WASHINGTON — Drug-eluting stents implanted using intravascular ultrasound guidance might be less susceptible to later stent thrombosis, Dr. Probal Roy reported at a symposium sponsored by the Cardiovascular Research Institute at Washington Hospital Center.
His single-center observational study found that IVUS-guided stents were 35% less likely to develop stent thrombosis by 1 year than were stents placed with angiographic guidance alone.
“IVUS guidance should be considered for routine use during drug-eluting stent implantation in patients who are at increased risk for these events,” said Dr. Roy of the Washington (D.C.) Hospital Center.
Dr. Roy and his colleagues examined outcomes in 1,786 patients (mean age 66 years) who received drug-eluting stents during 2003–2006. IVUS guidance was performed in 884 patients; angiographic guidance alone was used in the rest. Groups were matched for age, gender, cardiovascular risk factors, clinical presentation, left ventricular ejection fraction, and angiographic features. IVUS was performed either preintervention, post intervention or both, at the discretion of the operator. There were no significant differences in in-hospital outcomes between the two groups.
However, at 30 days, significantly fewer patients in the IVUS group experienced definite stent thrombosis than did those in the angiography-only group (0.5% vs. 1.4%, respectively). This difference remained significant at 1 year, when rates of definite stent thrombosis were 0.7% in the IVUS group, compared with 2% in the angiographic guidance group. “Freedom from stent thrombosis was largely driven by reductions in subacute stent thrombosis,” Dr. Roy said.