doi: 10.1016/S0140-6736(21)00249-X
Gaba P., Gersh B.J., Muller J., Narula J., Stone G.W. 2023. Evolving Concepts of the Vulnerable Atherosclerotic Plaque and the Vulnerable Patient: Implications for Patient Care and Future Research. Nat Rev. Cardiol; 20(3): 181–196. doi: 10.1038/s41569-022-00769-8
Geng L., Shi X., Yuan Y., Du P., Gao L., Wang Y., Li J., Guo W., Huang Y., Zhang Q. 2023. Anatomical and Functional Discrepancy in Diabetic Patients With Intermediate Coronary Lesions – An Intravascular Ultrasound and Quantitative Flow Ratio Study. Circ J; 87(2): 320–328. doi: 10.1253/circj.CJ-22-0238
Hermiller J.B., Buller C.E., Tenaglia A.N., Kisslo K.B., Phillips H.R., Bashore T.M., Stack R.S., Davidson C.J. 1993. Unrecognized Left Main Coronary Artery Disease in Patients Undergoing Interventional Procedures. Am. J. Cardiol.; 71(2): 173–6. doi: 10.1016/0002-9149(93)90734-t
Karády J., Taron J., Kammerlander A.A., Hoffmann U. 2020. Outcomes of Anatomical vs. Functional Testing for Coronary Artery Disease: Lessons from the Major Trials. Herz; 20; 45(5): 421–430. doi: 10.1007/s00059-020-04950-y
Katritsis D.G., Pantos I., Zografos T., Spahillari A., de Waha A., Kopanidis A., Foussas S., Stone P.H., Kastrati A., Cutlip D. 2021 Anatomic and Flow Characteristics of Left Anterior Descending Coronary Artery Angiographic Stenoses Predisposing to Myocardial Infarction. Am. J. Cardiol.; 141: 7–15. doi: 10.1016/j.amjcard.2020.11.012.
Koo B.K., Hu X., Kang J., Zhang J., Jiang J., Hahn J.Y., Nam C.W., Doh J.H., Lee B.K., Kim W., Huang J., Jiang F., Zhou H., Chen P., Tang L., Jiang W., Chen X., He W., Ahn S.G., Yoon M.H., Kim U., Lee J.M., Hwang D., Ki Y.J., Shin E.S., Kim H.S., Tahk S.J., Wang J.; FLAVOUR Investigators 2022. Fractional Flow Reserve or Intravascular Ultrasonography to Guide PCI. N. Engl. J. Med. ; 387(9): 779–789. doi: 10.1056/NEJMoa2201546
Lawton J.S., Tamis-Holland J.E., Bangalore S., Bates E.R., Beckie T.M., Bischoff J.M., Bittl J.A., Cohen M.G., Di Maio J.M., Don C.W., Fremes S.E., Gaudino M.F., Goldberger Z.D., Grant M.C., Jaswal J.B., Kurlansky P.A., Mehran R., Metkus T.S. Jr., Nnacheta L.C., Rao S.V., Sellke F.W., Sharma G., Yong C.M., Zwischenberger B.A. 2022, 2021. ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: Exective Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation; 145(3): e4-e17. doi: 10.1161/CIR.0000000000001039.
Lee K.Y., Chang K. 2019 Understanding Vulnerable Plaques: Current Status and Future Directions. Korean Circ. J; 49(12): 1115–1122. doi: 10.4070/kcj.2019.0211
Montone R.A., Meucci M.C., De Vita A., Lanza G.A., Niccoli G. 2021 Coronary Provocative Tests in the Catheterization Laboratory: Pathophysiological Bases, Methodological Considerations and Clinical Implications. Atherosclerosis; 318: 14–21. doi: 10.1016/j.atherosclerosis.2020.12.008
Neumann F.J., Sousa-Uva M., Ahlsson A., Alfonso F., Banning A.P., Benedetto U., Byrne R.A., Collet J.P., Falk V., Head S.J., Jüni P., Kastrati A., Koller A., Kristensen S.D., Niebauer J., Richter D.J., Seferovic P.M., Sibbing D., Stefanini G.G., Windecker S., Yadav R., Zembala M.O.; ESC Scientific Document Group. 2019. ESC Scientific Document Group. 2018. ESC/EACTS Guidelines on Myocardial Revascularization. Eur. Heart. J; 40(2): 87–165. doi: 10.1093/eurheartj/ehy394
Raftopoulos L., Aggeli C., Dimitroglou Y., Kakiouzi V., Tsartsalis D., Patsourakos D., Tsioufis C. 2022. The Fundamental Role of Stress Echo in Evaluating Coronary Artery Disease in Specific Patient Populations. Curr. Vasc. Pharmacol; 20(2): 156–167. doi: 10.2174/1570161120666211220104156
Park S.J., Kim Y.H., Park D.W., Lee S.W., Kim W.J., Suh J., Yun S.C., Lee C.W., Hong M.K., Lee J.H., Park S.W.; MAIN-COMPARE Investigators. 2009. MAIN-COMPARE Investigators. Impact of Intravascular Ultrasound Guidance on Long-Term Mortality in Stenting for Unprotected Left Main Coronary Artery Stenosis. Circ. Cardiovasc. Interv; (3): 167–77. doi: 10.1161/CIRCINTERVENTIONS.108.799494
Stone G.W., Maehara A., Ali Z.A., Held C., Matsumura M., Kjøller-Hansen L., Bøtker H.E., Maeng M., Engstrøm T., Wiseth R., Persson J., Trovik T., Jensen U., James S.K., Mintz G.S., Dressler O., Crowley A., Ben-Yehuda O., Erlinge D.; PROSPECT ABSORB Investigators. 2020. Percutaneous Coronary Intervention for Vulnerable Coronary Atherosclerotic Plaque. J. Am. Coll. Cardiol. ; 76(20): 2289–2301. doi: 10.1016/j.jacc.2020.09.547.
Thach N. Nguyen, Shao Liang Chen, Moo-Hyun Kim, Duane S. Pinto, Cindy L. Grines, C. Michael Gibson, Ernest F. Talarico Jr. Practical Handbook of Advanced Interventional Cardiology: Tips and Tricks. 2020. John Wiley & Sons Ltd. ISBN: 9781119382683 doi:10.1002/9781119383031
Valle J.A., Tamez H., Abbott J.D., Moussa I.D., Messenger J.C., Waldo S.W., Kennedy K.F., Masoudi F.A., Yeh R.W. 2019. Contemporary Use and Trends in Unprotected Left Main Coronary Artery Percutaneous Coronary Intervention in the United States: An Analysis of the National Cardiovascular Data Registry Research to Practice Initiative. JAMA Cardiol. 2019. Feb 1; 4(2): 100–109. doi: 10.1001/jamacardio.2018.4376. PMID: 30601910; PMCID: PMC6439629.
Tarantini G., Fovino L.N., Varbella F., Trabattoni D., Caramanno G., Trani C., De Cesare N., Esposito G., Montorfano M., Musto C., Picchi A., Sheiban I., Gasparetto V., Ribichini F.L., Cardaioli F., Saccà S., Cerrato E., Napodano M., Martinato M., Azzolina D., Andò G., Mugnolo A., Caruso M., Rossini R., Passamonti E., Teles R.C., Rigattieri S., Gregori D., Tamburino C., Burzotta F. 2023 A Large, Prospective, Multicentre Study of Left Main PCI Using a Latest-Generation Zotarolimus-Eluting Stent: the ROLEX Study. EuroIntervention; 18(13): e1108-e1119. doi: 10.4244/EIJ-D-22-00454
Zhang S., Liu Y., Cao Y., Zhang S., Sun J., Wang Y., Song S., Zhang H. 2022 Targeting the Microenvironment of Vulnerable Atherosclerotic Plaques: An Emerging Diagnosis and Therapy Strategy for Atherosclerosis. Adv. Mater; 34(29): e2110660. doi: 10.1002/adma.202110660.
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