IVUS -DBC: IVUS-guided drug-coated balloon angioplasty improves primary patency

By Alberto Castro Molina on

Key Points:

  • One-year success rates of angioplasty in peripheral artery disease (PAD) patients were significantly higher when guided by intravascular ultrasound (IVUS) alongside angiography.
  • IVUS, offering precise vessel measurements and visualization, demonstrated its effectiveness in achieving longer-lasting benefits from the procedure.
  • At 12 months, primary patency was achieved in 83.8% of patients who received IVUS and 70.1% of those receiving angiography alone, with IVUS group showing significant superiority.

Presenting advancements in peripheral artery disease (PAD) treatment, the recent findings unveiled at the American College of Cardiology’s Annual Scientific Session highlight the potential of intravascular ultrasound (IVUS) to significantly improve the success rates of angioplasty procedures. Led by Dr. Young-Guk Ko from Severance Hospital and Yonsei University in Seoul, South Korea, the IVUS-DCB study represents a pivotal moment in PAD management. The authors aimed to compare the outcomes of IVUS-guided DCB angioplasty with those of angiography-guided DCB angioplasty in the treatment of femoropopliteal artery disease. 

In this randomized controlled trial, patients undergoing angioplasty for femoropopliteal disease across seven sites in South Korea participated. Randomly split into two groups, half received IVUS alongside angiography, while the other half underwent angiography alone. Patients with symptomatic femoropopliteal artery disease were randomized to IVUS-guided drug-coated balloon angioplasty (n = 119) vs. angiography-guided drug-coated balloon angioplasty (n = 118). The primary outcome (primary patency) at 12 months was 83.8% in the IVUS-guided group vs. 70.1% in the angiography-guided group (p = 0.01). Additionally, patients in the IVUS group exhibited a lower likelihood of requiring revascularization procedures and a higher likelihood of sustained clinical improvement compared to their counterparts in the angiography group.

Despite potential complexities and added expenses associated with IVUS-guided procedures, operators were able to optimize balloon diameters and pressures, thereby enhancing the maintenance of patent target vessels at the 12-month follow-up. The IVUS-DCB trial is the first of its kind to showcase the clinical advantages of integrating IVUS into PAD interventions, offering precise vessel measurements and visualization. It demonstrates that IVUS-guided angioplasty leads to wider vessel openings and sustained clinical improvements, resulting in longer-lasting benefits from the procedure.

The IVUS-DCB trial paves the way for the integration of IVUS into PAD interventions, presenting clinicians with a valuable tool to improve patient outcomes and reinforce the efficacy of angioplasty procedures.