After the coronary stent is inserted, posterior expansion is required for the stent to be fully expanded and the stent to adhere well.
Chen Shaoliang, a joint Korean scholar from Nanjing First Hospital affiliated to Nanjing Medical University, and other Korean scholars published a study in the Circulation sub-journal that for patients with long drug-eluting stents, intravascular ultrasound (IVUS)-guided postdistension can improve long-term clinical prognosis compared with post-dilation guided by coronary angiography.
The study pooled data from two randomized controlled trials, the IVUS-XPL study and the ULTRAMATE study. The IVUS-XPL study analyzed the effect of intravascular ultrasound guidance on the outcome of Xience Prime stent placement for long lesions, and the ULTIMATE study compared the prognosis after drug-eluting stents under intravascular ultrasound and coronary angiography.
In the study, a total of 1037 patients (1265 lesions) received IVUS-guided posterior dilation, 905 patients (1170 lesions) received coronary angiography-directed posterior dilation, and 383 patients (397 lesions) received coronary angiography-guided drug-eluting stents without post-dilation as a control group. All patients were placed with long stents ≥ 28 mm.
The primary endpoints were 3-year cardiac death, target lesion-associated myocardial infarction, or ischemia-driven revascularization of target lesions.
The risk of primary endpoint events in the IVUS-guided dilation group was lower than that in the control group (4.5% vs.9.8%; HR=0.44) and the post-coronary angiography-guided dilation group (4.5% vs.8.6%; HR=0.51).
The minimum lumen diameter for post-dilation by coronary angiography was not different from the undilated control group.
The minimum lumen diameter in the post-dilation group under IVUS was significantly larger than that of the control group without post-dilation, and larger than that in the post-angiography-guided dilation group.
There was no difference in the incidence of primary endpoint events (8.6% vs. 9.8%) in the post-dilated group guided by coronary angiography compared with the control group without post-dilation.
来源：Lee YJ, et al. Is Routine Postdilation During Angiography-Guided Stent Implantation as Good as Intravascular Ultrasound Guidance?: An Analysis Using Data From IVUS-XPL and ULTIMATE. Circ Cardiovasc Interv. Epub 2022 Jan 18.
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