[Intracoronary ultrasound: A necessary tool for stent implantation? Arguments in against]

Intracoronary ultrasound has shown the little reliability of angiography to predict the interaction of stents with the arterial wall. In spite of implanting the stents with high pressures and a good angiographic result, a great proportion are still incompletely expanded. The use of intracoronary ultrasound as a guide for stent implant allows us to optimize the degree of expansion and apposition of the stent to the arterial wall, achieving greater intraluminal dimensions than with angiography. Nevertheless, this strategy is not necessarily translated in a clear clinical benefit. The rate of acute and subacute complications of stents implanted under angiographic control with high pressures and treatment with ticlopidine and aspirin is less than 1% and identical to the studies that use intracoronary ultrasound to optimize stent deployment. At the present time, it has not been documented either that the optimization of stent deployment with intracoronary ultrasound significantly reduces the rate of restenosis, the incidence of target vessel revascularization or the rate of major adverse cardiac events in mid-term follow-up. In addition, the use of intracoronary ultrasound to optimize stent deployment adds a small risk to the procedure, extends the time of occupation of the cardiac catheterization laboratory and prohibitively increases the costs of coronary stenting them being already high ones. Thus, the universal use of coronary intracoronary ultrasound to optimize stent deployment seems not to be, at present, a useful strategy.