Evaluation of Quantitative Coronary Angiography for Assessment of Adequacy of Stent Deployment
Keywords:
Intravascular ultrasound (IVUS), quantitative coronary angiography (QCA), percutaneous coronary intervention (PCI), right coronary artery (RCA), left anterior descending artery (LAD), left circumflex coronary artery (Circ)Abstract
Objective: To determine the adequacy of stent symmetry (deployment) as assessed by intravascular ultrasound
(IVUS) and its comparison with quantitative coronary angiography (QCA).
Methodology: In this comparative study we analyzed the stents for adequate deployment in 100 patients who
were randomly selected from the patients who were undergoing percutaneous coronary angiography (PCI) either
with bare metal or drug eluting stent at our catheterization laboratory, Cardiology department Postgraduate Medical
Institute (PGMI) Lady Reading Hospital Peshawar. The study was conducted from August 2010 to February
2011. We used Volcano therapeutic intravascular ultrasound (IVUS) system employing Volcano – eagle eye Gold
catheter. Stents was supposed to be symmetrical (adequately deployed) if the ratio of minimum luminal diameter
to maximum luminal diameter was 0.7.Performa was used to collect patient’s details and record the IVUS analysis.
Statistical Package for the Social Sciences SPSS version 15 was used to analyze the data.
Results: A total of 100 subjects were included in the study, their mean age was 54.38 ± 9.97 years and 85 %( 85)
were male. Diabetics were 40 %(40), hypertensive’s were 47%(47), dylipidemic were 46%(46) smokers were 36%(36)
and 40%(40) had a previous myocardial infarction. Both drug eluting and bare metal stents were used and the
main drug eluting stent was endeavor (Zatrolimus eluting stent) and the main bare metal stent was integrity.
Left anterior descending artery (LAD) was most commonly stented artery, followed by circumflex and right coronary
artery respectively.
Mean ratio of the minimum to maximal luminal diameter was 0.8205 ± 0.084. A ratio of greater than 0.7 was
achieved in 77.5% patients so that they had a better symmetry.
By quantitative coronary angiography (QCA) only 5% of the stented lesions were having greater than 10% residual
stenosis not properly deployed while 95% of the stents were adequately deployed. When we compared our finding
of IVUS with that of quantitative coronary angiography( QCA )by applying chi-square test, we found that there
were significant stents that were not properly deployed (p valve of 0.00312) and need further dilatation.
Conclusion: In significant number of patients stents were not adequately deployed requiring re-ballooning to
optimize the results as assessed by intravascular ultrasound (IVUS).
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