Published Online
on December 9, 2002

A more recent version of this article appeared on January 7, 2003

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Submitted on July 8, 2002
Revised on September 27, 2002
Accepted on September 30, 2002

Intravascular Ultrasound Guidance Improves Angiographic and Clinical Outcome of Stent Implantation for Long Coronary Artery Stenoses. Final Results of a Randomized Comparison With Angiographic Guidance (TULIP Study)

Pranobe V. Oemrawsingh MD^*, Gary S. Mintz MD, Martin J. Schalij MD, PhD, Aeilko H. Zwinderman PhD, J. Wouter Jukema MD, PhD, and Ernst E. v.d. Wall MD, PhD

From the Department of Cardiology (P.V.O., M.J.S., J.W.J., E.E.v.d.W.), Leiden University Medical Center, Leiden, the Netherlands; Cardiovascular Research Foundation (G.S.M.), New York, NY; and Department of Medical Statistics (A.H.Z.), Academic Medical Center, Amsterdam, the Netherlands.

^* To whom correspondence should be addressed. E-mail: p.v.oemrawsingh{at}lumc.nl.

Background—Long coronary lesions treated with stents have a poor outcome. This study compared the 6-month outcome of stent implantation for long lesions in patients randomized to intravascular ultrasound (IVUS; n=73) or angiographic guidance (n=71).

Methods and Results—Stenoses >20 mm in length and a reference diameter that permitted a stent diameter 3 mm were eligible. Primary end points were 6-month minimal lumen diameter (MLD) and the combined end point of death, myocardial infarction, and target-lesion revascularization (TLR). Baseline clinical and angiographic data were comparable in both groups. At 6 months, MLD in the IVUS group (1.82±0.53 mm) was larger than in the angiography group (1.51±0.71 mm; P=0.042). TLR and combined end-point rates at 6 months were 4% (n=3) and 6% (n=4) in the IVUS group and 14% (n=10) and 20% (n=14) in the angiography group, respectively (P=0.037 for TLR and P=0.01 for combined events). Restenosis (>50% diameter stenosis) was found in 23% of the IVUS group and 45% of the angiography group (P=0.008). At 12 months, TLR and the combined end point occurred in 10% (n=7) and 12% (n=9) of the IVUS group and 23% (n=17) and 27% (n=19) of the angiography group (P=0.018 and P=0.026), respectively.

Conclusions—Angiographic and clinical outcome up to 12 months after long stent placement guided by IVUS is superior to guidance by angiography.

Key words: stents • restenosis • ultrasonics

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