Study: Intravascular imaging for stent guidance improves outcomes for heart disease patients

Editor's Note

Using intravascular imaging to guide stent implantation during percutaneous coronary intervention (PCI) provides significantly better outcomes than angiography, according to findings published February 21 in The Lancet.

In a study of 15,964 patients undergoing PCI from 22 trials in hundreds of centers from March 2010 to August 2023, researchers found that using high-resolution imaging during stent implantation led to a 25% reduction in all-cause death, 45% reduction in cardiac death, and 48% reduction in stent thrombosis when compared with use of angiography. The study also found that intravascular imaging reduced target vessel myocardial infarction by 18% and target lesion revascularization by 28%.

The typical method employed by cardiologists is angiography-guided PCI, which employs contrast dye and X-rays to determine blood flow and identify blockages in arteries. However, this approach has limitations in showing artery size and plaque makeup, as well as whether the stent is fully expanded, researchers note. Intravascular ultrasound provides a more precise picture of the coronary arteries, but is only used in 15% to 20% of PCI cases in the U.S., in part because the procedure is not fully reimbursed.

This is reportedly the largest clinical study comparing intravascular ultrasound, or IVUS, and optical coherence tomography, or OCT, with angiography-guided PCI.