010 Optimal and suboptimal stent deployment in long coronary lesions: insights from IVUS

Background Optimal stent deployment is an essential predictor of success in patients with coronary artery stenosis treated by percutaneous coronary intervention (PCI). Objectives We sought to analyze stent deployment in long lesions treated with drug eluting stent (DES) using intravascular ultrasound imaging (IVUS) techniques. Methods N = 27 patients were treated for long (> 28 mm) coronary artery stenosis. The culprit lesion was analyzed by conventional angiography, then treated by PCI including DES implantation. Post implantation IVUS was performed to assess stent deployment using MUSIC and AVIO criteria. Elective post-dilation balloon inflation was performed at the discretion of the physician. Results N = 38 DES were implanted in N = 27 lesions (mean length:33.3 ± 8.5 mm), including n = 7 right coronary (RCA), n = 16 left anterior descending (LAD) and n = 4 circumflex (Cx) arteries. We observed progressive narrowing along the LAD and Cx lesions: there was a significant (p  After stent implantation, sub-optimal deployment was observed in 60% of cases using the MUSIC criteria and 38% using the AVIO criteria. IVUS guided post-dilation was performed in 89% of the cases, resulting in a mean main luminal area gain (MLA gain) of 1.9 ± 1.5 mm2. Multivariate analysis showed that EEM-CSA was the single independent predictor of MLA gain. Conclusion DES implantation in long lesions results frequently in suboptimal deployment. IVUS analysis could help improving PCI quality, although the current criteria for correct implantation should be modified to consider changes in diameters observed along long coronary stenosis, due to presence of bifurcations and side branches.