IVUS-Guided Versus OCT-Guided Coronary Stent Implantation: A Critical Appraisal

Procedural guidance with intravascular ultrasound (IVUS) imaging improves the clinical outcomes of patients undergoing percutaneous coronary intervention (PCI) by: 1) informing the necessity for lesion preparation; 2) directing appropriate stent sizing to maximize the final stent area and minimize g...

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Bibliographic Details
Published in:JACC. Cardiovascular imaging 2017-12, Vol.10 (12), p.1487-1503
Main Authors: Maehara, Akiko, Matsumura, Mitsuaki, Ali, Ziad A, Mintz, Gary S, Stone, Gregg W
Format: Article
Language:English
Subjects:
Clinical Decision-Making
Coronary Angiography
Coronary Artery Disease - diagnostic imaging
Coronary Artery Disease - therapy
Coronary Vessels - diagnostic imaging
Humans
Percutaneous Coronary Intervention - adverse effects
Percutaneous Coronary Intervention - instrumentation
Percutaneous Coronary Intervention - methods
Predictive Value of Tests
Prosthesis Design
Stents
Tomography, Optical Coherence
Treatment Outcome
Ultrasonography, Interventional
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Summary:Procedural guidance with intravascular ultrasound (IVUS) imaging improves the clinical outcomes of patients undergoing percutaneous coronary intervention (PCI) by: 1) informing the necessity for lesion preparation; 2) directing appropriate stent sizing to maximize the final stent area and minimize geographic miss; 3) selecting the optimal stent length to cover residual disease adjacent to the lesion, thus minimizing geographic miss; 4) guiding optimal stent expansion; 5) identifying acute complications (edge dissection, stent malapposition, tissue protrusion); and 6) clarifying the mechanism of late stent failure (stent thrombosis, neointimal hyperplasia, stent underexpansion or fracture, or neoatherosclerosis). Optical coherence tomography (OCT) provides similar information to IVUS (with some important differences), also potentially improving acute and long-term patient outcomes compared to angiography-guided PCI. The purpose of this review is to describe the similarities and differences between IVUS and OCT technologies, and to highlight the evidence supporting their utility to improve PCI outcomes.
ISSN:1876-7591
DOI:10.1016/j.jcmg.2017.09.008