on February 20, 2009
Published online before print February 20, 2009, doi: 10.1161/CIRCINTERVENTIONS.108.778647
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Original Article |
A Randomized Controlled Trial of Angiography Versus Intravascular Ultrasound-Directed Bare-Metal Coronary Stent Placement (The AVID Trial)
1 Scripps Clinic;
2 New York University Medical Center;
3 Northwestern University Feinberg School of Medicine;
4 Comprehensive Cardiovascular Care Group, WI;
5 Stanford University;
6 University of Washington Medical Center;
7 St. Vincent Hospital, IN;
8 Columbia University;
9 Strong Memorial Hospital of the University of Rochester;
10 Cornell University;
11 MedStar Research Institute, MD;
12 Austin Heart Hospital
13 E-mail: russo.robert{at}scrippshealth.org
Background—AVID (Angiography Vs. Intravascular ultrasound-Directed stent placement) is a multicenter, randomized controlled trial designed to assess the effect of intravascular ultrasound (IVUS)-directed stent placement on the 12-month rate of target lesion revascularization (TLR).
Methods and Results—After elective coronary stent placement and an optimal angiographic result (<10% stenosis), 800 patients were randomized to Angiography- or IVUS-directed therapy. Blinded IVUS was performed in the Angiography group without further therapy. In the IVUS group, IVUS criteria for optimal stent placement (<10% area stenosis, apposition, and absence of dissection) were applied. Final minimum stent area was 6.90±2.43 mm2 in the Angiography group and 7.55±2.82 mm2 in the IVUS group (P=0.001). In the IVUS group, only 37% with inadequate expansion (<90%) received further therapy. The 12-month TLR rate was 12.0% in the Angiography group and 8.1% in the IVUS group (P=0.08, 95% CI [-8.3%, 0.5%]). When vessels with a distal reference diameter <2.5 mm by core laboratory angiography measurement were excluded from analysis, the 12-month TLR rate was 10.1% in the Angiography group and 4.3% in the IVUS group (P=0.01, 95% CI [-10.6%, -1.2%]). With a prestent angiographic stenosis of 
70%, the TLR rate was lower in the IVUS group compared to the Angiography group (3.1% vs. 14.2%; P=0.002; 95% CI [-18.4%, -4.2%]).
Conclusions—IVUS-directed bare-metal stent placement results in larger acute stent dimensions without an increase in complications and a significantly lower 12-month TLR rate for vessels 2.5 mm by angiography and for vessels with high-grade prestent stenosis. However, for the entire sample analyzed on an intention-to-treat basis, IVUS-directed bare-metal stent placement does not significantly reduce the 12-month TLR rate when compared to stent placement guided by angiography alone. In addition, IVUS evaluation of adequate stent expansion is underutilized by experienced operators.
Key Words: angiography • imaging • restenosis • stents • intravascular ultrasound
Related Article
Circ Cardiovasc Interv 2009 2: 113-123.
This article has been cited by other articles:
 |
|
 |
|
  H. Kaneda, J. Ma, and T. Morita Stent Underexpansion in Early Drug-Eluting Stent Thrombosis J. Am. Coll. Cardiol. Intv., August 1, 2009; 2(8): 807 - 807. [Full Text] [PDF]
|
|