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STATE-OF-THE-ART PAPERS

Routine intravascular ultrasound guidance of percutaneous coronary intervention

A critical reappraisal

^* Department of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA

Manuscript received November 11, 2003; revised manuscript received December 8, 2003, accepted December 9, 2003.

^* Reprint requests and correspondence: Dr. David R. Holmes, Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA.
dholmes{at}mayo.edu

Intravascular ultrasound (IVUS) has played an integral role in the evolution of interventional cardiology. However, routine IVUS guidance of coronary stent implantation is not supported by a critical reappraisal of the available evidence. Although there is a trend toward a benefit with respect to target lumen revascularization favoring IVUS-guided coronary stent implantation, it is likely that this effect is driven by improved outcomes in small vessels, long coronary stenoses, and possibly saphenous vein graft interventions. No consistent trend in the incidence of death or myocardial infarction is apparent. Furthermore, the safety, efficacy, and effectiveness of IVUS should be taken into account when considering the goals, risks, benefits, and alternatives to such a treatment strategy.

Abbreviations and Acronyms   DES = drug-eluting stent(s)   FFR = fractional flow reserve   IVUS = intravascular ultrasound   MI = myocardial infarction   MLD = minimum lumen diameter   PCI = percutaneous coronary intervention   TLR = target lumen revascularization   TVR = target vessel revascularization

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