Intravascular Ultrasound Guided The Curative Effect Of Chronic Total Occlusion Coronary Artery Stenting META Analysis

Objective: To comprehensively evaluate the efficacy and safety of intravascular ultrasound-guided coronary artery occlusion stent implantation.Methods: Pub Med,EMBASE and Cochrane library,Web of Science databases were searched with the keywords of "Intravascular ultrasound,IVUS and chronic total occlusion(s),chronic total coronary artery occlusion,chronic total coronary occlusion,CTO";The keywords such as complete occlusion,intravascular ultrasound,etc.were combined to search the China Knowledge Network,Wanfang,and CBM databases.Randomized controlled trials and observational research literatures have been completed since March 2020.At the same time,manually search and search for gray literature to expand the search scope,extract relevant data from randomized controlled experiments(RCTs)and observational studies that meet the conditions for inclusion,and use the Review Manger5.3 software to perform meta-analysis on the included literature.Results: A total of 4 articles were included,3 randomized studies,and 1observational study.A total of 1106 patients met the established inclusion criteria,including 553 patients in the intravascular ultrasound-guided CTO-PCI group,and CTO-PCI guided by coronary angiography alone Group 553 cases.Compared with CTO-PCI guided by coronary angiography alone,intravascular ultrasound-guided CTO-PCI can effectively reduce the risk of stent thrombosis,and the difference between the two groups was statistically significant(RR: 0.13,95% CI: 0.03-0.54,P = 0.005 <0.05);the target vessel revascularization in the intravascular ultrasound group is lower than that of the conventional angiography group,and the difference between the two groups is statistically significant(RR: 0.50,95% CI: 0.28-0.89,P = 0.02 <0.05);The differences in major adverse cardiovascular events were statistically significant(RR: 0.68,95% CI: 0.49-0.95,P = 0.03 <0.05),and there was no statistically significant difference in myocardial infarction(RR: 1.03,95% CI: 0.67-1.57,P = 0.90),there was no statistically significant difference in revascularization of target lesions(RR: 0.77,95% CI: 0.50-1.18,P = 0.24),and there was no statistical significance for cardiac death(RR: 0.43,95% CI: 0.17-1.10,P = 0.08),all-cause death was not statistically significant(RR: 0.75,95% CI: 0.36-1.56,P = 0.44).Conclusion: In CTO-PCI,IVUS guidance can reduce TLR、ST、MACE compared with angiographic guidance.