How IVUS Improves Clinical Outcomes

Intravascular ultrasound imaging can significantly improve clinical outcomes in coronary interventions. A 2020 meta-analysis by Darmoch et al found the use of IVUS lead to a 43% reduction in stent thrombosis, 37% reduction in CV death, 29% reduction in myocardial infarction, and 19% reduction in target lesion revascularization.

While angiography is the standard for evaluating peripheral vascular interventions, using a 2-dimensional imaging modality to evaluate 3-dimensional vessels has its limitations, according to data presented at ISET 2023 by Eric Secemsky, MD, Director of Vascular Intervention at Beth Israel Deaconess Medical Center in New York.

PROSPERO used 25 cohort studies and 4 case series, with a combined total of 95,192 patients, to examine IVUS use in lower extremity peripheral artery procedures, including device sizing, placement, and optimization; lesion characteristics and severity; management of arterial dissections; and reentry of chronic total occlusions. Of the 29 included studies, 23 (79.3%) received a Level 2b rating, the second highest level of evidence rating. PROSPERO concluded that IVUS-guided intervention provided better clinical outcomes compared to angiography alone.

A prospective, single-center trial of 150 patients by Allan et al investigated whether adding IVUS during femoropopliteal artery interventions could reduce the rate of binary restenosis compared to angiography alone. The study found a significant reduction in restenosis rates and a change of treatment plan in 79% of cases.

A multitude of current data agree that the use of IVUS during peripheral artery and coronary interventions can significantly improve clinical outcomes, and integrating IVUS as standard practice should become a priority.