IVUS has more robust data than OCT for PCI guidance: PROS and CONS

Coronary angiography has long been used to guide percutaneous coronary intervention (PCI). However, it has limitations in accurately assessing atherosclerotic burden, vessel and lumen dimensions, stent morphology, and plaque characteristics. Intravascular imaging (IVI), including intravascular ultrasound (IVUS) and optical coherence tomography (OCT), has been associated with improved assessment of lesion significance, optimised stent implantation and superior stent-related outcomes. IVUS and OCT have distinct characteristics, such as penetration depth and axial resolution, that may make each of them more suitable for specific scenarios. Current evidence on PCI guidance mainly consists of studies comparing IVI to angiography, with direct comparisons of IVUS and OCT with respect to clinical endpoints being quite limited. As such, whether the use of either IVUS or OCT to guide PCI leads to better post-PCI outcomes remains an area of uncertainty.

Compared with OCT, IVUS can visualise the full thickness of the vessel wall and provide information on the appropriate device size and landing zone, even in PCI for diffuse disease. The major strength of IVUS is that it is technically easier to use, without the...