Clinicians should not rely on measurements obtained by intravascular ultrasound (IVUS) to evaluate the seriousness of non-left main coronary artery lesions without functional evidence to back them up, experts recommended in a consensus document published online Nov. 13 in Catheterization and Cardiovascular Interventions. This recommendation was one of several made for the optimal use of IVUS, optical coherence tomography (OCT) and fractional flow reserve (FFR).
“Physicians will find these recommendations helpful as they apply these techniques to help patients with more complex cases or who have tests that contradict one another,” said Lloyd W. Klein, MD, of Rush University Medical Center in Chicago and a consensus author, in a press release.
The group convened by the Society for Cardiovascular Angiography and Interventions (SCAI) recommended IVUS for other uses, however. IVUS is “definitely beneficial” for determining whether a stent is completely expanded and apposed and whether there are complications after placement. IVUS is “probably beneficial” to assess left main coronary artery (LMCA) stenosis and whether revascularization may be necessary. There may be benefit to IVUS for evaluating plaque morphology, but the group categorized this use as “possibly beneficial.”
OCT, however, offers better stent placement imaging than IVUS, the panel noted. The experts also recommend OCT for determining changes in plaque morphology. OCT should not be used to determine functional significance of stenosis.
FFR offers clinical benefits in patients with multivessel coronary disease when used to guide PCI. Previous research, the group noted, found FFR and PCI led to better outcomes when compared to angiography alone. FFR could also be used to further evaluate intermediate to more severe coronary stenosis.
The panel did not recommend FFR to measure the vessel involved in an STEMI or if there is a possibility of unstable acute coronary syndrome, saying there is “no proven benefit” of FFR in these cases.
Additionally, FFR measurements can help clinicians decide whether revascularization is necessary in patients with stable ischemic heart disease by enabling reclassification of the number of disease vessels and/or SYNTAX score. If PCI is done with FFR of lesions less than 0.8, there would be better symptom management and patients may not need hospitalization for urgent revascularizations in comparison to medication alone.
“The writing group concurs with current guidelines that these modalities are not indicated when non-invasive imaging and angiographic data are concordant or when the result of the additional procedure will not alter the planned treatment strategy or optimization of stent implantation,” the authors concluded.