A randomized controlled trial of angiography versus intravascular ultrasound-directed bare-metal coronary stent placement (the AVID trial)

Robert J. Russo, Patricia D. Silva, Paul S. Teirstein, Michael J. Attubato, Charles J. Davidson, Anthony C. DeFranco, Peter J. Fitzgerald, Steven L. Goldberg, James B. Hermiller, Martin B. Leon, Frederick S. Ling, Jennifer E. Lucisano, Richard A. Schatz, S. Chiu Wong, Neil J. Weissman, David M. Zientek

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121 Scopus citations


Background-AVID (Angiography Versus Intravascular ultrasound-Directed stent placement) is a multicenter, randomized controlled trial designed to assess the effect of intravascular ultrasound (IVUS)-directed stent placement on the 12-month rate of target lesion revascularization (TLR). Methods and Results-After elective coronary stent placement and an optimal angiographic result (< 10% stenosis), 800 patients were randomized to Angiography-or IVUS-directed therapy. Blinded IVUS was performed in the Angiography group without further therapy. In the IVUS group, IVUS criteria for optimal stent placement (<10% area stenosis, apposition, and absence of dissection) were applied. Final minimum stent area was 6.90 ±2.43 mm2 in the Angiography group and 7.55±2.82 mm2 in the IVUS group (P=0.001). In the IVUS group, only 37% with inadequate expansion (<90%) received further therapy. The 12-month TLR rate was 12.0% in the Angiography group and 8.1% in the IVUS group (P=0.08, 95% confidence level [CI], [-8.3% to 0.5%]). When vessels with a distal reference diameter <2.5 mm by core laboratory angiography measurement were excluded from analysis, the 12-month TLR rate was 10.1% in the Angiography group and 4.3% in the IVUS group (P=0.01, 95% CI, [- 10.6% to -1.2%]). With a prestent angiographic stenosis of >70%, the TLR rate was lower in the IVUS group compared with the Angiography group (3.1% versus 14.2%; P=0.002; 95% CI, [- 18.4% to -4.2%]). Conclusions-IVUS-directed bare-metal stent placement results in larger acute stent dimensions without an increase in complications and a significantly lower 12-month TLR rate for vessels >2.5 mm by angiography and for vessels with high-grade prestent stenosis. However, for the entire sample analyzed on an intention-to-treat basis, IVUS-directed bare-metal stent placement does not significantly reduce the 12-month TLR rate when compared with stent placement guided by angiography alone. In addition, IVUS evaluation of adequate stent expansion is underutilized by experienced operators. (Circ Cardiovasc Intervent. 2009;2:113-123.)

Original languageEnglish (US)
Pages (from-to)113-123
Number of pages11
JournalCirculation: Cardiovascular Interventions
Issue number2
StatePublished - Apr 2009


  • Angiography
  • Intravascular ultrasound
  • Randomized controlled trial
  • Restenosis
  • Stents

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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