Mechanical outcomes of coronary stenting guided by intravascular ultrasound versus optical coherence tomography: A systematic review and meta-analysis with trial sequential analysis of randomized trials

Abstract

Background: Intravascular imaging with intravascular ultrasound (IVUS) or optical coherence tomography (OCT) may guide stent sizing and placement during percutaneous coronary intervention (PCI). We compared IVUS- vs. OCT-guided PCI in terms of mechanical outcomes.

Methods: PubMed, Embase and Cochrane databases were systematically searched until December 2024 for randomized controlled trials (RCTs) comparing IVUS- vs. OCT-guided PCI. Random-effects models were used to estimate mean differences (MDs) and standard mean differences (SMDs) with 95 % confidence intervals (CIs).

Results: Six RCTs with 2696 patients were included; 1396 (49.6 %) underwent IVUS-guided PCI. The mean age was 65.1 ± 10.2 years. In the pooled analysis, the post-PCI minimum stent area (MSA) was significantly higher with IVUS-guided PCI than with OCT-guided PCI (MD 0.64 mm²; 95 % CI 0.17-1.10; p < 0.01), and post-PCI mean diameter stenosis was significantly lower with IVUS (MD -1.05 %; 95 % CI -1.90 to -0.21; p = 0.01). There were no significant differences between groups in acute lumen gain, stent expansion index, malapposition, tissue protrusion, or edge dissection. In a subgroup analysis, IVUS-guided PCI yielded a greater MSA in studies that did not size vessels by measurement of the external elastic membrane. However, trial sequential analysis suggested that the RCTs to date have not reached the required quantity of information to support definitive conclusions about MSA and mean diameter stenosis.

Conclusion: This meta-analysis demonstrated that IVUS-guided PCI was associated with greater MSA and reduced diameter stenosis compared to OCT-guided PCI, with no difference in stent expansion index, more trials are required to confirm this hypothesis.