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P 7
PHASED ARRAY INTRA-CORONARY ECHO IN A HEART TRANSPLANT CENTER.
6 YEARS OF EXPERIENCE.
Présentateur : LOMBARDO Letizia, Palerme - ITA
Auteur : LOMBARDO Letizia
Co-Auteurs : ROBERTO Baglini
Background: Coronary angiography (CA) has been the “gold standard” for evaluating the anatomy features
of coronary artery disease in vivo. However, the increasing complexity of percutaneous coronary intervention
(PCI), has highlighted the pathophysiologyl and prognostic importance of the arterial wall changes. As angiography
is only a luminal study, intravascular echo (IVUS) has been increasingly used to assess the distribution,
extension and histology of coronary artery walls during PCI.
Purpose: The 6 years experience of a single interventional laboratory with phased array IVUS during coronary
procedures in end-stage patients of a heart transplant center is reported.
Methods: (51 males, 16 females, mean age 59,3 years) with end stage heart failure (LVEF les than 20% in all) and
critical three vessels coronary artery disease, in waiting list for heart transplantation, underwent to coronary
angiography and IVUS. Among these, 45 (36 males, 9 females) underwent to percutaneous myocardial revascularization
with stenting.The following data were measured at culprit sites: basal minimal endoluminal diameter
(bELD) and area (bELA), basal reference minimal endoluminal diameter (brELD) and area (brELA), post procedure
in-stent ELD and ELA, immediate luminal gain (ELD minus bELD). Under-expansion and mal-apposition of
stents were evaluated according to literature definition.
Furthermore, virtual histology allowed to dividing patients population in three groups: 1. mainly calcific plaques,
2. mainly lipidic plaques, 3. TICKFA, according with the prevalence of color coded features. THICKFA was defined
as plaque with thin, lipo-necrotic shoulders according with literature.
Results: All interventional procedures were optimized to reach at least 80% of brELA by using adequately
sized NC balloons at high atmospheres.Rotablation was used in 13% of cases, following the indication of IVUS
(concentric180 to 360 degrees subintimal calcium). Less extent of calcium deposition required use of NC ballons
at high atmospheres (38%). In these case IMPELLA and/or aortic counterpulsation we used to support
heart function.Immediate luminal gain was 2, 1±0, 4 mm while 80% of post procedure in stent ELA was reached
in 98% of cases.THICKFA was shown in 25% of cases but in almost half of those patients it was out of the borders
of the most critical stenosis.6 patients with diabetes and chronic renal insufficiency (mean creatinine 3,6
mg%) underwent to mainly IVUS guided procedure: in these cases contrast dye was reserved only to initial wire
positioning and final angiographic shots. The mean amount of dye was only 10±2 ml and in no case a subsequent
further renal damage developed.
Conclusion: Phased array IVUS in end-stage patients in waiting list for heart transplant allows to guiding coronary
interventional procedures through quantitative and morphologic evaluation of coronary artery walls
changes. Furthermore, in selected patients, IVUS may be used as the main diagnostic tool during PCI, in order to
save contrast dye and reduce the probability of renal damage.
58 Congrès Francophone de Cardiologie Interventionnelle 2011