Intracoronary ultrasound before coronary interventions: a prospective comparison of two different catheters

Intravascular ultrasound (IVUS) provides unique information about the coronary arterial wall that can be used to guide transcatheter therapy. In this prospective study, two different IVUS systems were compared with respect to feasibility of imaging before intervention and angiographic changes induced by the simple advancement of the catheter across the lesion. Eighty-five patients (mean age 59 +/- 10 yr, 11 female) were studied with IVUS before intervention. In 34 patients, a 4.8 F (1.6-mm) IVUS catheter was used (Group I), whereas in the remaining 51 patients, a 3.5 F (1.2-mm) IVUS catheter was used (Group II). Quantitative angiography was performed before and after the IVUS study to determine potential changes in lumen diameter. Clinical and angiographic characteristics were similar in the two groups. A successful IVUS interrogation of the target lesion was obtained more frequently in Group II (45/51 (88%) vs. 19/34 (56%) patients, P < 0.01). After the IVUS study, a change in minimal lumen diameter was seen in Group I (baseline 0.84 +/- 0.2 vs. final 1.17 +/- 0.2 mm, P < 0.001) and Group II patients (baseline 0.80 +/- 0.3 vs. final 1.03 +/- 0.4 mm, P < 0.01). In the 64 lesions successfully crossed, the absolute gain in lumen diameter was significantly higher in Group I (0.40 +/- 0.2 vs. 0.23 +/- 0.2 mm, P < 0.05). In addition, an inverse correlation was found between baseline minimal lumen diameter and the absolute lumen gain induced by the IVUS study in Group I (r = -0.47, P < 0.05) but not in Group II patients (r = -0.16, NS). Neither angiographic nor echogenic lesion characteristics were associated with the change in lumen diameter. When multivariate analysis was applied, catheter size was the only independent predictor of lumen gain induced by IVUS after adjustment. Thus, the advancement of IVUS catheters across severe coronary lesions induces significant angiographic changes consistent with plaque remodeling and a Dotter effect. The use of smaller catheters not only allows a higher number of lesions to be studied before intervention, but also lessens the mechanical disruption of the plaque, yielding a more accurate and veracious picture of baseline plaque characteristics.