Defining a new standard for IVUS optimized drug-eluting stent implantation--the PRAVIO study: do we know the right technique for stent optimization?

摘要

Recently, there has been a marked improvement in the quality of intravascular ultrasound (IVUS) images as well as IVUS catheter performance. As a result, the indications for IVUS have expanded and presently include both diagnostic imaging as well as IVUS-guided interventional therapy. There is divergence of opinions with respect to need for the use of IVUS to improve the outcome of coronary interventions. This lack of consensus most likely arises from the paucity of randomized data on acute procedural results and long-term outcome. Drug-eluting stents (DES) have improved clinical outcome in patients undergoing PCI, but are not free of restenosis and are limited by thrombosis, particularly in more complex lesion types. Stent under-expansion, malposition, and incomplete lesion coverage have been identified as the key mechanisms by which DES may fail to achieve the long-lasting results. The identification of these features by IVUS and optimization of stent expansion may lead to improved clinical outcomes. Although a clinical benefit is intuitive, results from randomized trials in the era of DES are still lacking.