Author + information
The purpose of the study aimed to evaluate the efficacy of the intravascular ultrasound (IVUS) in endovascular therapy (EVT) for subclavian artery disease (SCAD).
A total of 550 lesions (542 patients) undergoing successful EVT for SCAD between January 2003 and December 2012 were retrospectively analyzed from a multicenter registry (SubClavian Artery disease treated with endovascuLar therapy; muLticenter retrOsPective registry: SCALLOP) and the outcomes were analyzed with classified into two groups: IVUS (+) for IVUS guided EVT (n=177) and IVUS (-) for non-IVUS guided EVT (n=373).
538 lesions (97.8%) were deployed with stents and 12 lesions were treated with balloon angioplasty alone. Peri-procedure and In-hospital overall complications were no significant difference between two groups. (IVUS(+) vs. IVUS(-): 10.2% vs. 8.8%, p=0.617). Long term follow-up result demonstrated no significance between IVUS(+) and IVUS(-) groups in 5-year all-cause mortality (p=0.37), myocardial infarction (MI) (p=0.07), stroke (p=0.31) and major adverse cardiovascular event (p=0.07) including all-cause mortality, MI, stroke.5-year primary patency rate revealed significant in IVUS(+) groups (IVUS(+) vs. IVUS(-):88.5% vs 77.7%, p=0.03).5-year Assisted primary patency rate (IVUS(+) vs. IVUS(-):90.4% vs.89.9%,p=0.81)and 5-year secondary patency rate (IVUS(+) vs. IVUS(-):99.4% vs 97.1%, p=0.25) indicated insignificance. On multivariate analysis for IVUS(+) group, in-hospital stroke (HR:16.92, CI:3.60-79.42, p<0.01) and combination use of balloon-expandable and self-expandable stents (HR:5.59, CI:1.22-25.65, p=0.02) are negative independent prognosticator to primary patency rate.
Our result suggested that IVUS-guided EVT for SCAD didn’t reduce more peri-procedure complication but significantly improved 5-year primary patency rate.