Stent sizing in imaging-guided percutaneous coronary intervention: potential benefits of a more cautious approach

With the publication of several large randomised clinical trials (RCT), intracoronary imaging-guided percutaneous coronary intervention (PCI) was a well-covered topic in 20231234. In general, these studies confirmed the benefit of the application of both sound- (intravascular ultrasound [IVUS]) and light- (optical coherence tomography [OCT] or optical frequency domain imaging [OFDI]) based intracoronary imaging systems. The most important benefits are seen in the most challenging PCI cases, such as in patients with coronary bifurcation lesions2.

In this issue of EuroIntervention, Otake et al report the results of the OPINION ACS randomised controlled trial, a comparison of OFDI- vs IVUS-guided PCI in the specific subset of patients presenting with an acute coronary syndrome (ACS)5. With a total of 158 patients enrolled, the current study is much smaller than other recently reported trials in this field (e.g., ILUMIEN IV: 2,487 patients; OCTIVUS: 2,008 patients; RENOVATE COMPLEX PCI: 1,639 patients; OPINION: 829 patients; OCTOBER: 1,201 patients)12346. It is also not the first report on intracoronary imaging in ACS patients, as more than half of...