Clinical outcomes with intravascular ultrasound guidance of percutaneous coronary interventions: a targeted literature review of randomized controlled trials

Abstract

The use of intravascular ultrasound (IVUS) to guide and optimize percutaneous coronary intervention (PCI) has been subject to robust clinical investigation for the last three decades. In this narrative review, we summarize the major clinical outcomes of the randomized controlled trials evaluating the potential benefit of IVUS-guided PCI, compared with either angiography alone or other coronary imaging and physiology technologies. These studies, spanning decades and continents, provide the most rigorous evidence base that clinicians can use to guide real-world decision making regarding the utility of IVUS guidance during PCI in contemporary clinical practice.

Keywords

Intravascular ultrasound (IVUS) / percutaneous coronary intervention (PCI) / coronary artery disease (CAD)

References

[1] Xu J.Fundamentals and role of intravascular ultrasound in percutaneous coronary intervention.Cardiovasc Diagn Ther2020;10:1358-70 PMCID:PMC7666933

[2] Mintz GS,Ali Z.Clinical utility of intravascular imaging: past, present, and future.JACC Cardiovasc Imag2022;15:1799-820

[3] Lawton JS,Bangalore S.Writing Committee Members2021 ACC/AHA/SCAI guideline for coronary artery revascularization: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.J Am Coll Cardiol2022;79:e21-129

[4] Smilowitz NR,Razzouk L,Slater JN.Impact and trends of intravascular imaging in diagnostic coronary angiography and percutaneous coronary intervention in inpatients in the United States.Catheter Cardiovasc Interv2018;92:E410-5 PMCID:PMC6258336

[5] Shlofmitz E,Maehara A,Shlofmitz R.Intravascular imaging-guided percutaneous coronary intervention: a universal approach for optimization of stent implantation.Circ Cardiovasc Interv2020;13:e008686

[6] Jakabcin J,Bystron M.Long-term health outcome and mortality evaluation after invasive coronary treatment using drug eluting stents with or without the IVUS guidance. Randomized control trial. HOME DES IVUS.Catheter Cardiovasc Interv2010;75:578-83

[7] Mariani J Jr,Soares P.Intravascular ultrasound guidance to minimize the use of iodine contrast in percutaneous coronary intervention: the MOZART (minimizing cOntrast utiliZation with IVUS guidance in coRonary angioplasTy) randomized controlled trial.JACC Cardiovasc Interv2014;7:1287-93 PMCID:PMC4637944

[8] Wang HX,Li ZJ,Wang K.Application of intravascular ultrasound in the emergency diagnosis and treatment of patients with ST-segment elevation myocardial infarction.Echocardiography2015;32:1003-8

[9] Zhang J,Kan J.Intravascular ultrasound versus angiography-guided drug-eluting stent implantation: the ULTIMATE trial.J Am Coll Cardiol2018;72:3126-37

[10] Gao XF,Kong XQ.ULTIMATE Investigators3-year outcomes of the ULTIMATE trial comparing intravascular ultrasound versus angiography-guided drug-eluting stent implantation.JACC Cardiovasc Interv2021;14:247-57

[11] Chieffo A,Caussin C.A prospective, randomized trial of intravascular-ultrasound guided compared to angiography guided stent implantation in complex coronary lesions: the AVIO trial.Am Heart J2013;165:65-72

[12] Lee JM,Song YB.Intravascular Imaging-Guided or Angiography-Guided Complex PCI.N Engl J Med2023;388:1668-79

[13] Hong D,Lee SY.Prognostic impact of intravascular imaging-guided percutaneous coronary intervention in chronic total occlusion.Circulation2023;148:903-5

[14] Kwon W,Yun KH.Clinical benefit of intravascular imaging compared with conventional angiography in left main coronary artery intervention.Circ Cardiovasc Interv2023;16:e013359

[15] Hahn YH. Impact of intravascular imaging in patients with ACS undergoing complex PCI A prespecified substudy of the RENOVATE-COMPLEX-PCI. TCT 2023; 2023 Oct 23-26; San Francisco, California, USA.

[16] Tian NL,Ye F.Angiographic and clinical comparisons of intravascular ultrasound- versus angiography-guided drug-eluting stent implantation for patients with chronic total occlusion lesions: two-year results from a randomised AIR-CTO study.EuroIntervention2015;10:1409-17

[17] Kim BK,Hong MK.Clinical impact of intravascular ultrasound-guided chronic total occlusion intervention with zotarolimus-eluting versus biolimus-eluting stent implantation: randomized study.Circ Cardiovasc Interv2015;8:e002592

[18] Kim JS,Mintz GS.Randomized comparison of clinical outcomes between intravascular ultrasound and angiography-guided drug-eluting stent implantation for long coronary artery stenoses.JACC Cardiovasc Interv2013;6:369-76

[19] Hong SJ,Shin DH.Effect of intravascular ultrasound-guided vs angiography-guided everolimus-eluting stent implantation: the IVUS-XPL randomized clinical trial.JAMA2015;314:2155-63

[20] Hong SJ,Ahn CM.Effect of intravascular ultrasound-guided drug-eluting stent implantation: 5-year follow-up of the IVUS-XPL randomized trial.JACC Cardiovasc Interv2020;13:62-71

[21] Tan Q,Liu D,Zhang Y.Intravascular ultrasound-guided unprotected left main coronary artery stenting in the elderly.Saudi Med J2015;36:549-53 PMCID:PMC4436750

[22] Liu XM,Liu XK.Intravascular ultrasound-guided drug-eluting stent implantation for patients with unprotected left main coronary artery lesions: a single-center randomized trial.Anatol J Cardiol2019;21:83-90 PMCID:PMC6457420

[23] Koo BK,Kang J.Fractional flow reserve or intravascular ultrasonography to guide PCI.N Engl J Med2022;387:779-89

[24] Maehara A,Ali ZA,Stone GW.IVUS-guided versus OCT-guided coronary stent implantation: a critical appraisal.JACC Cardiovasc Imag2017;10:1487-503

[25] Ali ZA,Généreux P.Optical coherence tomography compared with intravascular ultrasound and with angiography to guide coronary stent implantation (ILUMIEN III: OPTIMIZE PCI): a randomised controlled trial.Lancet2016;388:2618-28

[26] Kubo T,Okamura T.Optical frequency domain imaging vs. intravascular ultrasound in percutaneous coronary intervention (OPINION trial): one-year angiographic and clinical results.Eur Heart J2017;38:3139-47 PMCID:PMC5837511

[27] Kang DY,Yun SC.Optical coherence tomography-guided or intravascular ultrasound-guided percutaneous coronary intervention: the OCTIVUS randomized clinical trial.Circulation2023;148:1195-206

[28] Neumann FJ,Ahlsson A.2018 ESC/EACTS guidelines on myocardial revascularization.Eur Heart J2019;40:87-165

[29] Elgendy IY,Elgendy AY.Outcomes with intravascular ultrasound-guided stent implantation: a meta-analysis of randomized trials in the era of drug-eluting stents.Circ Cardiovasc Interv2016;9:e003700

[30] Gao XF,Wang F.Intravascular ultrasound guidance reduces cardiac death and coronary revascularization in patients undergoing drug-eluting stent implantation: results from a meta-analysis of 9 randomized trials and 4724 patients.Int J Cardiovasc Imag2019;35:239-47

[31] Malik AH,Aronow WS,Cooper HA.Intravascular ultrasound-guided stent implantation reduces cardiovascular mortality - updated meta-analysis of randomized controlled trials.Int J Cardiol2020;299:100-5

[32] Vyas R,Moukarbel GV.Intravascular ultrasound-guided versus angiography-guided percutaneous coronary intervention with drug-eluting stents: a meta-analysis of randomized trials.J Soc Cardiovasc Angiography Interventions2023;2:101045

[33] Ali ZA,Maehara A.Optical coherence tomography-guided versus angiography-guided PCI.N Engl J Med2023;389:1466-76

[34] Holm NR,Neghabat O.OCT or angiography guidance for PCI in complex bifurcation lesions.N Engl J Med2023;389:1477-87

[35] Stone GW,Ali ZA.Intravascular imaging-guided coronary drug-eluting stent implantation: an updated network meta-analysis.Lancet2024;403:824-37

[36] Shlofmitz E,Mintz GS.The IMPact on revascularization outcomes of intraVascular ultrasound-guided treatment of complex lesions and economic impact (IMPROVE) trial: study design and rationale.Am Heart J2020;228:65-71

[37] Intravascular ultrasound guidance for complex high-risk indicated procedures. ClinicalTrials.gov Identifier: NCT04854070. Available from: https://classic.clinicaltrials.gov/ct2/show/study/NCT04854070 [Last accessed on 6 Jun 2024]

[38] Engstrom T,Joshi F. Intravascular ultrasound guided PCI in STEMI (iSTEMI). ClinicalTrials.gov Identifier: NCT04775914. Available from: https://classic.clinicaltrials.gov/ct2/show/NCT04775914 [Last accessed on 6 Jun 2024]

[39] Ge Z,Gao XF.Comparison of intravascular ultrasound-guided with angiography-guided double kissing crush stenting for patients with complex coronary bifurcation lesions: Rationale and design of a prospective, randomized, and multicenter DKCRUSH VIII trial.Am Heart J2021;234:101-10

[40] De Maria GL,de la Torre Hernandez JM.A multi-center, international, randomized, 2-year, parallel-group study to assess the superiority of IVUS-guided PCI versus qualitative angio-guided PCI in unprotected left main coronary artery (ULMCA) disease: study protocol for OPTIMAL trial.PLoS One2022;17:e0260770 PMCID:PMC8740965