Comparison of usefulness of percutaneous coronary intervention guided by angiography plus computed tomography versus angiography alone and its impact on instent restenosis

Background: Optimal stent selection and placement would be expected to improve clinical outcomes. Coronary computed tomography angiography [CCTA] may permit better preprocedural planning

Objectives: To assess the impact of incorporating coronary computed tomography angiogaphy guidance in defining reference value for stent length and diameter on angiographic and clinical outcomes in comparison to quantitative coronary angiography and its effect on incidence of instent restenosis

Methods: The study was conducted on 153 diabetic patients with stable coronary artery disease. Patients were divided into two groups: group A and group B according to PCI guidance either with quantitative computed tomography angiography [QCTA] datasets or quantitative computed tomography [QCA] datasets respectively. Follow up clinically for six months to assess incidence of major adverse cardiac events [MACE] and angiographically by coronary angiography at six months or before if clinically indicated to assess incidence of instent restenosis [primary end point]

Results: QCTA was associated with longer lesions [p=0.001] and larger reference vessel diameter [p=0.001] than that measured by invasive QCA in group A. No statistical significant difference between group A and group B regarding restenosis rate, minimum lumen diameter at follow up and incidence of MACE

Conclusions: CCTA guided percutaneous coronary intervention [PCI] is a safe and effective strategy for treatment of coronary artery disease however it didn't add a beneficial role in reducing incidence of instent restenosis or MACE in comparison to angiographic guidance alone

Guard wire use during percutaneous intervention of saphenous vein bypass grafts in non-MI patients is associated with a reduction of in-hospital and 30-day major adverse cardiac events- a small scale randomized study

Distal embolization is known to be an awful complication of vein graft intervention, especially so in old friable and degenerated vein grafts. Distal protection offers an attractive option to prevent embolization, and hence preserve the myocardium. Fifty- three patients [with chronic stable angina, unstable angina, or myocardial infarction [MI] with the cardiac enzymes back to normal] were randomized to two treatment modalities. Thirty-one patients were randomized to conventional angioplasty and/or stenting of vein grafts, as opposed to 22 patients who were randomized to distal protection utilizing the Guard Wire treatment. Major Adverse Cardiac Events [MACE] during index hospitalization and at thirty days were recorded for both groups. There was a 19.4% absolute [100% relative] reduction in the Major Adverse Cardiac Events [MACE] during index hospitalization [19.4% of the patients in the control group versus zero percent of the patients in the guard wire group, P= 0.032]. Major Adverse Cardiac Events [MACE] during the first 30 days following the index procedure were seen in 25.8% [n=8] of the patients in the control group, as opposed to zero percent of the patients in the control group [P= 0.009]. The results of the current study suggest that distal protection might be superior to the current conventional PTCA and/or stenting techniques when percutaneous treatment of saphenous vein grafts is to be attempted. Distal protection needs to be the "standard" procedure during SVG interventions, especially in light of the accumulating evidence of its superiority over stand-alone PTCA and stenting