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Ultrasound vs Angiography for Drug-Eluting Stent Implantation--Reply.

In comparing the IVUS-guided with the angiography-guided strategy for drug-eluting stent optimization, different end points and methods of vessel diameter measurement were used, as noted by Dr Hoffer, due to the intrinsic difficulty in defining common optimization criteria for both groups. We think these differences are unlikely to explain the results. Previous studies, such as the Angiography Vs IVUS Optimization (AVIO) trial1 and a meta-analysis,2 also reported larger postintervention minimal lumen diameter and lesser residual stenosis with IVUS-guided drug-eluting stent implantation. However, in the AVIO trial, the greater minimal lumen diameter in the IVUS-guided group failed to lead to better clinical outcomes, unlike in our IVUS-XPL trial.