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(Circulation. 2003;107:62.)
© 2003 American Heart Association, Inc.

Clinical Investigation and Reports

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; 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.

Correspondence to P.V. Oemrawsingh, Cardiology Dept C5-P, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, The Netherlands. 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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