Impact of Intravascular Imaging on Stent Sizing and Vessel Wall Dissection Compared to Angiographic Guidance in PCI

Abstract

Aim: To evaluate the impact of intravascular imaging (IVI) and angiography in guiding stent size and vessel wall dissection in patients undergoing percutaneous coronary intervention (PCI). Study Design: Open-label, double-arm observational study Place and Duration of Study: This study was conducted in the Department of Cardiology, Apollo Hospital, Greams Road, Chennai, between August 2023 and July 2024. Methodology: Adults over 18 years old with coronary artery disease requiring simple or complex PCI were included. All patients underwent coronary angiography. In the imaging-guided group, IVUS/OCT was performed before stenting to assess lesion characteristics, to guide stent sizing and to evaluate dissection post-stenting. OCT guidance utilised the MLD-MAX algorithm. Stent optimisation in the angiography group relied on visual assessment, whereas in the imaging group, adequate optimisation required <10% residual stenosis and MSA ≥80% of the reference lumen area. Results: The analysis showed deployment of larger stents in imaging-guided PCI compared to angiographic guidance (length: 32.8 ± 10.16 mm vs 30.04 mm ± 10.14; diameter: 2.96 ± 0.54 mm vs 2.80 ± 0.38 mm). The incidence of vessel wall dissection was considerably less in the imaging arm. (8% vs 20%) Conclusion: Our study showed that larger stents were deployed and a lower incidence of vessel wall dissection in imaging-guided PCI. Studies have shown that intravascular imaging is superior to angiography in determining the appropriate stent size (diameter and length) and has a lower occurrence of dissection due to higher resolution and precision during angioplasty. However, the utility of intravascular imaging in real-time practice is much lower when compared to other countries due to various factors.