This study examines the influence of post-PCI intravascular ultrasound (IVUS) evaluation on operator strategy. The objective is to evaluate the effects of additional optimization in patients with low post-PCI FFR values. The trial indicates that performing additional optimization techniques improves post-PCI FFR in patients with FFR < 0.90. The FFR REACT trial utilized IVUS guidance to optimize PCI in patients with low post-PCI FFR values.
Background: Additional optimization in patients with low post-PCI FFR significantly improves post-PCI FFR values. In the FFR REACT trial, we used IVUS to guide PCI optimization in patients with post-PCI FFR < 0.90.
Aims: To assess the impact of post-PCI FFR pullback data and post-PCI IVUS findings on operator strategy.
IVUS evaluation changed treatment strategy in 53.1% of vessels (76/143, p<0.001)
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The objective of this study was to examine the impact of IVUS-guided post-PCI optimization on the occurrence of target vessel failure (TVF) at a 2-year follow-up, in comparison to standard of care. The study was conducted after the FFR React trial, where intravascular ultrasound (IVUS) was utilized to guide PCI optimization in patients with post-PCI FFR <0.90. The results demonstrated that IVUS-guided optimization significantly improved post-PCI FFR and post-PCI IVUS parameter values. Although there was a trend towards lower rates of TVF, TVMI (target vessel myocardial infarction), and TVR (target vessel revascularization) favoring the IVUS-guided optimization group, these findings did not reach statistical significance.
Background: In the FFR REACT trial, IVUS-guided PCI optimization in patients with post-PCI FFR <0.90 significantly improved post-PCI FFR and post-PCI IVUS parameters. IVUS-guided PCI optimization in patients with post-PCI FFR <0.90 did not reduce target vessel failure (TVF) as compared to standard of care.
Aims: To investigate whether IVUS-guided post-PCI optimization in patients with post-PCI FFR <.90 as compared to standard of care reduces TVF at 2-year follow-up.
IVUS-guided PCI optimization in patients with post-PCI FFR <.90 did not significantly reduce TVF at 2-year follow-up as compared to standard of care.
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This informative graph demonstrates the effectiveness of intravascular ultrasound (IVUS) compared to angiography in identifying dissections. Key findings indicate that IVUS outperforms angiography, identifying 4 times more post-stent dissections, 3.4 times more post-angioplasty dissections, and 6 times more post-atherectomy dissections. These results underscore the benefits of utilizing the IVUS system and intracoronary imaging for accurate dissection detection.
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This graphic highlights an outcome disparity between intravascular ultrasound (IVUS) and angiography, specifically when examining the femoropopliteal artery. The data reveals that IVUS identified twice as much thrombus compared to angiography. This disparity underscores the enhanced thrombus detection capability of IVUS/intracoronary imaging in this arterial segment.
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This graphic depicts a comparison between intravascular imaging (IVUS) and angiography in identifying peripheral artery lesions with calcium. Within the same lesions, IVUS detects 69% more calcium compared to angiography. This data highlights IVUS/intracoronary imaging’s ability to accurately identify and quantify calcium deposits in peripheral artery lesions.
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In this graphic, a comparison is presented between intravascular imaging (IVUS) and Digital Subtraction Angiography (DSA) in patients with peripheral artery disease (PAD), focusing on different locations. The study’s findings indicate that visual estimation measurements obtained from angiographic images were consistently smaller in all arterial segments compared to those obtained from IVUS assessment. This highlights the discrepancy in size estimation between the two imaging modalities, emphasizing the potential for IVUS/intracoronary imaging to provide more accurate and precise measurements in evaluating PAD across various arterial segments.
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Discover the impact of intravascular ultrasound (IVUS) on clinically driven target lesion revascularization when combined with Directional Atherectomy, as opposed to using Directional Atherectomy alone. The one-year follow-up results reveal a reduction of 2.8 instances of target lesion revascularization when IVUS is employed in directional atherectomy procedures, compared to relying solely on angiography. This highlights the contribution of IVUS/intracoronary imaging in improving outcomes and minimizing the need for subsequent revascularization procedures in this context.
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This graphic illustrates the influence of intravascular ultrasound (IVUS) on different complications in lower extremity procedures. It compares outcomes such as death, amputation rate, amputation below the knee (BTK), amputation above the knee, and minor amputations between cases with IVUS use and cases without IVUS use. The study findings demonstrate a consistent trend: the utilization of IVUS/intracoronary imaging in lower extremity procedures is associated with a reduced risk of post-procedural complications and a lower likelihood of amputation.
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Radiation safety is of utmost importance in the catheterization lab, as invasive cardiac diagnostic and interventional procedures can contribute significantly to a patient’s overall radiation exposure. In the cath lab there is an increasing need for operators and staff to find ways to minimize their exposure in every case until radiation is at a level that is as low as reasonably achievable (ALARA). One of the ways to limit radiation exposures to staff is to increase the distance between the operator and the source of radiation. The ACIST CVi® Contrast Delivery System makes it easier to step back, moving one’s hand farther away from the radiation source during the image acquisition. This task is more difficult to do with the simple hand manifold. Continue reading to learn more about radiation safety in the Cath lab using CVi® along with other important measures.
Important measures that can be taken to reduce radiation exposure specific to the X-ray imaging system are listed below:
- Stay off the pedal
- Maximize table height and source to intensifier distance (SID)
- Use the appropriate image size
- Use collimation and filters
- Balance kVp and mA
- Used pulsed fluoro
- Use the lowest frame rate possible
- Use the tools provided to determine dose
- Think about the angles used for the procedure
- Use fluoroscopy storage
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Dr. Richard Solomon, Chief of Nephrology in the Department of Medicine at the University of Vermont College of Medicine and Fletcher Allen Health Care, introduces causes of Contrast-Induced Nephropathy (CIN) in the catheterization lab and its impact on patient outcomes. He became involved with contrast-induced nephropathy (CIN) from a research perspective in the early 1990s, when he designed and conducted the first prospective randomized trial evaluating different therapies for prevention of CIN. CIN, an acute kidney injury resulting from exposure to radiopaque contrast agents during catheterization, possesses long-term risks of systemic adverse events for affected patients. Moreover, CIN bears a significant economic burden. This comes with higher immediate costs stemming from extended hospital stays, intensified patient care, and increased long-term financial responsibilities associated with managing future adverse events. Dr. Solomon outlines the prerequisites for CIN prevention and presents diverse strategies to mitigate its occurrence. Notably, one key aspect in reducing the risk of CIN lies in optimizing contrast delivery. The ACIST CVi® Contrast Delivery System enables precise control over contrast volume and flow rate, surpassing the capabilities of manual hand injectors. This precise control potentially leads to shorter procedures, decreased contrast administration, and the possibility of earlier post-procedural hydration. For further insights into CIN reduction, prevention strategies, and how ACIST CVi® can play a pivotal role in mitigating CIN for patients through optimal contrast delivery, read on.
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