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IVUS Stent Optimisation Criteria — EECC MCQ

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HardCoronary Artery DiseaseIVUS Stent Optimisation CriteriaEECC

A 58-year-old man with NSTEMI undergoes PCI with a DES to the mid-LAD. The operator uses intravascular ultrasound (IVUS) to optimise stent deployment. What are the IVUS criteria for adequate stent expansion?

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Correct answer: A — Minimum stent area (MSA) ≥80% of the reference vessel lumen area, with complete stent apposition to the vessel wall and no significant edge dissection — inadequate expansion is the strongest predictor of stent thrombosis and restenosis

IVUS-guided stent optimisation criteria per the 2024 ESC CCS Guidelines: (1) minimum stent area (MSA) ≥80% of average reference lumen area (or ≥5.0-5.5 mm² for non-left main vessels, ≥8.0 mm² for left main); (2) complete apposition — no gap between stent struts and vessel wall; (3) no significant edge dissection (>60° arc with longitudinal extension); (4) no geographic miss (uncovered disease at stent edges); (5) adequate lesion coverage. Inadequate stent expansion is the single strongest predictor of both stent thrombosis and in-stent restenosis. The IVUS-XPL, ULTIMATE, and RENOVATE-COMPLEX trials demonstrated that IVUS-guided PCI reduces MACE compared with angiography-guided PCI. Post-dilation with a non-compliant balloon at high pressure is the primary technique for optimising expansion.

Reference: ESC (2024): CCS Guidelines; ULTIMATE/RENOVATE-COMPLEX Trials