IVUS vs OCT to Guide PCI: Which Should We Choose?

Controlling stent expansion with optical coherence tomography (OCT) based on an external elastic membrane–based protocol for stent sizing resulted non-inferior to the control group which used intravascular ultrasound (IVUS) and superior the angiography only group. Based on these study outcomes and the prior outcomes, we should use IVUS imaging if available. 

IVUS vs OCT para guiar la angioplastia ¿Cuál elegir?

There are no specific algorithms to guided PCI with OCT and neither is there much information on its relative benefits vs. IVUS.

The iSIGHT trial carried out by our Brazilian colleagues, recently published in Circulation Cardiovascular Interventions, has provided significant data on the matter, which makes us proud. 

All patients receiving PCI in at least one native lesion in coronary arteries between 2.25 and 4 mm in diameter, were randomized 1:1:1 to OCT, IVUS or angiography alone. 

An external elastic membrane–based protocol was applied for stent sizing in patients guided by IVUS and OCT.

The primary end point was non-inferiority of OCT vs IVUS to reach optimal stent expansion (minimum stent area ≥90% of the average reference lumen area)


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It included 156 lesions (151 patients), 51 receiving OCT, 52 IVUS and 53 angiography.

Stent expansion with OCT (98.01 ± 16.14%) resulted non-inferior to the one obtained with IVUS (91.69 ± 15.75%) and superior to the angiography one (90.53 ± 14.84%, p=0.041).

Stent expansion obtained with IVUS was not superior to the one obtained with angiography alone (p=0.921). This should not discourage the use of IVUS, supported by significant evidence. 

Conclusion

Stent expansion with OCT based on an external elastic membrane–based protocol for stent sizing resulted non-inferior to the one obtained with IVUS and superior to the one obtained with angiography.

Original Title: Optical Coherence Tomography Versus Intravascular Ultrasound and Angiography to Guide Percutaneous Coronary Interventions. The iSIGHT Randomized Trial.

Reference: Daniel Chamié et al. Circulation: Cardiovascular Interventions. 2021;14:e009452. https://doi.org/10.1161/CIRCINTERVENTIONS.120.009452.


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