Volcano Corporation VOLC, a leading developer and manufacturer of precision guided tools designed
to enhance the diagnosis and treatment of coronary and peripheral vascular
disease, today announced new two-year outcomes from an analysis of use of
intravascular ultrasound (IVUS) in the ADAPT-DES (Assessment of Dual
AntiPlatelet Therapy with Drug-Eluting Stents) Study, the largest prospective
registry of IVUS use to date. Results suggest that, in the ADAPT-DES study,
use of IVUS with angiography (compared with angiography alone) in placing the
current generation of drug-eluting stents (DES) was associated with reductions
in certain serious patient events, including stent thrombosis and myocardial
infarction (MI), as well as target lesion revascularizations (TLR),
particularly for patients with more complex lesions.
The two-year data were presented here by study investigator Bernhard
Witzenbichler, M.D., during an oral presentation session at the 25^th Annual
Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium, which is
sponsored by the Cardiovascular Research Foundation (CRF). One-year data from
the analysis of IVUS use in the ADAPT-DES study were presented at the 2012 TCT
scientific symposium. The two-year data confirm and extend the one-year
findings.
"It is especially encouraging that the suggested positive association between
IVUS use and patient outcomes reported by the ADAPT-DES study was observed to
continue out to two years of follow-up, with a trend that indicates the
possibility of even greater improvement in the years to come," said Dr.
Witzenbichler, chief of internal medicine for cardiology and pulmonology at
Amper Kliniken AG in Germany. "I believe the routine use of IVUS as an adjunct
to angiography in stent placements could significantly influence clinical
practice given the data from ADAPT-DES that use of IVUS was associated with a
change in procedure strategy nearly three-fourths of the time."
"We believe that the two-year results from this large-scale, prospective,
multi-center registry add to the considerable evidence supporting IVUS
guidance as an important component of care for stent placement, particularly
for patients with more complex lesions," said Akiko Maehara, M.D., director of
the Intravascular Imaging Core Laboratory at the CRF and an assistant
professor of medicine at Columbia University College of Physicians and
Surgeons in New York. "The use of IVUS may help interventionalists choose a
better, more personalized treatment path for their patients with coronary
artery disease."
Two-Year Results of ADAPT-DES IVUS Analysis
The CRF's ADAPT-DES study was a prospective, multi-center registry of 8,582
patients with coronary artery disease undergoing PCI with DES. The analysis of
IVUS use was designed to determine the frequency, timing and correlates
(clinical, angiographic and IVUS) of DES thrombosis (a blood clot on the
surface of a stent) and the relationship of aspirin and/or clopidogrel
hyporesponsiveness, and general platelet reactivity to early and late DES
thrombosis. Volcano's Eagle Eye^® IVUS catheters were used in 3,361 patients
at the initiation of the analysis and in follow-up assessments.
After two years of clinical follow-up, data suggested that IVUS-guidance in
the study procedures was associated with a significant reduction in stent
thrombosis, all death, cardiac death, all MI, clinically driven TLR and
clinically driven target vessel revascularization (TVR) compared with
procedures without IVUS. Specifically:
o The incidence of stent thrombosis was reduced by 53 percent (0.55% vs.
1.16%; p=0.004).
o The incidence of MI was reduced by 38 percent (3.47% vs. 5.59%; p<0.0001).
o The incidence of MACE (stent thrombosis, cardiac death and MI) was reduced
by 34 percent (4.9% vs. 7.4%; p<0.001).
IVUS guidance changed the procedure 74 percent of the time. IVUS use was
associated with longer stent length and larger stent size without increasing
peri-procedural MI or the number of stents utilized. The majority of stents
used in the study were of the latest generation and marketed globally. No
additional safety issues were identified in the procedures in the study in
which IVUS was used to place stents.
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